Substance Abuse Brief Intervention Referral to Treatment an Evidence-Based Approach to Reduce Risk

In the United States, 88,000 deaths are related to alcohol, making it the fourth leading cause of preventable deaths (Stahre, Roeber, Kanny, Brewer & Zang, 2014). 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. A recent survey indicated that only 19.8% were ever treated (Grant et al., 2015). Substance abuse frequently begins in adolescence. Substance abuse at an early age can lead to long term physical and social problems (Carney, Myers, Louw & Okwundu, 2016). Although substance abuse leads to deterioration of physical and mental health, most nursing curriculum does not include information on screening and intervening for substance abuse. The United States Joint Commission on Accredidation recently included SBIRT core measures for alcohol as part of their evaluation measures (Broyles, Kraemer, Kengor, & Gordon,2013). Nurses, as the largest group of healthcare providers should be taught to screen and intervene for substance abuse (Pushkar, 2013).

Substance Abuse, Brief Intervention and Referral for Treatment (SBIRT) is an evidence-based practice to reduce risk. SBIRT is built upon change theory and motivational interviewing. 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 the client identify the positives and negatives of a behavior and describe benefits of change. Motivational interviewing has had a positive impact on medication adherence in bipolar disorder, (McKenzie & Chang, 2015), weight loss and increased physical activity (Hardcastle, Taylor, Bailey, Harley, & Hagger, 2013) and smoking cessation (Lindson‐Hawley,Thompson, & Begh, 2015).

Two faculty (one nursing and one social work) at Ramapo College participate in a nationwide learning collaborative on substance abuse. In response to a call for funding, the faculty (Nursing and Social Work) collaborated on a proposal to introduce Substance Abuse Screening and Brief Intervention (SBIRT) to both the graduate and undergraduate nursing and social work programs. 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 and social work 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 nursing and social work 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 interactive simulation with avatars as patients. The interactive learning simulation allowed students to learn and practice the skills needed for SBIRT. After completing these three activities, the students signed up to participate in role play using SBIRT with their peers. Students were given the opportunity to play both the client and the nurse/social worker. The student were given client scenarios and were asked to role play the assigned client. The client’s background, age, substance use and willingness to change were on the client scenarios. The professional (nurse or social work student) had a check sheet to use as they did their assessment. They took turns playing the client and nurse or social worker and used motivational interviewing to discuss change. Peer and instructor feedback was provided to each participant. Debriefing in all groups included reflection and discussion regarding beliefs about substance use and abuse.

The faculty decided to provide inter-professional learning opportunities. Due to class schedules and clinical, it was hard to arrange a joint time for the undergraduates to engage in interdisciplinary education. However, we were able to arrange a joint experience with the graduate students. The graduate nursing and social work students did inter-professional role plays with each other. When possible nurse-social work dyads were utilized. Peer feedback was given and the role and perspective of nursing and social work was discussed. Both the nurses and social workers reported being apprehensive at first, but said in the debriefing they appreciated the opportunity for inter-professional role play.

During two academic years, 250 nursing and social work students and field preceptors were educated on motivational interviewing and SBIRT. Students completed surveys (before and after SBIRT) assessing knowledge and skills in discussing use of substances. Post surveys showed increased knowledge, skills and attitude towards persons with substance abuse disorders after completion of the education. Widespread integration of SBIRT into the curriculum will allow for SBIRT to become a routine part of care for nurses and social workers. The use of SBIRT at routine visits, during hospitalizations and emergency department visits may help idenitfy persons and risk and lead to early intervention.