Substance Abuse: The Case for Early Intervention

Tableau of drugs- pills, coke, marijuana, and alcohol.
Tableau of drugs- pills, coke, marijuana, and alcohol.

SHARELINES

A new compilation of research reports edited by two UConn Health researchers finds that a brief, early intervention may keep someone who’s at moderate risk of abusing drugs or alcohol off that dangerous path.

Thomas Babor and Frances Del Boca, researchers in UConn Health’s Department of Community Medicine and Health Care, were guest editors of a group of research reports on the method known as SBIRT – Screening, Brief Intervention, and Referral to Treatment. The reports, which make up a special issue of the scientific journal Addiction, analyzed the early stages of a federally funded national demonstration program that has screened more than a million patients.

The reports, by researchers who study addiction, say substance abusers are more likely to reduce their use when a primary care or emergency medicine physician screens them, provides brief intervention, and if necessary, refers them to treatment.

“Brief intervention refers to any time-limited effort, maybe one or two conversations or meetings, to provide information or advice, increase motivation to avoid substance abuse, or to teach behavior change skills that will reduce substance abuse as well as the chances of negative consequences,” says Babor, the Health Net Inc. Endowed Chair in Community Medicine and Public Health in the UConn School of Medicine.

“Brief interventions and the screenings that precede them can be opportunistic – for example, precipitated by alcohol-related conditions such as hypertension, depression, insomnia, or an injury – or they can be routine, such as those conducted at the time of an annual physical,” Babor explains.

… new technologies and concepts, supported by clinical research, have begun to put alcohol- and drug-related health risks on the agenda of mainstream health practitioners …

The origins of the SBIRT concept go back to the early 1980s, with a shift in thinking about alcohol dependence. Instead of considering alcohol dependence as a mere shortcoming, it began to be seen as a physical, psychological, and behavioral condition that is treatable and preventable. The approach was studied and refined over two decades, leading to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) awarding five-year grants to six states and a tribal council to promote the adoption and sustained implementation of the approach in various medical settings.

The scope was broadened beyond alcohol disorders to cover all substance-related disorders, with the idea of integrating substance abuse treatment and early intervention into the traditional medical care system.

In their conclusion, the editors of the new reports write, “SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. SBIRT implementation was associated with improvements in treatment system equity, efficiency, and economy.”

They also call it one of the most successful examples of translational research in the history of addiction science. It was only in the past decade that practice-oriented – translational – research began to facilitate the transfer of the emerging scientific findings to patient care.

Looking at the record of SAMHSA’s SBIRT program, the field of addiction research can point to a clear example of how new technologies and concepts, supported by clinical research, have begun to put alcohol- and drug-related health risks on the agenda of mainstream health practitioners for the first time, the authors say.

“The idea of translating research into practice is a hope that is seldom realized in addiction science,” says assistant professor Bonnie McRee, one of the report authors. “To go from the development of screening tests to national implementation programs in the course of 20 years is a dream come true for an addiction scientist.”

SAMHSA funding for SBIRT programs now has made its way into 29 states, two tribal councils, and one U.S. territory, and more than two million patients have been screened in the U.S. to date. Research findings showed significant reductions in substance abuse.

Researchers also considered the best approach to implementing SBIRT as a public health program. While they concluded that committed leadership was significant, and the use of substance-use specialists, rather than medical generalists, to deliver services facilitated implementation, they noted that the intervention approach inevitably varies according to the patient and the setting. They also found that the program thrived when there was initial support from federal grants, but it was not clear whether the program is sustainable beyond the grant funding. Questions also remain about cost-effectiveness, and the best ways to train front-line providers.

More information about the SBIRT program is available at www.samhsa.gov/sbirt.

The third co-editor of the Addiction supplement, with Babor and Del Boca, was Jeremy Bray, professor of economics at the University of North Carolina at Greensboro.