Georgia BASICS An Evidence-Based Approach to the Identification, Intervention and Treatment of Substance Use Problems

1. Georgia BASICSAn Evidence-Based Approach to the Identification, Intervention and Treatment of Substance Use Problems Stephen H. O’Neil, MA Director, Georgia BASICS Project Division of Addictive Diseases

2. Forget Everything You Know • About Substance Use Problems • About Substance Using Populations • About Substance Use Counseling • About Substance Use Treatment

3. Understanding the Problem With Alcohol

4. Historically • Substance use services have been focused in two areas: • Primary Prevention – Delaying onset of substance use. • Treatment – Providing time, cost, and labor intensive services to patients who are acutely or chronically ill.

5. Substance Dependent No Problem

6. Substance Dependent Treatment No Problem No Intervention

7. Substance Dependent Abstinence No Problem Enjoy Yourself

8. What isModerate Drinking?

9. People don’t know how much is too much Not even doctors

10. U.S. Dietary Guidelines • “Those who choose to drink alcoholic beverages should do so sensibly and in moderation . . .” • Women: ≤ 1 drink per day • Men: ≤ 2 drinks per day

11. NIAAA Maximum Limits • Healthy Men < 65 • ≤ 4 drinks per day AND • ≤ 14 drinks per week • Healthy Women & Men ≥ 65 • ≤ 3 drinks per day AND • ≤ 7 drinks per week

12. U.S. Population

13. Excessive

14. Dependent

15. 4% Dependent 25% Excessive 71% Low or No Risk

16. dependent 4% dependence symptoms harmful hazardous 25% low risk 71% current abstinence lifetime abstinence

17. 6 1

18. If We could provide a 100% cure to every substance dependent person in the United States we wouldn’t be close to curing most of the substance related problems in our country.

19. What’s the Problem? Excessive Drinking

20. Georgia BASICS • The Georgia BASICS (Brief Assessment, Screening, Intervention, and Continuum of Services) Project is a 5 year cooperative agreement between the State of Georgia and the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

21. A New Initiative • Substance use screening, brief intervention, referral, and treatment is a systems change initiative requiring us to re-conceptualize, how we understand substance use problems, re-define how we identify substance use problems, and re-designhow we treat substance use problems.

22. Support for SBIRT • SBIRT is an evidenced based practice that is supported by: • Center for Substance Abuse Treatment • The World Health Organization • The American Preventative Task Force • The American Trauma Nurses Association • The American Medical Association • The American College of Surgeons • The Office of National Drug Control Policy

23. Substance use has been seen as: A moral problem An individual problem A family problem A social problem A criminal justice problem A combination of one or more Historically

24. Substance Use Is A Public Health Problem

25. Risk Reduction SBIRT is a primary, secondary, and tertiary prevention and treatment strategy designed to intervene based on patient need and prevent/treat substance use problems at various levels.

26. SBIRT Provides • Identification of substance use problems using a public health approach and universal screening. • Progressive levels of clinical interventions based on level of need and motivation for change.

27. Primary Goal • The primary goal of SBIRT is not to identify those who are dependent and need higher levels of care. • The primary goal of SBIRT is to identify those who are at moderate or high risk for psycho-social or health care problems related to their substance use choices.

28. Learning from Health Care • The health care system routinely screens for potential medical problems (cancer, diabetes, hypertension), provides preventative services prior to the onset of acute symptoms, and delays or precludes the development of chronic conditions.

29. The SBIRT Concept • SBIRT uses a public health approach to universal screening for substance use problems. • SBIRT provides: • Immediate rule out of non-problem users; • Identification of levels of risk; • Identification of patients who would benefit from brief advise, and; • Identification of patients who would benefit from higher levels of care.

30. The Moving Parts • Pre-screening (universal). • Full screening (for those with a positive pre-screen). • Brief Intervention (for those scoring over the cut off point).

31. The Moving Parts • Brief Treatment (for those who have moderate risk, high risk, abuse, or dependence, would benefit from ongoing, targeted interventions, and are willing to engage). • Traditional Treatment (for those who are dependent and are willing to engage).

32. Georgia BASICSEmergency Department Patients step 1 If Positive step 2 Patient Pre-screen Past year binge (5+ male, 4+ female) or Past year illicit drug use or prescription drug use not as prescribed Full Screen ASSIST - Developed by WHO ASSIST scores indicate: 0-4 Screen only 4-19 Brief Intervention 20-26 BI + Referral to BT 27+ BI + Referral to Tx Conducted by Nurses at triage

33. Who are Georgia BASICS Patients? Setting Urban Hospital EDs Gender 68% Male 32% Female Race 72% Black or African American 20% White 2.5% Hispanic/Latino 1% Native American

34. Substances of Choice in Urban EDs The most common & predominant substances used by those receiving our services at BI or higher 1. Alcohol 2. Marijuana 3. Cocaine

35. Georgia BASICSPatterns of Alcohol Use (For those patients receiving at least a BI) 44% had 5+ drinks in one sitting during the past month 17% had 5+ drinks in one sitting >14 days during the past month 9% had 5+ drinks in one sitting every day during the past month

36. Georgia BASICSPatterns of Marijuana Use 36% used marijuana during the past month 16% used marijuana >14 days during the last month 10% used marijuana every day during the last month

37. Georgia BASICSPatterns of Cocaine Use 19% used cocaine during the past month 6% used cocaine >14 days during the past month 3% used cocaine every day during the past month

38. % Using for Each Age Group (past 30 days)

39. What Are We Preventing • DUI • Trauma • Violence • Pregnancy • STD • Substance Dependence • Health Care Problems

40. There must be a pony in here somewhere

41. Benefits to You • New Referral Streams • Evidence-based Practices • Improved Outcomes • Enhanced Relationships with Health Care • More Inclusive Continuum of Care • Broader Patient Base • Alternate Funding Streams • Larger Role and Increased Credibility

42. For Additional Information Steve O’Neil Project Director – Georgia BASICS 2 Peachtree Street, Suite 22-265 Atlanta, GA 30303 (404) 651-8450 shoneil@dhr.state.ga.us