considering sbirt and various...
TRANSCRIPT
Considering SBIRT and
Various Substances
Gerald Cochran, MSW, PhD
Eric Hulsey, DrPH
Carolyn Swenson, MSPH, MSN, FNP
June 9, 2015
Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol and other drug use:
An Interprofessional Conference
Dr. Gerald (Jerry) Cochran earned his Ph.D. from The University of Texas at Austin School of Social
Work and completed postdoctoral training with the Johns Hopkins School of Medicine, Department of
Psychiatry and Behavioral Sciences. Dr. Cochran’s research interests are centered on behavioral health
services research. His area of expertise involves identifying and studying appropriate care for
underserved populations in healthcare settings, with particular emphasis on individuals who misuse
drugs and alcohol. Dr. Cochran’s work aims to improve substance abuse prevention and treatment
services provided in health care settings.
Eric Hulsey, DrPH, is Manager of Behavioral Health Analytics at the Allegheny County Department of
Human Services, Office of Data Analysis, Research and Evaluation. Prior to this, he served as the
Services Innovations Specialist at Allegheny HealthChoices, Inc. (AHCI) where his focus was to
increase the application of the science of substance use disorder treatment and recovery within the PA’s
Medicaid program. Dr. Hulsey earned a Doctor of Public Health from the University of Pittsburgh’s
Graduate School of Public Health, a Master of Arts in Psychology from Duquesne University, and a
Bachelor of Science in Psychology from the University of Florida.
Carolyn Swenson, MSPH, MSN RN, is the Manager of Training and Consultation for the SBIRT-
Colorado initiative at Peer Assistance Services, Inc. in Denver, Colorado. Carolyn also provides training
on depression, motivational interviewing, tobacco cessation and is a certified Question-Persuade-Refer
(QPR) suicide prevention trainer. During her career she has worked as a pediatric ICU nurse, a public
health nurse on the Navajo Indian Reservation, in refugee healthcare in Africa and migrant farmworker
healthcare in Colorado, managing quality improvement projects, and coordinating population-based
research on diabetes, cardiovascular disease and aging in rural Colorado.
This is an interprofessional audience.
The workshop is 2 hours, so each presentation should be approx. ½ hr
to allow 10 minutes for questions, or a full ½ at the end of all 3
presentations.
• Include:
– Learning objectives
– Overview
– Hot topics
– Brief interviewing
– Handoff
– Referral to treatment
Learning Objectives
1. Explore the evidence for screening and
brief intervention (SBI) for drug use.
2. Introduce a marijuana screening
question.
3. Describe approaches to brief
interventions for marijuana.
4. Explore further assessment and
marijuana use disorder.
Defining “drugs”
• “Illegal”- “Illicit”- “Recreational”- “Street”
• Marijuana: medical and recreational
• Nonmedical use of Rx or OTC medications
The evidence: SBI for drugs
• United States Preventive Services Task
Force” Insufficient evidence statement
• Research on SBI efficacy for drugs has
been disappointing.
• Individuals who use drugs may require
multiple and more intensive interventions
Marijuana in Colorado
Marijuana screening:
SBIRT Colorado“How many times have you used
marijuana in the past year?”
Positive = 1 or more times
Any marijuana use warrants further assessment
and discussion to address harm reduction
Brief interventions for marijuana• Explore quantity, frequency, methods of use
• Explore reasons for use
• Provide feedback
• Understand beliefs and (mis)perceptions
• Enhance motivation
• Harm reduction
• Negotiate and advise
Will SBI for marijuana become
more like alcohol SBI?
Feedback on marijuana• General
• Pregnancy and breastfeeding
• Adolescents
• Driving and safety
• Accidental and second-hand smoke exposure
• Parental role: expectations, restrict access
• Do not overstate risks
Marijuana and Health
Common beliefs and misperceptions
• “It’s all natural…so how could it be harmful?”
• “It’s legal…so it must be safe.”
• “It’s not addictive.”
• “It’s safer than tobacco or alcohol.”
• “It’s a better way to manage stress and
improve sleep.”
• “It’s better than conventional treatments… for
all sorts of diseases!”
Enhancing motivation
• Ask about pros and cons
• Identify and address underlying issues
• Tie to goals and values
• Enhance awareness of context and triggers
• Explore importance, readiness and confidence
• Quitting may increase motivation!
Harm Reduction• Impaired driving
• Edibles vs. smoked; potency
• Legal ramifications
• Workplace considerations
• Restrict access in minors
• Safety and storage
• Second-hand smoke exposure
• Dabbing
Colorado Department of Public
Health and Environment
https://sites.google.com/a/state.co.us/marijuana/
Further Assessment
• CUDIT-R
• Marijuana Use Disorder (DSM-5)
Scripted Brief Intervention