Integrating Substance Abuse Screening Brief Intervention and Referral to Treatment Into Nursing Curriculum

It is estimated that about 30 percent of US adults experience a mental health or substance abuse disorder in a year, and many struggle with both. There is also wide geographical variation in the proportion of alcohol-attributable deaths and disability adjusted life years (DALYs), with the highest alcohol-attributable fractions reported in the WHO European Region (WHO, 2014). It is estimated that 15.3 million persons worldwide suffer from a substance use disorder (WHO, 2014). Globally, excess alcohol intake is responsible for approximately 6% of deaths. Culture, gender and religious norms impact alcohol consumption throughout the world. Substance abuse disorders are associated with high rates of disability and earlier mortality worldwide (Whiteford, Degenhart & Rehm, 2013). In the United States, 88,000 deaths are related to alcohol, making it the fourth leading cause of preventable deaths (Stahre, Roeber, Kanny, et.al., 2014). In spite of these grim statistics, universal screening for substance disorders is lacking.

Motivational interviewing is a person centered counselling style that can be utilized to promote a number of lifestyle changes (Ostlund, Wadensten, Kristofferzon & Haagstrom, 2015). Motivational interviewing has been used as an effective strategy in a variety of settings. Motivational interviewing has had a positive impact on medication adherence in bipolar disorder, (McKenzie & Chang, 2013), weight loss and increased physical activity (Hardcastle, Taylor, Bailey, Harley, & Hagger, 2013) and smoking cessation (Lindson‐Hawley,Thompson, & Begh, 2015).

In spite of the prevalence of substance abuse, few nurses are taught to screen for substance abuse or use motivational interviewing to discuss change. To bridge this gap, a state college introduced Substance Abuse Screening, Brief Intervention and Referral for Treatment (SBIRT) into its undergraduate and graduate nursing curriculum. SBIRT is an evidence based practice that has been an effective strategy for risk reduction in persons with substance use disorders (Tanner-Smith & Lipsey, 2015). Studies have noted that SBIRT can take five to thirty minutes, depending on the patient’s reported use and is appropriate for many settings. Nurse led integration of SBIRT into practice can identify patients at risk of substance abuse and allow intervention early in the addiction process.

To educate our undergraduate and graduate students in the use of SBIRT, we introduced the topic of substance abuse through required readings and an online education program on substance abuse. After completion of the introductory information students completed an online tutorial in motivational interviewing and “change talk”. The nursing students then signed up to participate in role play using motivational interviewing techniques with their peers. Students were given case studies that described their substance use and willingness to change. They took turns playing the client and nurse and used motivational interviewing to discuss change. Instructor and peer feedback was provided after the role play.

Pre and post surveys assessing knowledge and skills in discussing use of substances showed increased knowledge, skills and attitude towards persons with substance abuse disorders after completion of the education. It is believed that early intervention in persons using substances can prevent long term dependence (Lacey, 2012). Nurse led integration of SBIRT into practice can identify patients at risk of substance abuse and allow intervention early in the addiction process. Widespread integration of SBIRT into the curriculum will allow for SBIRT to become a routine part of nursing care.