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How To Do…

How To Do…. Screening. Screening: Why do SBIRT? “Who are the addicts?”. Screening: Why screen universally?. Drinking and drug use… are common often go undetected can increase risks to safety and health problems

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How To Do…

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  1. How To Do… Screening

  2. Screening: Why do SBIRT?“Who are the addicts?”

  3. Screening: Why screen universally? Drinking and drug use… • are common • often go undetected • can increase risks to safety and health problems Routine screening for other potential medical problems (e.g. cancer, diabetes, hypertension). Why not for alcohol and drug use? *People are more open to change than we might expect.

  4. Criteria for Screening • Significant morbidity/mortality • High prevalence • Long asymptomatic period • Valid, feasible screening test • Early intervention better (than later) • Available and effective treatments

  5. Screening: Benefits • Detect current health problems related to at-risk alcohol and drug use • Detect alcohol and drug use patterns that can increase risk of future injury/illness • Intervene and educate about risky alcohol and drug use • Prevent medical and prescribing errors

  6. Targeted Intervention

  7. Drinkers who screen positive may meet criteria for… • Alcohol Misuse (at-risk drinking) • hazardous drinking (no consequences yet) • harmful drinking (consequences experienced) • Alcohol Abuse • Alcohol Dependence

  8. What is Alcohol Dependence? DSM-IV-TR Criteria • Evidence of tolerance or symptoms of withdrawal • Sweating, increased pulse rate, hand tremor, anxiety, nausea • A prior patient history that includes a pattern of compulsive use, high levels of alcohol intake, and increased alcohol-related problems • Devoting substantial periods of time to obtaining and consuming alcohol • Often drinking more than intended to • Unsuccessful efforts to cut-down or control intake American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. Test Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Association, 2000.

  9. What is Alcohol Abuse? DSM-IV-TR Criteria • Diagnosed after the absence of alcohol dependence as been established • A maladaptive pattern of use leading to significant clinical impairments within the past 12mos., including one or more of the following: • Failure to fulfill role obligations • Recurring use of alcohol in hazardous situations • Recurring alcohol-related legal problems • Continued alcohol use despite recurrent interpersonal problems American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. Test Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Association, 2000.

  10. The medical setting is a good home for screening & intervention Alcohol & drug use contributes to injury & illness Alcohol & illicit drugs interact with prescribed medications Alcohol & drug use affects families & communities Early intervention may reduce health consequences and save health care dollars For many patients, SBI alone may be sufficient

  11. Patients Are Open to Discussing Their Substance Use to Help Their Health Survey on Patient Attitudes: Source: Miller, PM, et al. Alcohol & Alcoholism; 2006 Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum (www.sbirtoregon.org)

  12. Introduction to Screening • Hello, I’m ______, a Health Promotion Advocate here at ____. • As a part of your medical team, my job is to ask all patients some personal questions to help you get the best care possible. • You do not have to answer them if you feel uncomfortable.

  13. It’s Useful to Clarify What is One Drink!

  14. How Much Is “One Drink”? 5-oz glass of wine (5 glasses in one bottle) 12-oz glass of beer (one can) 1.5-oz spirits 80-proof 1 jigger Equivalent to 14 grams pure alcohol

  15. NIAAA Definitions for Unhealthy Drinking At-risk for increase in illness & injury • men: >14 drinks/wk or 5+ drinks/occasion • women: >7 drinks/wk or 4+ drinks/occasion • elders (+ 65): >7 drinks/week or 2+ drink/day • pregnant women: any use of alcohol

  16. Brief Alcohol and Drug Screening Questions

  17. Validated Screening Instruments Reimbursement requires using validated screening instruments • AUDIT, AUDIT-C • DAST

  18. The AUDIT • Developed by WHO • Evaluated over 20 yrs • Accurate measure of risk across gender, age, & cultures • 3 domains of drinking • Scores 8 > indicate risky drinking (give BNI) • Scores 20 > may indicate need for treatment

  19. AUDIT-C (shorter version)

  20. The DAST

  21. Enter scores into electronic medical records for billing

  22. Transition to Brief Intervention Thanks so much for answering those questions. I was wondering if it would be okay if we talked a little bit more about _____?

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