alcohol screening, brief intervention and referral (sbir)addictionday.ca/handouts/rm 252/morning...
TRANSCRIPT
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Alcohol Screening, Brief Intervention and Referral
(SBIR)
CSAM Fundamentals Course
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Disclosures
No financial or pharma conflict of interest.
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Objectives
• Review the genesis of Canada’s SBIR initiative.
• Explore the process of SBIR for various risk categories. • Critique the approach and discuss practice
implementation.
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Alcohol SBIR
CCSA and CFPC Development
and Background
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Canada’s National Alcohol Strategy
• Led by the Canadian Centre on Substance Abuse.
• Developed a comprehensive, collaborative, stakeholder endorsed set of 41 recommendations:
• Reducing Alcohol Related Harm in Canada: Toward a Culture of Moderation (CCSA 2007)
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Alcohol SBIR: NAS Recommendations
• #7 Develop integrated, culturally sensitive screening, brief intervention and referral (SBIR) tools and strategies.
• #9 Improve access to addiction services in isolated, rural and remote regions of Canada, and for vulnerable populations.
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Development and Implementation
• CCSA contracted Dr. David Brown PhD to develop and pilot test a prototype.
• Prototype refined through IT consultants, focus groups and beta testing in conjunction with the College of Family Physicians of Canada (CFPC).
• CFPC now maintains the site, with open access, and have assumed responsibility for further KE activity.
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Challenges to Primary Care SBIR Uptake
• Need for national Low Risk Drinking Guidelines. • Credible information and endorsement. • Time: seamless inclusion in busy practices.
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Challenges to Primary Care SBIR Uptake
• Comfort with the process and inclusion of Motivational Interviewing
• Ability to address alcohol abuse and dependency
• Appropriate technology and resources for both the practice and patients
(Lit Review and Practitioner Feedback)
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The Site • College of Family Physicians of Canada, open
source www.sbir-diba.ca
The Site
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Alcohol SBIR
The site, LRDG and Standard Drinks
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Alcohol SBIR
Menu Orientation
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Alcohol SBIR
Screening and Assessment
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Screening Alternatives
• Evidence based LRDG’s • Waiting room screening alternatives: • 1) Primary level AUDIT-C, CRAFFT, or PHQ 4 • 2) Secondary level GAINS-SS • Potential for App and EMR migration of broader
lifestyle and mental health screening, with focused intervention.
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Alcohol SBIR
Brief Intervention and Referral
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Therapeutic Factors & Improvement
Relationship 30%
Expectancy 15%
Technique 15%
Extra-Therapeutic 40%
(Asay & Lambert 1999)
29
Factors Related to Improvement
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Factors Related to Improvement Pre-contemplation
Contemplation
Planning Action
Maintenance
Relapse Success
(Prochaska & Di Clemente, Transtheoretical Model of Change)
Stages of Change
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• Start wherever the person is at: acknowledge their reality. • Roll with resistance. • Avoid arguments or a power struggle. • Be persuasive, not confrontational or abusive.
(From Miller)
A Motivational Approach
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Alcohol SBIR
Brief Intervention, Follow up and Support
for Elevated Risk
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Alcohol SBIR
Brief Intervention, Follow up and Support
for Alcohol Abuse
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Alcohol SBIR
Brief Intervention, Referral, Follow up and
Support for Alcohol Dependency
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Objectives Accomplished
• Review the genesis of Canada’s SBIR initiative
• Explore the content and format • Critique the approach
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References & Recommended Reading • American Society of Addiction Medicine,
www.ASAM.org • Canadian Society of Addiction Medicine, www.CSAM.org • Canadian Centre on Substance Abuse,
www.CCSA.ca
• National Institute of Drug Abuse, www.NIDA.org
References & Recommended Reading
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References & Recommended Reading • National Native Addiction Partnership
Foundation, www.nnapf.org • Wellbriety Movement, www.whitebison.org • Mate, Gabor. In The Realm of Hungry
Ghosts. A.A.Knopf Canada. 2008
References & Recommended Reading
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Thank you
Questions?
Contact: P.R. Butt, MD, CCFP(EM), FCFP Assoc. Professor, Family Medicine, University of Saskatchewan [email protected]