Home — SBIRT Training

Training Activity References

AHFS. Varenicline. Drugs.com. 2000-2014. Available at: https://www.drugs.com/monograph/chantix.html Accessed on: 2010-06-25.
Alberta Health Services . Brief Tobacco Intervention: Ready 2 Quit . YouTube . 2012. Available at: https://www.youtube.com/watch?v=Z4B74E_8ncc Accessed on: 2015-04-27.
American Academy of Family Physicians. HCPCS, CPT, & ICD-9 Codes Related to Tobacco Cessation Counseling. AAFP.org. 2011. Available at: http://www.integration.samhsa.gov/images/res/Coding-list.pdf Accessed on: 2013-10-28.
American Academy of Family Physicians. HCPCS, CPT, & ICD-9 Codes Related to Tobacco Cessation Counseling. Ask and Act: A Tobacco Cessation Program. 2010. Available at: http://www.integration.samhsa.gov/images/res/Coding-list.pdf Accessed on: 2014-11-06.
American Academy of Pediatrics. Policy statement. Substance use screening, brief intervention, and referral to treatment for pediatricians. Pediatrics. 2011; 128(5): e1330-e1340. Available at: http://pediatrics.aappublications.org/content/128/5/e1330.full Accessed on: 2011-12-13.
American Cancer Society. Guide for quitting smoking. American Cancer Society Website. 2009. Available at: https://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-toc Accessed on: 2010-06-23.
American Lung Association. Helping Smokers Quit: Tobacco Cessation Coverage 2011. American Lung Association. Fighting for Air. 2011. Available at: http://www.lung.org/stop-smoking/help-someone-quit/ Accessed on: 2012-02-02.
American Society of Health-System Pharmacists. Medline Plus – Trusted Health Information for You. Medline Plus – Trusted Health Information for You. 2014. Available at: https://www.nlm.nih.gov/medlineplus/druginformation.html Accessed on: 2014-04-28.
Audrain-McGovern J, Benowitz NL. Cigarette Smoking, Nicotine, and Body Weight. Clin Pharmacol Ther. 2011; 90: 164-168. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195407/ Accessed on: 2014-10-23.
Babb S, Melarcher A, Schauer G, et al.. Quitting Smoking Among Adults — United States, 2000–2015. Morbidity and Mortality Weekly Report (MMWR). 2017; 65(52): 1457–1464. Available at: https://www.cdc.gov/mmwr/volumes/65/wr/mm6552a1.htm?s_cid=mm6552a1_e Accessed on: 2017-01-09.
Bader P, McDonald P, Selby P. An algorithm for tailoring pharmacotherapy for smoking cessation: results from a Delphi panel of international experts. Tob Control. 2009; 18: 34-42. Available at: http://tobaccocontrol.bmj.com/content/18/1/34.full.pdf Accessed on: 2010-08-26.
Breslau N, Kilbey MM, Andreski P. Nicotine withdrawal symptoms and psychiatric disorders: findings from an epidemiologic study of young adults. Am J Psychiatry. 1992; 149: 464-469. Available at: https://www.ncbi.nlm.nih.gov/pubmed/1554030 Accessed on: 2013-10-28.
CDC. Planning and Implementing Screening and Brief Intervention for Risk Alcohol Use: A Step-by-Step Guide for Primary Care Providers. National Center on Birth Defects and Developmental Disabilities. 2014. Available at: https://www.cdc.gov/ncbddd/fasd/documents/alcoholsbiimplementationguide.pdf Accessed on: 2014-12-16.
CDC. Tobacco Use and Pregnancy . CDC’s Division of Reproductive Health. 2014. Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/tobaccousepregnancy/index.htm Accessed on: 2014-12-16.
Center for Disease Control and Prevention. Secondhand Smoke Fact Sheet. CDC Website. 2010. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm Accessed on: 2010-06-15.
Center Watch. Chantix® (varenicline) receives FDA approval. Center Watch. 2000-2014. Available at: http://www.centerwatch.com/drug-information/fda-approved-drugs/drug/897/chantix-varenicline Accessed on: 2014-04-28.
Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults in the United States. Smoking and Tobacco Use. CDCP Website. Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. 2016; December 1: . Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/ Accessed on: 2017-01-09.
Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults — United States, 2005–2014. Morbidity and Mortality Weekly Report. 2015; 64(44): 1233-1240. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a2.htm?s_cid=mm6444a2_e Accessed on: 2015-11-12.
Centers for Disease Control and Prevention. Tobacco Use: Targeting the Nation’s Leading Killer. CDC Website. 2011. Available at: http://stacks.cdc.gov/view/cdc/5527/
Centers for Medicare & Medicaid Services. Medicaid Benefits: Prevention. Medicaid.gov. 2014. Available at: https://www.medicaid.gov/medicaid/benefits/prevention/index.html Accessed on: 2014-11-06.
Centers for Medicare & Medicaid Services. New Medicaid Tobacco Cessation Services. CMS. 2011. Available at: https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD11-007.pdf Accessed on: 2012-02-14.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Department of Health and Human Services (USDHHS). The Health Consequences of Smoking: A Report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C.: For sale by the Supt. of Docs., U.S. G.P.O.. 2004. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/2004/complete_report/index.htm/index.htm Accessed on: 2014-04-28.
Durcan MJ, Deener G, White J, Johnston JA, Gonzales D, Niaura R, Rigotti N, Sachs DP. The effect of bupropion sustained-release on cigarette craving after smoking cessation. Clinical Therapeutics. 2002; 24(4): 540-551. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12017399 Accessed on: 2013-10-28.
Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. Journal of Dental Research. 2012; 91: 914-20. Available at: http://jdr.sagepub.com/content/91/10/914 Accessed on: 2014-12-16.
FDA. Chantix (varenicline) may increase the risk of certain cardiovascular adverse events in patients with cardiovascular disease. FDA Safety Communication. 2011. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm259161.htm Accessed on: 2014-04-28.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008. Available at: https://www.ncbi.nlm.nih.gov/books/NBK63952/ Accessed on: 2013-09-26.
GlaxoSmithKline. Nicoderm CQ (nicotine) patch, extended release. DailyMed. 2012. Available at: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=93b2d1b9-83c1-40b5-b6af-90c38c8d6cef Accessed on: 2013-10-28.
GlaxoSmithKline. Nicorette (nicotine polacrilex) gum, chewing . DailyMed. 2013. Available at: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=673fd19f-69b3-4f73-b9b4-18b5f4cbf69c Accessed on: 2013-10-28.
GlaxoSmithKline. NICORETTE (nicotine polacrilex) lozenge. DailyMed. 2012. Available at: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=fdee1637-8049-4bc5-b196-b6d854c9f9f3 Accessed on: 2013-10-28.
GlaxoSmithKline. ZYBAN® (bupropion hydrochloride) Sustained-Release Tablets . GSK. 2012. Available at: https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Zyban/pdf/ZYBAN-PI-MG.PDF Accessed on: 2013-12-05.
Glynn TJ, Manley MW. How to help your patients stop smoking- a National Cancer Institute manual for physicians. Smoking and Tobacco Control Program, National Cancer Institute, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. Bethesda, MD. 1998. Available at: http://books.google.com/books/about/How_to_help_your_patients_stop_smoking.html?id=TM1pAAAAMAAJ
Gonzales D, Rennard SI, Nides M, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation. A randomized controlled trial. JAMA. 2006; 296(1): 47-55. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16820546 Accessed on: 2014-04-28.
Jensen CD, Cushing CC, Aylward BS, Craig JT, Sorell DM, Steele RG. Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review. J of Consulting and Clinical Psychology. 2011; 79(4): 443-40. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21728400 Accessed on: 2013-10-24.
Kozink RV, Lutz AM, Rose JE, Froeliger B, McClernon FJ. Smoking withdrawal shifts the spatiotemporal dynamics of neurocognition. Addiction Biology. 2010; 15: 480-490. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1369-1600.2010.00252.x/full Accessed on: 2014-10-23.
Lai DTC, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation (Review). The Cochrane Collaboration. 2010. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20091612 Accessed on: 2015-04-20.
Medicare Learning Network. “Incident to” Services. Medicare Learning Network. 2013. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se0441.pdf Accessed on: 2014-11-06.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Obach RS, Reed-Hagen AE, Krueger SS, Obach BJ, O’Connell TN, Zandi KS, Miller S, Coe JW. Metabolism and disposition of varenicline, a selective alpha4beta2 acetylcholine receptor partial agonist, in vivo and in vitro. Drug Metab Dispos. 2006; 34(1): 121-30. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16221753 Accessed on: 2013-10-28.
Parrott A.C. Nesbitt’s Paradox resolved? Stress and arousal modulation during cigarette smoking . Addiction. 1993; 93(1): 27-39. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9624709 Accessed on: 2013-10-28.
PDR Staff. Physician’s Desk Reference. Thomson Healthcare. 2003. Available at: http://www.pdr.net/ Accessed on: 2013-10-28.
Resnicow K, McMaster F. Motivational Interviewing: moving from why to how with autonomy support. Int J Behav Nutr Phys Act.. 2012; 9: . Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330017/ Accessed on: 2014-10-13.
Shiffman CH, Jarvick ME. Smoking withdrawal symptoms in two weeks of abstinence. Journal of Psychopharmacology. 1976; 50(1): 35-39. Available at: https://www.ncbi.nlm.nih.gov/pubmed/827760 Accessed on: 2013-10-28.
Shiffman S, Dresler CM, Hajek P, Gilburt SJA, Targett DA, Strahs KR. Efficacy of a nicotine lozenge for smoking cessation. Arch Intern Med. 2002; 62: 1267-1276. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12038945 Accessed on: 2013-10-28.
Siu AL, U.S. Preventive Services Task Force. Behavioral counseling and pharmacotherapy interventions for tobacco cessation in adults, including pregnant women: A review of reviews for the U.S. Preventive Services Task Force. Ann Intern Med. 2015. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26389730 Accessed on: 2016-02-09.
Smedslund G, Berg RC, Hammerstrøm TK, Steirol A, Leiknes KA, Dahl HM, Karlsen K. Motivational interviewing for substance abuse . The Cochrane Library. 2011. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008063.pub2/abstract Accessed on: 2014-10-30.
Sobell LC, Sobell MB, Agrawal S. Self-change and dual recoveries among individuals with alcohol and tobacco problems: current knowledge and future directions. Alcohol Clinical Experimental Research. 2002; (12): 1936-1938. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12500127 Accessed on: 2013-10-28.
Stotts AL, Schmitz JM, Grabowski J. Concurrent treatment for alcohol and tobacco dependence: are patients ready to quit both?. Drug and Alcohol Dependence. 2003; 69: 1-7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12536060 Accessed on: 2013-10-28.
Texas Department of State Health. Billing Codes Guide. Yes You Can. 2011. Available at: http://www.yesquit.org/downloads/guides/BillingCodesGuide.pdf Accessed on: 2014-11-06.
Tobacco Control Legal Consortium. The Mental Health Parity and Addiction Equity Act and the Affordable Care Act. SAMHSA. 2011. Available at: http://www.integration.samhsa.gov/health-wellness/The_Mental_Health_Parity_and_Addiction_Equity_Act.pdf Accessed on: 2012-02-02.
Tonstad S, Tonnesen P, Hajek P, Williams KE, Billing CB, Reeves KR. Effect of maintenance therapy with varenicline on smoking cessation. A randomized controlled trial. JAMA. 2006; 296(1): 64-71. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16820548 Accessed on: 2013-10-28.
Tran K , Asakawa K, Cimon K, Moulton K, Kaunelis D, Pipe A, Selby P. Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses. Canadian Agency for Drugs and Technologies in Health (CADTH). 2012. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442619/ Accessed on: 2013-10-28.
U.S. Department of Health & Human Services. Cigarette Smoke Affects Your Body. Be Tobacco Free.gov. 2014. Available at: https://betobaccofree.hhs.gov/health-effects/smoking-health/ Accessed on: 2014-12-16.
U.S. Department of Health and Human Services (USDHHS). Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Ga: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 2000. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/2000/complete_report/index.htm Accessed on: 2013-10-28.
U.S. Department of Health and Human Services. Alcohol Alert: Alcohol and Tobacco. Alcohol Alert. 2007. Available at: https://pubs.niaaa.nih.gov/publications/AA71/AA71.pdf Accessed on: 2014-10-10.
U.S. Department of Health and Human Services.. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. . Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention . 2014. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm Accessed on: 2014-04-28.
U.S. Food and Drug Administration. FDA Approves Novel Medication for Smoking Cessation. FDA Website. Press release, 11 May 2006. Available at: https://www.fda.gov/NewsEvents%2FNewsroom%2FPressAnnouncements%2F2006%2Fucm108651.htm Accessed on: 2010-06-15.
U.S. Food and Drug Administration. Information for Healthcare Professionals: Varenicline (marketed as Chantix) and Bupropion (marketed as Zyban, Wellbutrin, and generics). FDA Alert. 2009b. Available at: https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm169986.htm Accessed on: 2014-04-28.
U.S. Preventative Services Task Force, Moyer VA. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventative Services Task Force Recommendation Statement. Annals of Internal Medicine. 2013. Available at: http://www.integration.samhsa.gov/sbirt/USPSTF_Screening_forAlcohol_5_13_13_0000605-201308060-00652.pdf Accessed on: 2014-12-16.
Walters ST, Rotgers F. Treating Substance Abuse: Theory and Technique. The Guilford Press. 2011. Available at: https://www.guilford.com/books/Treating-Substance-Abuse/Walters-Rotgers/9781462513512 Accessed on: 2014-10-13.
West R, Hajek P. What happens to anxiety levels on giving up smoking?. American Journal Psychiatry. 1997; 154: 1589-1592. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9356569 Accessed on: 2013-10-28.
U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2010 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute. 2013. Available at: https://nccd.cdc.gov/uscs/ Accessed on: 2013-10-28.

Professional Practice Gaps

Tobacco use is still fairly common; in the United States. Approximately 28.4% of persons aged 12 or older used a tobacco product in the last month in a 2008 survey (NSDUH, 2009). Tobacco is estimated to be responsible for 443,000 premature deaths annually (CDCP, 2008) and cause significant morbidity (Surgeon General, 2004). The effectiveness of tobacco interventions by health care providers was evaluated in a review of the literature by the review panel for the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (Fiore, et al., 2008). They found that medication and counseling are more effective for promoting tobacco cessation than no treatment and that intervention effectiveness increases with increased intervention intensity. The Clinical Practice Guideline (Fiore, et al., 2008), also provided evidence-based guidelines for clinicians on how to provide brief and more extensive interventions in tobacco use. Despite the documented need for tobacco cessation and effectiveness of clinical interventions and availability of practice guidelines, many health providers still are not providing evidence-based tobacco interventions. A number of studies have found that screening for tobacco use and recommending cessation occurs as frequently as 75% of the time in primary care, other appropriate tobacco interventions are made by in primary care less frequently (Schnoll R et al., 2006; Braun et al., 2004; Jaen et al., 2001; Ellerbeck et al., 2001). Training health care professionals in evidence-based, brief tobacco interventions in order to assure that all health providers know and are confident to provide tobacco interventions will help address this practice gap.

Practice Gap References
Braun B, Fowles J, Kind E, Lando H, Pine D. Smoking-related attitudes and clinical practices of medical personnel in Minnesota. American Journal of Preventive Medecine. 2004; 27(4): 316-322.
Department of Health and Human Services (USDHHS). The Health Consequences of Smoking: A Report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C.: For sale by the Supt. of Docs., U.S. G.P.O.. 2004. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/2004/complete_report/index.htm/index.htm Accessed on: 2014-04-28.
Ellerbeck EF, Ahluwalia JS, Jolicoeur DG, Gladden J, Mosier MC. Direct observation of smoking cessation activities in primary care practice. J Fam Pract. 2001; 50(8): 688-93. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11509163 Accessed on: 2014-07-28.
Fiore MC, Bailey WC, Cohen SJ, et al. Clinical Practice Guideline: Treating Tobacco Use and Dependence. Rockville, Md: Public Health Service, US Dept of Health and Human Services. 2000.
Jaen CR, McIlvain H, Phillips RL, Flocke S, Crabtree BF. Tailoring tobacco counseling to the competing demands in the clinical encounter. Journal of Family Practice. 2001; 50(10): .
National Center for Chronic Disease Prevention and Health Promotion. Targeting tobacco use: the nation’s leading cause of death, at-a-glance. CDC Web site. 2010. Available at: https://stacks.cdc.gov/view/cdc/5527 Accessed on: 2016-09-06.
Schnoll R, Rukstalis M, Wileyto E, Shields A. Smoking cessation treatment by primary care physicians: An update and call for training. American Journal of Preventive Medicine. 2006; 31(3): 233-239.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-36, DHHS Publication SMA 09-4434 . 2009. Available at: http://archive.samhsa.gov/data/NSDUH/2k8nsduh/2k8Results.htm Accessed on: 2010-10-29.

Training Activity References

American Psychiatric Association. Substance-Related and Addictive Disorders. APA. 2013.
Babor T, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary care. World Health Organization: Department of Mental Health and Substance Dependence. Second Edition. 2001. Available at: http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf Accessed on: 2008-10-10.
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Brown RL, Leonard T, Saunders LA, Papasouliotis O. A two-item conjoint screen for alcohol and other drug problems. Journal of the American Board of Family Practice. 2001; 14(2): 95-106. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11314930 Accessed on: 2013-10-24.
Brown RL, Leonard T, Saunders LA, Papasouliotis O. The prevalence and detection of substance use disorder among inpatients ages 18 to 49: an opportunity for prevention. Preventive Medicine. 1998; 27(1): 101-110. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9465360 Accessed on: 2013-10-24.
Bush K, Kivlahan DR, McDonnell MB, et al.. The AUDIT Alcohol Consumption Questions (AUDIT-C): An effective brief screening test for problem drinking. Arch Internal Med. 1998; 3: 1789-1795. Available at: http://www.integration.samhsa.gov/images/res/tool_auditc.pdf Accessed on: 2015-09-25.
Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, MD. Center for Substance Abuse Treatment. 1997. Available at: https://www.ncbi.nlm.nih.gov/books/NBK64827/ Accessed on: 2010-06-15.
Chang G. Alcohol Screening Instruments for Pregnant Women. National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2001; 25(3): 204-9. Available at: https://pubs.niaaa.nih.gov/publications/arh25-3/204-209.pdf Accessed on: 2011-01-10.
Clinical Tools Inc.. AUDIT Screening Tool. Clinical Tools, Inc.. 2015. Available at: https://youtu.be/Xdsz__MaC1g Accessed on: 2015-09-25.
Clinical Tools, Inc.. Diagnosing Alcohol Use Disorder. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/zGuiEbaAk3g Accessed on: 2016-01-08.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
D’Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984; 252(14): 1905-1907. Available at: https://www.ncbi.nlm.nih.gov/pubmed/6471323 Accessed on: 2013-10-24.
Fiellin DA, Reid MC, O’Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. 2000 ; 160(13): 1977-89. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10888972 Accessed on: 2013-10-24.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008. Available at: https://www.ncbi.nlm.nih.gov/books/NBK63952/ Accessed on: 2013-09-26.
Gavin DR, Ross HE, Skinner HA. Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM-III drug disorders. Addiction. 2006; 84: 301-307.
Glynn TJ, Manley MW. How to help your patients stop smoking- a National Cancer Institute manual for physicians. Smoking and Tobacco Control Program, National Cancer Institute, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. Bethesda, MD. 1998. Available at: http://books.google.com/books/about/How_to_help_your_patients_stop_smoking.html?id=TM1pAAAAMAAJ
Ingersoll KS, Wagner CC, Gharib S. Motivational groups for community substance abuse problems. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. 2000. Available at: http://people.uncw.edu/ogler/MI%20Groups%20for%20Com%20SA%20Prog.pdf Accessed on: 2013-10-24.
Knight JR, Sherritt L, Harris SK, Gates EC, Chang G. Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcohol Clin Exp Res. 2003; 27(1): 67-73.
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Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Martino S, Grilo CM, Fehon DC. Development of the Drug Abuse Screening Test for adolescents (DAST-A). Addict Behav. 2000; 25(1): 57-70.
Mersy DJ. Recognition of alcohol and substance abuse. American Family Physician. 2003; 67: 1529-1532. Available at: http://www.aafp.org/afp/2003/0401/p1529.html Accessed on: 2013-10-24.
Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior.. New York, NY; Guilford Press. 1991. Available at: http://www.amazon.com/Motivational-Interviewing-Preparing-Addictive-Behavior/dp/089862469X Accessed on: 2013-10-24.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Assessing Alcohol Problems: A guide for clinicians and researchers. NIH Publication No. 03–3745. 2003. Available at: https://pubs.niaaa.nih.gov/publications/AssessingAlcohol/index.pdf Accessed on: 2013-10-24.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Helping Patients Who Drink Too Much: A Clinician’s Guide, Updated 2005 Edition. Bethesda, MD. 2007. Available at: https://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf Accessed on: 2010-10-28.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Helping Patients Who Drink Too Much: A Clinician’s Guide. Bethesda, Md. 2005 (Updated 2007). Available at: https://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf Accessed on: 2013-10-24.
National Institute on Drug Abuse. The NIDA-Modified ASSIST. NIDA. 2010. Available at: http://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen Accessed on: 2011-04-08.
NIDA. The NIDA Quick Screen. Screening for Drug Use in General Medical Settings Resource Guide. 2012. Available at: http://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen Accessed on: 2013-12-18.
Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning and monitoring compliance. Pain Med. 2008; 9: S145-S166.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.
Rollnick S, Miller WR. What is motivational interviewing?. Behav Cognitive Psychother. 1995; 23: 325-334. Available at: http://www.motivationalinterview.net/clinical/whatismi.html Accessed on: 2013-10-24.
Rosengren D, Wagner CC. Motivational interviewing: shall we dance? . In: Coombs R, ed. Addiction Recovery Tools: A Practitioner’s Handbook. Sage Publications. 2001. Available at: https://us.sagepub.com/en-us/nam/addiction-recovery-tools/book9537 Accessed on: 2015-11-11.
Rounsaville BJ. Using motivational interviewing in routine care. Paper presented at: National Institute on Drug Abuse Conference–Blending Clinical Practice and Research. March 14, 2002. Available at: http://archives.drugabuse.gov/pdf/blending/Rounsaville.pdf Accessed on: 2010-06-15.
SAMHSA. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS . 2013. Available at: http://archive.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.pdf Accessed on: 2014-11-26.
Saunders JB, Aasland OG, Babor TF. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption —II. Addiction. 1993; 88(6): 791-803. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8329970
SBIRT Oregon . Brief intervention: “Steve”. YouTube. 2010. Available at: https://www.youtube.com/watch?v=b-ilxvHZJDc Accessed on: 2015-04-27.
SBIRTOregon.org. Readiness ruler. SBIRT Primary Care. 2013. Available at: http://www.sbirtoregon.org/tools.php Accessed on: 2013-12-20.
Skinner HA. The drug abuse screening test. Addiction Behavior. 1982; 7(4): 363-71. Available at: https://www.ncbi.nlm.nih.gov/pubmed/7183189 Accessed on: 2013-10-24.
Smith PC, Schmidt SM, Saitz R. A single-question screening test for drug use in primary care. Annals Intern Med. 2010; 170(13): 1155-1160. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911954/ Accessed on: 2014-09-10.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2009 National Survey on Drug Use and Health. . (Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4856Findings). Rockville, MD. Electronic Access and Copies of Publication. 2010. Available at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm#Ch7 Accessed on: 2011-04-13.
Trachtenberg AI, Fleming MF. Diagnosis and Treatment of Drug Abuse in Family Practice. American Family Physician monograph. National Institute on Drug Abuse. American Academy of Family Physicians. 1994. Available at: http://archives.drugabuse.gov/diagnosis-treatment/diagnosis3.html
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 . 7th Edition, Washington, DC: U.S. Government Printing Office. 2010. Available at: https://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf Accessed on: 2014-09-23.
USDHHS. Facing Addiction in America. The Surgeon General’s Report on Alcohol, Drugs, and Health. Surgeon General Reports. 2016. Available at: https://addiction.surgeongeneral.gov/ Accessed on: 2016-11-17.
Wagner C, Conners W. Interaction techniques. Mid-Atlantic Addiction Technology Transfer Center. 2003c. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Wagner C, Conners W. Motivational interviewing principles. Motivational Interviewing Website. 2003b. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
World Health Organization. ASSIST V3.0. World Health Organization. 2004. Available at: http://www.who.int/substance_abuse/activities/assist_v3_english.pdf Accessed on: 2011-04-08.
Yudko E, Lozhkina O, Fouts A, et al. A comprehensive review of the psychometric properties of the drug abuse screening test. Journal of Substance Abuse Treatment. 2007; 32(2): 189-198. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17306727

Professional Practice Gaps

Implementation rates for screening, brief intervention, and referral to treatment (SBIRT) are low for patients with substance use problems in a primary care setting (Seale et al., 2010; CDC, 2017) despite evidence of efficacy (Agerwala & McCance-Katz, 2012; Pilowsky & Wu, 2012). Approximately 20 to 25% of primary care patients are likely to have a current substance use or related health problem (Pilowsky & Wu, 2012). Primary care providers can improve patient care and outcomes by implementing SBIRT appropriately and effectively.

Practice Gap References

Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: A brief review. Journal of Psychoactive Drugs. 2012; 44: 307-317. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801194/ Accessed on: 2017-07-26.
CDC. Screening for Excessive Alcohol Use and Brief Counseling of Adults — 17 States and the District of Columbia, 2014. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR). 2017; 66(12): 313–319. Available at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6612a1.htm Accessed on: 2017-03-14.
Le KB, Johnson AJ, Seale JP, Woodall H, Clark DC, Parish DC, Miller DP. Primary care residents lack comfort and experience with alcohol screening and brief intervention: A multi-site survey. Journal of General Internal Medicine. 2015; 30: 790-796. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25666210 Accessed on: 2015-06-19.
Pilowsky DJ, Wu L. Screening for alcohol and drug use disorders among adults in primary care: a review. Substance Abuse and Rehabilitation. 2012; 3: 25-34. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22553426 Accessed on: 2015-06-16.
Saitz R. Addressing Unhealthy Alcohol Use in Primary Care. Springer. 2013. Available at: https://www.amazon.com/Addressing-Unhealthy-Alcohol-Primary-Care/dp/146144778X Accessed on: 2017-07-26.
Seale JP, Shellenberger S, Velzsquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening and clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC Fam Pract. 2010; 11:18: . Available at: https://www.ncbi.nlm.nih.gov/pubmed/20205740 Accessed on: 2014-07-28.

Training Activity References

BoiseCoE. Motivational Interviewing — OARS Skills. BoiseCoE. 2012. Available at: https://youtu.be/_KNIPGV7Xyg Accessed on: 2015-10-06.
Butler C, Rollnick S, Cohen D, Russell I, Stott N. Motivational counseling versus brief advice for smokers in general practice: a randomized trial. BR J Gen Pract. 1999; 49: 611-616. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1316198/ Accessed on: 2013-10-25.
Carey KB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Mental Health Journal. 1996; 32: 291-306. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8790970 Accessed on: 2013-10-28.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Clinical Tools, Inc.. Motivational Interviewing: Managing Challenging Patient Behavior. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Community Care of North Carolina. CCNC Motivational Interviewing Resource Guide. . 2013. Available at: https://www.communitycarenc.org/media/files/mi-guide.pdf Accessed on: 2015-06-11.
Copeland L, McNamara R, Kelson M, et al. Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: A systematic review. Patient Educ Couns. 2015; 98(4): 401-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25535015 Accessed on: 2015-09-29.
DiLillo V , West DS. Motivational interviewing for weight loss . Psychiatric Clinics of North America . 2011; 34: 861-869. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22098809 Accessed on: 2015-05-27.
Emmons K, Rollnick S. Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11137778 Accessed on: 2013-10-24.
Engle B. Motivational Interview with “Resistant” Heavy Drinker. . 2012. Available at: https://youtu.be/eNfy-FVvnRs Accessed on: 2015-10-06.
Glynn LH, Moyers TB. Chasing change talk: the clinician’s role in evoking client language about change. Journal of Substance Abuse Treatment. 2010; 39(1): 65-70. Available at: http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(10)00073-5/abstract Accessed on: 2015-10-06.
Ingersoll KS, Wagner CC, Gharib S. Motivational groups for community substance abuse problems. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. 2000. Available at: http://people.uncw.edu/ogler/MI%20Groups%20for%20Com%20SA%20Prog.pdf Accessed on: 2013-10-24.
Lundal B, Moleni T, Burke B L, et al. Motivational Interviewing in Medical Care Settings: A systematic review and meta-analysis randomized controlled trials. Patient Education and Counseling. 2013; 93(2): 157-68. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24001658 Accessed on: 2015-09-29.
Lyme A. Motivational Interviewing – Good Example. TheIRETAchannel. 2013. Available at: https://youtu.be/67I6g1I7Zao Accessed on: 2015-10-06.
Marlatt GA. Harm Reduction: come as you are. Addict Behav. 1996; 21: 779-88. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8904943 Accessed on: 2013-10-25.
Miller W. Motivational interviewing with problem drinkers. Behav Psych. 1983; 11: 147-172. Available at: https://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5845668 Accessed on: 2013-10-25.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Applications of Motivational Interviewing Series. New York: Guilford Press.. 2012; 3rd edition: . Available at: https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274 Accessed on: 2014-07-08.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior.. New York, NY; Guilford Press. 1991. Available at: http://www.amazon.com/Motivational-Interviewing-Preparing-Addictive-Behavior/dp/089862469X Accessed on: 2013-10-24.
Moyers TB. The Relationship in Motivational Learning. Psychotherapy (Chic). 2014; 51(3): 358-63. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25068193Accessed on: 2015-09-29.
Pirlott AG, Kisbu-Sakarya Y, Defrancesco CA, et al. Mechanisms of Motivational Interviewing in Health Promotion: A Bayesian mediation analysis. Int J Behav Nutr Phys Act. 2012; 9(1): 69. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22681874 Accessed on: 2015-09-29.
Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research and Practice. 1982; 19: 276-288. Available at: http://psycnet.apa.org/journals/pst/19/3/276/ Accessed on: 2013-10-25.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion. 1997; 12: 38-48. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10170434 Accessed on: 2013-10-25.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Rollnick S, Butler CC, Stott N. Helping smokers make decisions: the enhancement of brief interventions for general medical practice. Patient Educ Couns. 1997; 31: 191-203. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9277242 Accessed on: 2013-10-25.
Rollnick S, Mason P, Butler C. Health behavior change: a guide for practitioners. Churchill Livingstone. 2003. Available at: https://books.google.com/books?id=iWjZQAAACAAJ&lr= Accessed on: 2013-10-25.
Rollnick S, Miller WR. What is motivational interviewing?. Behav Cognitive Psychother. 1995; 23: 325-334. Available at: http://www.motivationalinterview.net/clinical/whatismi.html Accessed on: 2013-10-24.
Rosengren D, Wagner CC. Motivational interviewing: shall we dance? . In: Coombs R, ed. Addiction Recovery Tools: A Practitioner’s Handbook. Sage Publications. 2001. Available at: https://us.sagepub.com/en-us/nam/addiction-recovery-tools/book9537 Accessed on: 2015-11-11.
Rounsaville BJ. Using motivational interviewing in routine care. Paper presented at: National Institute on Drug Abuse Conference–Blending Clinical Practice and Research. March 14, 2002. Available at: http://archives.drugabuse.gov/pdf/blending/Rounsaville.pdf Accessed on: 2010-06-15.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 . 7th Edition, Washington, DC: U.S. Government Printing Office. 2010. Available at: https://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf Accessed on: 2014-09-23.
van der Wouden JC, Rietmeijer C. Motivational Interviewing in the Medical Care Setting. Patient Education Counseling . 2014; 96(1): 142. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24856448 Accessed on: 2015-09-29.
Wagner C, Conners W. Interaction techniques. Mid-Atlantic Addiction Technology Transfer Center. 2003c. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Wagner C, Conners W. Motivational interviewing principles. Motivational Interviewing Website. 2003b. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Westar HA , Aviram A. Core Skills in Motivational Interviewing. Psychotherapy (Chic). 2013; 50(3): 273-8. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24000834 Accessed on: 2015-09-29.
Westra HA. Motivational interviewing in the treatment of anxiety . The Guilford Press. 2012. Available at: https://www.guilford.com/books/Motivational-Interviewing-in-the-Treatment-of-Anxiety/Henny-Westra/9781462525997 Accessed on: 2015-06-25.

Participant Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

Module Practice Gap References

BoiseCoE. Motivational Interviewing — OARS Skills. BoiseCoE. 2012. Available at: https://youtu.be/_KNIPGV7Xyg Accessed on: 2015-10-06.
Butler C, Rollnick S, Cohen D, Russell I, Stott N. Motivational counseling versus brief advice for smokers in general practice: a randomized trial. BR J Gen Pract. 1999; 49: 611-616. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1316198/ Accessed on: 2013-10-25.
Carey KB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Mental Health Journal. 1996; 32: 291-306. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8790970 Accessed on: 2013-10-28.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Clinical Tools, Inc.. Motivational Interviewing: Managing Challenging Patient Behavior. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
Community Care of North Carolina. CCNC Motivational Interviewing Resource Guide. . 2013. Available at: https://www.communitycarenc.org/media/files/mi-guide.pdf Accessed on: 2015-06-11.
Copeland L, McNamara R, Kelson M, et al. Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: A systematic review. Patient Educ Couns. 2015; 98(4): 401-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25535015 Accessed on: 2015-09-29.
DiLillo V , West DS. Motivational interviewing for weight loss . Psychiatric Clinics of North America . 2011; 34: 861-869. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22098809 Accessed on: 2015-05-27.
Emmons K, Rollnick S. Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11137778 Accessed on: 2013-10-24.
Engle B. Motivational Interview with “Resistant” Heavy Drinker. . 2012. Available at: https://youtu.be/eNfy-FVvnRs Accessed on: 2015-10-06.
Glynn LH, Moyers TB. Chasing change talk: the clinician’s role in evoking client language about change. Journal of Substance Abuse Treatment. 2010; 39(1): 65-70. Available at: http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(10)00073-5/abstract Accessed on: 2015-10-06.
Ingersoll KS, Wagner CC, Gharib S. Motivational groups for community substance abuse problems. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. 2000. Available at: http://people.uncw.edu/ogler/MI%20Groups%20for%20Com%20SA%20Prog.pdf Accessed on: 2013-10-24.
Lundal B, Moleni T, Burke B L, et al. Motivational Interviewing in Medical Care Settings: A systematic review and meta-analysis randomized controlled trials. Patient Education and Counseling. 2013; 93(2): 157-68. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24001658 Accessed on: 2015-09-29.
Lyme A. Motivational Interviewing – Good Example. TheIRETAchannel. 2013. Available at: https://youtu.be/67I6g1I7Zao Accessed on: 2015-10-06.
Marlatt GA. Harm Reduction: come as you are. Addict Behav. 1996; 21: 779-88. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8904943 Accessed on: 2013-10-25.
Miller W. Motivational interviewing with problem drinkers. Behav Psych. 1983; 11: 147-172. Available at: https://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5845668 Accessed on: 2013-10-25.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Applications of Motivational Interviewing Series. New York: Guilford Press.. 2012; 3rd edition: . Available at: https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781609182274 Accessed on: 2014-07-08.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. The Guilford Press. 2013. Available at: http://www.amazon.com/Motivational-Interviewing-Third-Edition-Applications/dp/1609182278 Accessed on: 2014-10-10.
Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior.. New York, NY; Guilford Press. 1991. Available at: http://www.amazon.com/Motivational-Interviewing-Preparing-Addictive-Behavior/dp/089862469X Accessed on: 2013-10-24.
Moyers TB. The Relationship in Motivational Learning. Psychotherapy (Chic). 2014; 51(3): 358-63. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25068193Accessed on: 2015-09-29.
Pirlott AG, Kisbu-Sakarya Y, Defrancesco CA, et al. Mechanisms of Motivational Interviewing in Health Promotion: A Bayesian mediation analysis. Int J Behav Nutr Phys Act. 2012; 9(1): 69. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22681874 Accessed on: 2015-09-29.
Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research and Practice. 1982; 19: 276-288. Available at: http://psycnet.apa.org/journals/pst/19/3/276/ Accessed on: 2013-10-25.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion. 1997; 12: 38-48. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10170434 Accessed on: 2013-10-25.
Rahm AK, Boggs JM , Martin C, et al.. Facilitators and barriers to implementing SBIRT in primary care in integrated health care settings . Subst Abus. 2014. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25127073 Accessed on: 2015-05-27.
Rollnick S, Butler CC, Stott N. Helping smokers make decisions: the enhancement of brief interventions for general medical practice. Patient Educ Couns. 1997; 31: 191-203. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9277242 Accessed on: 2013-10-25.
Rollnick S, Mason P, Butler C. Health behavior change: a guide for practitioners. Churchill Livingstone. 2003. Available at: https://books.google.com/books?id=iWjZQAAACAAJ&lr= Accessed on: 2013-10-25.
Rollnick S, Miller WR. What is motivational interviewing?. Behav Cognitive Psychother. 1995; 23: 325-334. Available at: http://www.motivationalinterview.net/clinical/whatismi.html Accessed on: 2013-10-24.
Rosengren D, Wagner CC. Motivational interviewing: shall we dance? . In: Coombs R, ed. Addiction Recovery Tools: A Practitioner’s Handbook. Sage Publications. 2001. Available at: https://us.sagepub.com/en-us/nam/addiction-recovery-tools/book9537 Accessed on: 2015-11-11.
Rounsaville BJ. Using motivational interviewing in routine care. Paper presented at: National Institute on Drug Abuse Conference–Blending Clinical Practice and Research. March 14, 2002. Available at: http://archives.drugabuse.gov/pdf/blending/Rounsaville.pdf Accessed on: 2010-06-15.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 . 7th Edition, Washington, DC: U.S. Government Printing Office. 2010. Available at: https://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf Accessed on: 2014-09-23.
van der Wouden JC, Rietmeijer C. Motivational Interviewing in the Medical Care Setting. Patient Education Counseling . 2014; 96(1): 142. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24856448 Accessed on: 2015-09-29.
Wagner C, Conners W. Interaction techniques. Mid-Atlantic Addiction Technology Transfer Center. 2003c. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Wagner C, Conners W. Motivational interviewing principles. Motivational Interviewing Website. 2003b. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Westar HA , Aviram A. Core Skills in Motivational Interviewing. Psychotherapy (Chic). 2013; 50(3): 273-8. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24000834 Accessed on: 2015-09-29.
Westra HA. Motivational interviewing in the treatment of anxiety . The Guilford Press. 2012. Available at: https://www.guilford.com/books/Motivational-Interviewing-in-the-Treatment-of-Anxiety/Henny-Westra/9781462525997 Accessed on: 2015-06-25.

Professional Practice Gaps

Professional practice gaps exist when there is a disparity between educational needs and the ideal or desired level of knowledge, competence, and performance. Few primary care providers routinely provide substance use interventions with their patients or appropriate follow-up (Roche & Freeman, 2004; D’Amico et al., 2005). The structured counseling skills of motivational interviewing are an effective means of motivating patients to change addictive behavior (Miller & Rollnick, 2012). Motivational Interviewing has been used successfully in primary care as a brief intervention for addiction (Rahm et al., 2014) particularly for enhancing readiness to change, goal-oriented action, and treatment adherence (VanBuskirk & Wetherell, 2014). Training physicians in motivational interviewing skills will prepare them to provide effective substance use interventions for patients.

Providers vary a great deal with respect to their self-efficacy in counseling skills to address substance use problems (Midboe, et al., 2011). Providing instruction on the steps involved in motivational interviewing will adhere the foundation for building self-efficacy and fulfill the knowledge need. Also, primary care providers express uncertainty in their ability to perform brief counseling interventions (Saitz, 2013). Understanding how to apply the clinical steps will help address this competence need. Additionally, experience with interactive case scenarios will help providers transfer competency in motivational interviewing into practice to help address the performance need for greater self-efficacy with counseling skills for substance use problems.

Practice Gap References

Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3): 7-30. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18077300 Accessed on: 2014-07-28.
Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE, National Institute on Drug Abuse Clinical Trials Network. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006; 81(3): 301-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16169159 Accessed on: 2014-07-29.
Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. HHS Publication. 2015; SMA 15-4927, NSDUH Series H-50: . Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm
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