Evidence suggests low implementation rates for screening, brief intervention, and referral to treatment (SBIRT) for patients with substance use problems in a primary care setting (CDC, 2017) despite evidence of efficacy (Knapp et al., 2019; Agerwala & McCance-Katz, 2012; Pilowsky & Wu, 2012). Approximately 20 to 25% of primary care patients are likely to have a current substance use or health-related problem (Pilowsky & Wu, 2012). Inadequate training is the most frequently reported barrier to practicing SBIRT (Le et al., 2015). Primary care referrals are also infrequent. Two-thirds of patients who screened positive for unhealthy drug use at a VA center in one study did not receive a referral or a return appointment to address the problem (Hodgkin et al., 2020).
Medical schools and post-graduate residency education do not typically prepare medical students and residents for implementing SBIRT (Saitz, 2013).
Due to insufficient SBIRT training, primary care providers not only lack confidence in assessing unhealthy substance use, but also express uncertainty in their ability to perform brief interventions and confusion regarding handling referrals for substance use patients who need a higher level of care than they can provide (Saitz, 2013).
Primary care providers screen fewer than a third to a half of their patients for substance use problems (Sahker et al., 2017; McNealy, 2018). Brief interventions happen even less often (NCMH, 2018). Fewer than 75% of patients who screened positively received a brief intervention.
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.
- American Public Health Association. Alcohol Screening and Brief Intervention: A guide for public health practitioners. Substance Abuse and Mental Health Services Administration. 2008. Available at: https://www.integration.samhsa.gov/clinical-practice/alcohol_screening_and_brief_interventions_a_guide_for_public_health_practitioners.pdf Accessed on: 2017-07-26.
- Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.
- Knapp MM, McCabe D. Screening and interventions for substance use in primary care. Nurse Practitioner. 44(8):p 48-55, August 2019. doi: 10.1097/01.NPR.0000574672.26862.24. Available at: https://journals.lww.com/tnpj/Abstract/2019/08000/Screening_and_interventions_for_substance_use_in.11.aspx
- 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.
- 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.
- McNeely J, Kumar PC, Rieckmann T, et al. Barriers and facilitators affecting the implementation of substance use screening in primary care clinics: a qualitative study of patients, providers, and staff. Addiction Science & Clinical Practice. 2018;13(1):8. doi:10.1186/s13722-018-0110-8
- National Council for Behavioral Health. Implementing Care for Alcohol & Other Drug Use Medical Settings. An extension of SBIRT. SBIRT Change Guide 1.0. February 2018.
- Pilowsky DJ, Wu LT. 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.dovepress.com/screening-for-alcohol-and-drug-use-disorders-among-adults-in-primary-c-peer-reviewed-article-SAR Accessed on: 2014-04-28.
- Pringle JL, Kowalchuk A, Meyers JA, Seale JP. Equipping residents to address alcohol and drug abuse: The national SBIRT residency training project. Journal of Graduate Medical Education. 2012; 4: 58-63. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23451308 Accessed on: 2017-07-27.
- 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.
- Ruiz P, Strain EC, Lowinson JH. Lowinson and Ruiz’s substance abuse: A comprehensive textbook. Wolters Kluwer Health/Lippincott Williams & Wilkins. 2011. Available at: https://www.amazon.com/Lowinson-Ruizs-Substance-Abuse-Comprehensive/dp/1605472778 Accessed on: 2017-07-26.
- Sahker E, Arndt S. Alcohol use screening and intervention by American primary care providers. International Journal of Drug Policy. 2017;41:29-33. doi:10.1016/j.drugpo.2016.11.013
- 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.
