Approximately 20 to 25% of primary care patients are likely to have a current substance use problem or health problem related to tobacco, alcohol, or drug use (Madras et al., 2009; Pilowsky & Wu, 2012). Screening, brief interventions, and referral to treatment (SBIRT) provided to all patients is effective in reducing alcohol, drug, and tobacco use (Agerwala & McCance-Katz, 2012; Pilowsky & Wu, 2012). Brief intervention in primary care is an effective and cost-efficient approach to reduce patients’ alcohol use (Seale et al., 2010; Madras et al., 2009). SBIRT was originally designed for patients with alcohol and tobacco use, but there is growing evidence that brief interventions for illicit drug use also leads to positive patient outcomes (Compton, 2009). Motivational interviewing is a set of structured counseling skills that has been shown to be one of the most effective means of motivating patients to change addictive behavior (Miller and Rollnick, 2012) and has been used successfully in primary care settings as the brief intervention phase of addiction treatment (Rahm et al., 2014).
Unfortunately, PCPs screen less than half of their patients for tobacco use and less than a third for alcohol use (Roche & Freeman, 2004; Seale et al., 2010). Brief interventions happen even less often than screening (NDCP, 2008). In patients who screened positive for substance use, less than 75% received a brief intervention. A lack of adequate training is the most frequently reported barrier to screening and brief intervention (Le et al., 2015). Appropriate follow-up is also happening less often as well (D’Amico et al., 2005). Only 48% of people with excessive alcohol use reported receiving follow-up, with most simply being told to “stop drinking”. There is also a practice gap in referral to treatment. Less than one-fifth of PCPs make a referral after screening positively for substance abuse or risky substance use (Madras et al., 2009). Primary care physicians need to understand the different types of specialty treatment so that they can make appropriate referrals for their substance abuse patients (SAMHSA, 1997).
Practice Gap References
Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: A brief review. Journal of Psychoactive Drugs. 2012; 44: 307-317. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/ Accessed on: 2017-07-26.
Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, MD. Center for Substance Abuse Treatment. 1997. Available at: https://www.ncbi.nlm.nih.gov/books/NBK64827/ Accessed on: 2010-06-15.
Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.
D’Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Le KB, Johnson AJ, Seale JP, Woodall H, Clark DC, Parish DC, Miller DP. Primary care residents lack comfort and experience with alcohol screening and brief intervention: A multi-site survey. Journal of General Internal Medicine. 2015; 30: 790-796. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25666210 Accessed on: 2015-06-19.
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Office of National Drug Control Policy. Screen & brief intervention. . 2008. Available at: https://www.ncjrs.gov/pdffiles1/ondcp/screen_brief_intv.pdf Accessed on: 2015-06-18.
Pilowsky DJ, Wu LT. Screening for alcohol and drug use disorders among adults in primary care: a review. Substance Abuse and Rehabilitation. 2012; 3: 25-34. Available at: https://www.dovepress.com/screening-for-alcohol-and-drug-use-disorders-among-adults-in-primary-c-peer-reviewed-article-SAR Accessed on: 2014-04-28.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.
Seale JP, Shellenberger S, Velzsquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening and clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC Fam Pract. 2010; 11:18: . Available at: https://www.ncbi.nlm.nih.gov/pubmed/20205740 Accessed on: 2014-07-28.
