Integrating Care through the
Use of Screening and Brief
Intervention in HIV Settings
TRAINER’S NAME
TRAINING DATE
TRAINING LOCATION
• Pacific AIDS Education and Training Center
 Charles R. Drew University of Medicine and
Science
 University of California, Los Angeles
• Pacific Southwest Addiction Technology
Transfer Center
• UCLA Integrated Substance Abuse Programs
2
Test Your Knowledge
3
1. What is the maximum number of
standard drinks that are within the low-risk
drinking range for a healthy, non-pregnant
35 year-old woman?
A. No more than 1 drink per occasion
B. No more than 2 drinks per occasion
C. No more than 3 drinks per occasion
D. No more than 4 drinks per occasion
4
2. Please identify what the 5-letters in the
AUDIT acronym stand for:
A. Alcohol Use Disease Inventory Test
B. Alcohol Use Disorders Identification Test
C. Alcohol Use Disorders Inventory Test
D. Alcohol Use Disease Inventory Training
5
3. Because of the linkage between
substance use and HIV, screening and brief
intervention protocols have been adopted
throughout the United States.
A. True
B. False
6
4. Brief interventions often include:
A. Feedback about the patient’s drug and/or
B.
C.
D.
E.
alcohol use
Advice on how to cut down on one’s alcohol
and/or drug use
Motivational techniques
A and B only
All of the above
7
Briefly tell us:
What is your name?
Where do you work and what you do there?
Who is your favorite musician or performer?
What is one reason you decided to attend this
training session?
8
This brief training course will teach you how to:
• Administer substance use
screening
• Deliver a brief intervention
• Employ a motivational
approach
• Make referrals to specialized
treatment, if needed
9
Take some time to think about
the most difficult change that
you had to make in your life.
How much time did it take you
to move from considering that
change to actually taking action?
10
Screening: Very brief set of questions that identifies risk
of substance use related problems.
Brief Intervention: Brief counseling that raises
awareness of risks and motivates client toward
acknowledgement of problem.
Brief Treatment: Cognitive behavioral work with clients
who acknowledge risks and are seeking help.
Referral: Procedures to help patients access specialized
care.
11
Substance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality
SBI reduces accidents, injuries, trauma, emergency
department visits, depression, drug-related infections
and infectious diseases
Health care costs
Studies have indicated that SBI for alcohol saves $2 - $4
for each $1.00 expended
Other outcomes
SBI may reduce work-impairment, reduce DUIs, and
improve neonatal outcomes
12
• Increases clinicians’ awareness of
substance use issues.
• Offers clinicians more systematic
approach to addressing substance use
(less of a “judgment call”).
13
Brief interventions are successful when
clinicians relate patients’ risky substance
use to improvement in patients’ overall
health and wellbeing.
14
•
•
•
College students
Primary care patients
Mental health patients
•
Patients in infectious disease clinics
•
People with alcohol- or drug-related
legal offenses (e.g., DUI)
15
Rationale for Conducting SBIRT
in an HIV Care Setting
16
• HIV is now considered a manageable, chronic
illness
• HIV patients are living longer and facing
multiple health issues in addition to their HIV
disease
•
•
•
•
Homelessness
Disease progression
Mental illness
Substance abuse
• Engagement, retention, and adherence
among HIV patients continues to present
challenges to HIV care providers
SOURCE: Center for Community Collaboration, UMBC Psychology Department. (2012).
17
• Poorer adherence to treatment and
•
•
•
•
•
medication regimens
Higher hospitalization rates for medical
complications
Greater likelihood of treatment drop-out or
being lost to follow-up
Greater risk for opportunistic (re-) infection
Greater risk of psychosocial problems
Greater risk of suicide or accidental death
SOURCE: Center for Community Collaboration, UMBC Psychology Department. (2012).
18
• SBIRT in primary care settings is effective in
changing behavior and preventing adverse
outcomes attributable to alcohol and other
drugs.
• People living with HIV are more likely than the
general population to experience substance
abuse problems.
• SBI protocols have not been readily
implemented in HIV care settings.
SOURCE: Fischer, L. (2012). Addiction Science & Clinical Practice, 7(Suppl 1): A73.
19
SOURCE: Center for Community Collaboration, UMBC Psychology Department. (2012).
20
• Implemented in San Francisco General Hospital’s
Positive Health Program (PHP) in 2010-11:
•
•
•
Most common substances reported were: tobacco
(68%), alcohol (64%), cannabis (58%), cocaine (39%),
amphetamines (37%), nonmedical sedative use (32%),
and nonmedical opioid use (26%).
SBI for unhealthy substance use is acceptable to
patients in HIV primary care settings
Significant decreases observed with amphetamines and
sedatives; significant increase in number of patients
with HIV viral suppression.
SOURCE: Dawson Rose et al. (2012). IAC Poster.
21
• Of 2,500 patients screened:
• 31% (n=775) received a BI for risky alcohol, tobacco,
or drug use
• 23% (n=575) were referred for therapy or specialized
treatment
• Recommendations for standardizing SBIRT in HIV
settings include:
•
•
•
•
Apply a systematic screening approach
Train providers to conduct BI
Establish a referral network
Integrate SBIRT with adherence and retention efforts
SOURCE: Fischer, L. (2012). Addiction Science & Clinical Practice, 7(Suppl 1): A73.
22
Can SBIRT work in your setting?
3 minutes
End
23
Screening
to Identify Patients At-Risk for
Substance Use Problems
24
What’s going on in these pictures?
Assessment
Screening
25
Self-report
• Interview
• Self-administered
questionnaires
Biological markers
• Breathalyzer
testing
• Blood alcohol levels
• Saliva or urine
testing
• Serum drug testing
26
• Brief (10 or fewer questions)
• Flexible
• Easy to administer, easy for patient
• Addresses alcohol and other drugs
• Indicates need for further assessment or
intervention
• Has good “sensitivity” and “specificity”
27
•
Provide historical
picture
• Inexpensive
• Non-invasive
• Highly sensitive for
detecting potential
problems or
dependence
28
Self-reports are more accurate when people
are:
• Alcohol- or drug-free when interviewed
• Told that their information is confidential
• Asked clearly worded, objective questions
• Provided memory aides (calendars,
response cards)
29
Screen
Target
Population
#
Items
Assessment [Type]
Setting
(most common)
URL
ASSIST
(WHO)
-Adults
-Validated in
many cultures
and languages
8
Hazardous, harmful, or dependent drug
use (including injection drug use)
[Interview]
Primary Care
http://www.who.int
/substance_abuse/a
ctivities/assist_test/
en/index.html
AUDIT
(WHO)
-Adults and
adolescents
-Validated in
many cultures
and languages
10
Identifies alcohol problem use and
dependence. Can be used as a pre-screen
to identify patients in need of full
screen/brief intervention
[Self-admin, Interview, or computerized]
-Different
settings
-AUDIT CPrimary Care (3
questions)
http://whqlibdoc.w
ho.int/hq/2001/wh
o_msd_msb_01.6a.
pdf
DAST-10
Adults
10
To identify drug-use problems in past year
[Self-admin or Interview]
Different settings
http://www.integrat
ion.samhsa.gov/clin
icalpractice/screeningtools
CRAFFT
Adolescents
6
To identify alcohol and drug abuse, risky
behavior, & consequences of use [Selfadmin or Interview]
Different settings
http://www.ceasarboston.org/CRAFFT/
CAGE
Adults and youth
>16
4
-Signs of dependence, not risky use
[Self-admin or Interview]
Primary Care
http://www.integrat
ion.samhsa.gov/clin
icalpractice/sbirt/CAGE
_questionaire.pdf
TWEAK
Pregnant women
5
-Risky drinking during pregnancy. Based
on CAGE.
-Asks about number of drinks one can
tolerate, alcohol dependence, & related
problems [Self-admin, Interview, or
computerized]
Primary Care,
Women’s
organizations,
etc.
http://www.sbirttrai
ning.com/sites/sbirt
training.com/files/T
WEAK.pdf
30
What is a Standard Drink?
31
Drinking Guidelines
 Men: No more that 4 drinks on any day and 14 drinks
per week
 Women: No more than 3 drinks on any day and 7
drinks per week
 Men and Women >65: No more than 3 drinks
on any day and 7 drinks per week
NIAAA, 2011
285 ml
Beer
12 oz
100 ml
Wine
5 oz
60 ml
Fortified Wine
3.5 oz
30 ml
Liquor
1.5 oz
32
Pre-screening is a very quick approach to
identifying people who need to do a longer
screen and brief intervention.
• Self-report, 1-4 questions
• Biological, blood alcohol level test
33
NIAAA 1-item for alcohol use
“How many times in the past year have you had X
or more drinks in a day?”
• Identifies unhealthy alcohol use
• Positive screen > 1 or more
(provide BI)
5 for men
4 for women
SOURCE: Smith, P.C. et al. (2009). Primary care validation of a single-question alcohol screening test. Journal of
General Internal Medicine, 24(7), 787-780 .
34
NIDA 1-item for drug use
"How many times in the past year have you used
an illegal drug or used a prescription medication
for non-medical reasons?”
• Identifies overall drug use
• Positive screen = 1 or more
SOURCE: Smith, P.C. et al. (2010). A single question screening test for drug use in primary care. Archives of Internal
Medicine, 170, 1155-160.
35
Complete Pre-Screen
Alcohol:
Women = 0 – 2
Men = 0 – 4
Alcohol Screen
Complete
Alcohol:
Women = 4+
Men = 5+
Other Drugs:
Any Yes
Administer
the AUDIT
Administer
the DAST
Low/No Risk:
Alcohol = 0 – 7
Other drugs = 0
At Risk:
Alcohol = 8 – 15
Other drugs = 1 – 2
Mod/High Risk:
Alcohol = 16 – 19
Other drugs = 3 – 5
Reinforce
behavior;
Monitor
Brief Intervention
Goal: Lower Risk;
Reduce use to
acceptable levels
BI/Referral to tx/BT
Goal: Encourage pt.
to accept a referral
to tx, or engage in BT
Other Drugs:
All Nos
Other Drug
Screen Complete
High/Severe Risk:
Alcohol = 20 – 40
Other drugs = 6 – 10
Referral to tx.
Goal: Encourage pt.
to accept referral to
tx, or engage in BT
36
•
10-question alcohol use screening instrument
•
Original target groups included:
•
•
Medical patients
•
Accident victims
•
DWI offenders
•
Mental health clients
Designed for primary health care workers
37
Hazardous Alcohol Use
Question 1: Frequency of Drinking
Question 2: Typical quantity
Question 3: Frequency of heavy drinking
38
Dependence Symptoms
Question 4: Impaired control over drinking
Question 5: Failure to meet expectations
because of drinking
Question 6: Morning drinking
39
Harmful Consequences of Alcohol Use
Question 7: Guilt after drinking
Question 8: Blackouts
Question 9: Alcohol-related injuries
Question 10: Others’ concerns about
drinking
40
Score
Level
Action
0-7
Low
Encouragement
8-19
Low/Moderate
BI
16-19
Moderate
BI/RT
20+
High
BT/RT
41
•
I am going to ask you some personal questions
about alcohol (and other drugs) that I ask all
my patients.
•
Your responses will be confidential.
•
These questions help me to provide the best
possible care.
•
You do not have to answer them if you are
uncomfortable.
42
Feedback?
Reactions?
43
Alcohol Screen
Complete
Administer
the AUDIT
Administer
the DAST
Low/No Risk:
Alcohol = 0 – 7
Other drugs = 0
At Risk:
Alcohol = 8 – 15
Other drugs = 1 – 2
Mod/High Risk:
Alcohol = 16 – 19
Other drugs = 3 – 5
Reinforce
behavior;
Monitor
Brief Intervention
Goal: Lower Risk;
Reduce use to
acceptable levels
BI/Referral to tx/BT
Goal: Encourage pt.
to accept a referral
to tx, or engage in BT
Other Drug
Screen Complete
High/Severe Risk:
Alcohol = 20 – 40
Other drugs = 6 – 10
Referral to tx.
Goal: Encourage pt.
to accept referral to
tx, or engage in BT
44
Start by asking two simple questions:
• Do you have a dentist?
• Do you have any mouth/oral pain or discomfort
that interferes with your eating or speaking?
SOURCE: Dr. Fariba Younai, UCLA School of Dentistry (personal communication, May 24, 2013.
45
Brief Interventions
for Patients At-Risk for
Substance Use Problems
46
“Brief…interventions are short, face-toface conversations regarding drinking,
motivation to change, and options for
change which are provided during a
window of opportunity or potentially
teachable moment occasioned by a
medical event.”
SOURCE: Dr. Craig Field, University of Texas.
47
Awareness
of problem
Presenting
problem
Motivation
Behavior
change
Screening
results
48
• Brief interventions trigger change.
•
A little counseling can lead to significant
change, e.g., 5 min. has same impact as 20 min.
• Research is less extensive for illicit drugs, but
promising.
• A randomized study with cocaine and heroin users
found that patients who received a BI had 50%
greater odds of abstinence at follow up compared
with controls.
SOURCE: Bernstein et al. (2005). Drug and Alcohol Dependence, 77, 49-59.
49
What you do depends on where the patient is in
the process of changing.
The first step is to be able to identify where the
patient is coming from.
50
1. Precontemplation
Definition:
Not yet considering change or
is unwilling or unable to change.
6. Recurrence
Definition:
Primary Task:
Raising Awareness
2. Contemplation
Definition:
Experienced a recurrence
of the symptoms.
Sees the possibility of change but
is ambivalent and uncertain.
Primary Task:
Primary Task:
Cope with consequences and
determine what to do next
5. Maintenance
Resolving ambivalence/
Helping to choose change
Stages of Change:
Primary Tasks
Definition:
Definition:
Has achieved the goals and is
working to maintain change.
Primary Task:
Develop new skills for
maintaining recovery
3. Determination
Committed to changing.
Still considering what to do.
4. Action
Definition:
Primary Task:
Help identify appropriate
change strategies
Taking steps toward change but
hasn’t stabilized in the process.
Primary Task:
Help implement change strategies
and learn to eliminate
potential relapses
51
Stages of Change: Intervention Matching Guide
1. Precontemplation
2.
Contemplation
3.
Determination
• Offer factual information
• Explore the person’s sense of self-
• Offer a menu of options for change
• Explore the meaning of events that
brought the person to treatment
efficacy
• Explore expectations regarding what
• Help identify pros and cons of various
change options
• Explore results of previous efforts
• Explore pros and cons of targeted
behaviors
the change will entail
• Summarize self-motivational
statements
• Continue exploration of pros and cons
4.
Action
• Support a realistic view of change
through small steps
• Help identify high-risk situations and
develop coping strategies
• Assist in finding new reinforcers of
positive change
• Help access family and social support
5.
Maintenance
• Help identify and try alternative
behaviors (drug-free sources of
pleasure)
• Maintain supportive contact
• Help develop escape plan
• Work to set new short and long term
goals
• Identify and lower barriers to change
• Help person enlist social support
• Encourage person to publicly
announce plans to change
6.
Recurrence
• Frame recurrence as a learning
opportunity
• Explore possible behavioral,
psychological, and social antecedents
• Help to develop alternative coping
strategies
• Explain Stages of Change & encourage
person to stay in the process
• Maintain supportive contact
52
53
All change contains an
element of ambivalence.
We “want to change
and don’t want to
change”
Patients’ ambivalence
about change is the
“heart” of the brief
intervention.
54
Young man is treated in the ER after a car accident. He had
been drinking heavily before the accident. How does the doctor
address drinking in this video?
(INSERT “BAD SBIRT” VIDEO)
SOURCE: The BNI-ART Institute, Boston University School of Public Health. Interactive Cases: SBIRT in Action. Accessed
on September 26, 2011 at http://www.bu.edu/bniart/sbirt-in-health-care/sbirt-educational-materials/sbirt-videos/ 55
• Listen to both what the patient says and to what
the person means
• Show empathy and don’t judge what patient says
•
You do not have to agree
• Be aware of intonation
•
Reflect what patient says with statement not
a question, e.g., “You couldn’t get up for work
in the morning.”
56
• Repeating – Repeating what was just said.
• Rephrasing/Paraphrasing – Restatement of
what the person said. Listener infers
meaning of what was said. Can be thought
of as continuing the thought.
• Reflecting Feeling – Listener reflects not
just the words, but the feeling or emotion
underneath what the person is saying.
57
• Challenging
“What do you think you are doing?”
• Warning
“You will damage your liver if you don’t stop
drinking.”
• Finger-wagging
“If you want to be a good student, you must stop
drinking on school nights.”
58
Benefits of
change
Benefits of using
drugs
Costs of
using drugs
Costs of change
59
The good
things
about
______
The notso-good
things
about ____
The good
things
about
changing
The not-sogood things
about
changing
Avoid questions that lead to a yes/no response.
60
• What change are you wanting to make?
• What makes you want to change?
• What are the good things about making
this change? Not-so-good things?
61
Change talk consists of self-motivational
statements that suggest:
• Recognition of a problem
• Concern about staying the same
• Intention to change
• Optimism about change
62
Same scenario, but different doctor. What does this doctor do
that is different? Does it work?
(INSERT “GOOD SBIRT” VIDEO)
SOURCE: The BNI-ART Institute, Boston University School of Public Health. Interactive Cases: SBIRT in Action. Accessed
on September 26, 2011 at http://www.bu.edu/bniart/sbirt-in-health-care/sbirt-educational-materials/sbirt-videos/ 63
64
Feedback
Listen & Understand
Options Explored
Warn
65
(that’s it)
O
Avoid Warnings!
L
W
F
Feedback
Setting the stage
Tell screening results
Explore pros & cons
Listen & understand
Explain importance
Assess readiness to change
Discuss change options
Options explored
Follow up
66
F
L
O
Feedback
Listen & Understand
Options Explored
67
The Feedback Sandwich
Ask Permission
Give Feedback
Ask for Response
68
What you need to cover:
1. Range of scores and context
2. Screening results
3. Substance use norms in population
4. Interpretation of results (e.g., risk level)
5. Patient feedback about results
69
What do you say?
1. Range of score and context - Scores on the AUDIT range
from 0-40. Most people who are social drinkers score less
than 8.
2. Results - Your score was 18 on the alcohol screen.
3. Norms - A score of 18 means that your drinking is higher
than 75% of the U.S. adult population.
4. Interpretation of results - 18 puts you in the moderateto-high risk range. At this level, your use is putting you at
risk for a variety of health issues.
5. Patient reaction/feedback - What do you make of this?
70
71
The 1st Task: Feedback
Handling Resistance
•
Look, I don’t have a drug problem.
•
My dad was an alcoholic; I’m not like him.
•
I can quit using anytime I want to.
•
I just like the taste.
•
Everybody drinks in college.
What would you say?
72
SUD
Anxiety
HIV
Confusion
Medical
Issues
SUD
73
The 1st Task: Feedback
To avoid this…
LET GO!!!
74
The
st
1
Task: Feedback
Easy Ways to Let Go
• I’m not going to push you to change
anything you don’t want to change.
• I’d just like to give you some information.
• What you do is up to you.
75
The
st
1
Task: Feedback
Finding a Hook
• Ask the patient about their concerns
• Provide non-judgmental feedback/information
• Watch for signs of discomfort with status quo or
interest or ability to change
• Always ask this question: “What role, if any, do
you think alcohol played in your (getting injured)?
• Let the patient decide.
• Just asking the question is helpful.
76
Activity: Role Play
Let’s practice F:
Role Play Giving Feedback Using Completed
Screening Tools
•
•
•
•
Focus the conversation
Get the ball rolling
Gauge where the patient is
Hear their side of the story
77
Score
Level
Action
0-7
Low
Encouragement
8-19
Low/Moderate
BI
16-19
Moderate
BI/BT
20+
High
BT/RT
78
O
L
F
Options Explored
Feedback
Listen & Understand
79
Ambivalence is
Normal
80
Tools for Change Talk
• Pros and Cons
• Importance/Readiness Ruler
81
Strategies for Weighing the Pros and Cons
• What do you like about drinking?
• What do you see as the downside of drinking?
• What else?
Summarize Both Pros and Cons
“On the one hand you said..,
and on the other you said….”
82
Listen for the Change Talk
• Maybe drinking did play a role in what happened.
• If I wasn’t drinking this would never have happened.
• Using is not really much fun anymore.
• I can’t afford to be in this mess again.
• The last thing I want to do is hurt someone else.
• I know I can quit because I’ve stopped before.
Summarize, so they hear it twice!
83
Importance/Confidence/Readiness
On a scale of 1–10…
• How important is it for you to change your drinking?
• How confident are you that you can change your drinking?
• How ready are you to change your drinking?
For each ask:
• Why didn’t you give it a lower number?
• What would it take to raise that number?
1
2
3
4
5
6
7
8
9
10
84
Activity: Role Play
Let’s practice L:
Role Play Listen & Understand
Using Completed Screening Tool
•
Pros and Cons
• Importance/Confidence/Readiness Scales
• Develop Discrepancy
• Dig for Change
85
O
Listen & Understand
Options Explored
Feedback
L
F
86
What now?
• What do you think you will do?
• What changes are you thinking about making?
• What do you see as your options?
• Where do we go from here?
• What happens next?
87
Offer a Menu of Options
• Manage drinking/use (cut down to low-risk limits)
• Eliminate your drinking/drug use (quit)
• Never drink and drive (reduce harm)
• Utterly nothing (no change)
• Seek help (refer to treatment)
88
During MENUS you can also explore previous
strengths, resources, and successes
• Have you stopped drinking/using drugs before?
• What personal strengths allowed you to do it?
• Who helped you and what did you do?
• Have you made other kinds of changes
successfully in the past?
• How did you accomplish these things?
89
Giving Advice Without Telling Someone What to Do
•
•
Provide Clear Information (Advise or Feedback )
•
What happens to some people is that…
•
My recommendation would be that…
Elicit their reaction
•
What do you think?
•
What are your thoughts?
90
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
91
Closing the Conversation (“SEW”)
•
Summarize patients views (especially the pro)
•
Encourage them to share their views
•
What agreement was reached (repeat it)
92
Activity: Role Play
Let’s practice O: Role Play Options Explored
•
Ask about next steps, offer menu of options
•
Offer advice if relevant
•
Summarize patient’s views
•
Repeat what patient agrees to do
93
Feedback
•
Range
Listen and Understand
•
•
•
Pros and Cons
Importance/Confidence/Readiness Scales
Summary
Options Explored
•
Menu of Options
94
At follow-up visit:
• Inquire about use
• Review goals and progress
• Reinforce and motivate
• Review tips for progress
95
Enhancing Motivation for Change Inservice Training
Based Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatment
www.samhsa.gov
SOURCE: SAMHSA/CSAT. Treatment Improvement Protocol (TIP) Series: Enhancing motivation for change in
substance abuse treatment. 35. Rockville (MD): U.S. DHHS.
96
Referral to Treatment
for Patients At-Risk for
Substance Dependence
97
• Approximately 5% of patients screened will
require referral to substance use evaluation and
treatment.
• A patient may be appropriate for referral when:
•
Assessment of the patient’s responses to the screening
reveals serious medical, social, legal, or interpersonal
consequences associated with their substance use.
These high risk patients will receive a brief
intervention followed by referral.
98
•
Describe treatment options to patients based on
available services
•
Develop relationships between health centers,
who do screening, and local treatment centers
•
Facilitate hand-off by:
•
Calling to make appointment for patient/student
•
Providing directions and clinic hours to patient/student
•
Coordinating transportation when needed
99
• Try screening
and giving
feedback only.
• After several
practices with
F add in L & O.
100
101
• Identify champions within primary care, HIV,
and substance abuse settings
• Promote SBI as a standard of care for all
patients
• Have an openness to new modalities, such as
brief intervention and brief treatment
• Expand scope of focus to include high-risk
alcohol and drug use, not only dependence
SOURCE: J. Esquibel (2012), Colorado SBIRT, www.improvinghealthcolorado.org .
102
What did you learn?
103
1. What is the maximum number of
standard drinks that are within the low-risk
drinking range for a healthy, non-pregnant
35 year-old woman?
A. No more than 1 drink per occasion
B. No more than 2 drinks per occasion
C. No more than 3 drinks per occasion
D. No more than 4 drinks per occasion
104
2. Please identify what the 5-letters in the
AUDIT acronym stand for:
A. Alcohol Use Disease Inventory Test
B. Alcohol Use Disorders Identification Test
C. Alcohol Use Disorders Inventory Test
D. Alcohol Use Disease Inventory Training
105
3. Because of the linkage between
substance use and HIV, screening and brief
intervention protocols have been adopted
throughout the United States.
A. True
B. False
106
4. Brief interventions often include:
A. Feedback about the patient’s drug and/or
B.
C.
D.
E.
alcohol use
Advice on how to cut down on one’s alcohol
and/or drug use
Motivational techniques
A and B only
All of the above
107
• Alcohol and drug problems are common,
identifiable, and treatable conditions in a
variety of medical settings.
• Screening helps HIV providers to understand
and address the consequences of untreated
substance use disorders.
• Screening and brief intervention strategies can
be used to maximize a “teachable moment”
with your HIV patients.
108
• Foundations of SBIRT Self-Paced, Online Course
(www.attcelearn.org)
• SBIRT Implementation Guide for HIV Care Service
Programs
(www.centerforcommunitycollaboration.org )
• NIAAA SBIRT Pocket Guide
(http://pubs.niaaa.nih.gov/publications/Practitio
ner/PocketGuide/pocket.pdf)
• SAMHSA SBIRT White Paper
(http://www.samhsa.gov/prevention/sbirt/)
109
• SAMHSA-HRSA Center for Integrated Health
Solutions – SBIRT Page
(http://www.integration.samhsa.gov/clinicalpractice/sbirt)
• Alcohol SBI Guide for Public Health Professionals
(http://www.apha.org/NR/rdonlyres/B03B4514CCBA-47B9-82B0-5FEB4D2DC983/0/
SBImanualfinal4_16.pdf)
• National SBIRT ATTC
(http://www.attcnetwork.org/regcenters/index_n
fa_sbirt.asp)
110
Thank You!
For more information:
Tom Freese: tfreese@mednet.ucla.edu
Beth Rutkowski: brutkowski@mednet.ucla.edu
Maya Talisa Gil-Cantu: maya@HIVtrainingCDU.org
Pacific Southwest ATTC: www.psattc.org
PAETC Training calendar: www.HIVtrainingCDU.org