Introduction- SBIRT

Question 1

SBIRT

Answer 1

Screening Brief Intervention and Referral to Treatment

Question 2

Main goal for SBIRT

Answer 2

Improve community health

Question 3

SBIRT Stages

Answer 3

Screening (rapid assessment of substance abuse)
Brief Intervention
Referral to Treatment

Question 4

CAGE

Answer 4

C: Have you felt you should Cut down on your drinking
A: Have people Annoyed you by criticizing your drinking
G: Have you ever felt guilty about your drinking
E: Have you ever had a drink first thing in the morning (Eye opener)

Question 5

AUDIT

Answer 5

Alcohol Use Disorder Identification Test

Question 6

CRAFFT

Answer 6

Used with adolescents
Car, Relax, Alone, Forgot, Friends/Family, Trouble

Question 7

DAST

Answer 7

Drug Abuse Screening Test

Question 8

Drug questionnaire use

Answer 8

Administered as part of clinical interview or completed giving access to computer/tablet

Question 9

Interviewing/Communicating

Answer 9

Open vs closed ended questions
Active listening (paraphrase, reflect, clarify, probe, summarize)
Non-verbal behavior
Transitions
Interview Flow
Integrating with Context (clinical reasoning)

Question 10

SBIRT was developed for

Answer 10

Tobacco and alcohol use disorders

Question 11

Patients receiving a brief intervention were ___________ likely to enter a _______ ________ ___________ program

Answer 11

More, substance abuse treatment

Question 12

Studies show that alcohol screening and brief counseling interventions ___________ unhealthy use in primary care patients

Answer 12

Reduce

Question 13

Barriers to implementation in primary care settings

Answer 13

Lack of SUD knowledge, lack of time, reimbursement issues, lack of faculty members

Question 14

To have a medical license in NH you have to do ______ CME SUD credits per year

Answer 14

10

Question 15

SBIRT use has shown

Answer 15

Improvements in general health, mental health, employment, housing and decreased criminal activity

Question 16

SBIRT intervention after 6 months has shown ______ decrease in illicit drug use

Answer 16

68%

Question 17

SBIRT intervention after 6 months has shown ______ decrease in alcohol consumption

Answer 17

39%

Question 18

SBIRT currently holds a _____ recommendation

Answer 18

B

Question 19

How do we get someone to change?

Answer 19

They have to be ready to change

Question 20

Health related behavior change ask

Answer 20

Are you ready to change?
Provide information, data supporting the risk

Question 21

Assess readiness for change (stages)

Answer 21

Pre-contemplation
Contemplation
Preparation
Action
Maintenance

Question 22

Pre-contemplation

Answer 22

Not ready
Brief information linked to individual’s health
Information and support available (keep the door open)
Non-judge mental, make sure patient knows you are available for discussion questions

Question 23

Contemplation

Answer 23

Thinking about it
Facilitate review of pros/cons
Reduce barriers
Identify resources

Question 24

Preparation

Answer 24

Getting ready
Goal setting
Cognitive/behavior modification
Programs/materials (don’t let them go cold turkey, wean down, make observations in a smoking diary)
Smoking (auto-pilot vs reactive cigarette)
Quit day reach out to them, remind them you are there for support and set follow up dates (even by phone)

Question 25

Action

Answer 25

Making changes but <6 months
Cognitive/behavioral modification

Question 26

Maintenance

Answer 26

Sticking with it >6 months to 5 years
Relapse prevention/high risk situations

Question 27

Readiness for change is ___________

Answer 27

Bidirectional
Continued support/encouragement/feedback, demonstrate how they are making improvements

Question 28

A patient may be ready to change but they may not be _________ to change

Answer 28

Motivated

Question 29

The key is discovering what will move them from _________ to _________

Answer 29

Readiness, action

Question 30

Motivational interviewing: Is it what ______ want or is it what _______ want?

Answer 30

You, they

Question 31

Steps to motivational interviewing

Answer 31

Is it what you want or what they want
Appealing to motivations (sell them what they want)
Stop the struggle (work with what they give you)
Maintaining professional boundaries (caring but you can only do so much)

Question 32

You need _______ when dealing with people

Answer 32

Patience

Question 33

Make sure you are more invested in the patient than the __________

Answer 33

Goal/outcome

Question 34

Paternalism

Answer 34

Responsibility/practice of people in authority restricting the freedom of those who are subordinate to them in the supposed interest of the subordinates best interest

Question 35

Shared decision making

Answer 35

Meet and find common ground

Question 36

Doug’s advice about housing

Answer 36

You have to be able to walk away