considering sbirt and various...

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