ATLANTA — Drugs and alcohol can cause havoc in the lives of some young people. Adults who work with kids sometimes wonder how to best address the issue.
Now a public health approach originally developed for doctors is being seen as a potential tool for youth organizations.
“It’s a respectful approach,” said Neil Campbell, executive director of the Georgia Council on Substance Abuse. It doesn’t shame or blame, she said. And it fosters conversations about drug and alcohol use.
The method, called SBIRT (pronounced S-PERT), stands for Screening, Brief Intervention and Referral to Treatment.
It’s promoted — mostly in medical settings — by the U.S. Substance Abuse and Mental Health Administration (SAMHSA), which has provided grants to states, college health centers, doctor training programs and other groups.
In addition, some pilot programs have been started in schools.
Now YouthBuild USA, a youth development organization serving young people ages 16-24, is using the approach in some of its affiliate organizations through a grant from the Conrad Hilton Foundation.
What it is
SBIRT developed as a way to screen a large population for risky use. It was designed to provide information to each individual and offer treatment to the minority who needed it.
Participants first fill out a short questionnaire. YouthBuild, in its pilot project, used a 10-question alcohol screening tool called AUDIT (Alcohol Use Disorders Identification Test) and a version of DAST, the Drug Abuse Screening Test.
AUDIT asks questions such as “How often do you have six or more drinks on one occasion?” DAST asks questions such as “Are you always able to stop using drugs when you want to?”
The second part of the process is a brief conversation with a trained staff person or "coach," using a technique known as motivational interviewing. When SBIRT is used in medical setting, this conversation is led by a doctor or other medical personnel.
The coach explains the risks as revealed by the questionnaire — and also asks the young person about both the pros and cons of drug or alcohol use. The coach provides feedback in a respectful way (“I have some information about the guidelines for low-risk drinking, would you mind if I shared them with you?”).
The coach also asks about readiness to change and takes note of whatever changes the young person says he or she is willing to do. The conversation can also include a referral to treatment.
“It’s a set of tools,” Campbell said. It’s about having conversations.
Motivational interviewing draws out the young person’s ambivalence about changing. Rather than seeking to persuade, it elicits the motivation to change.
“Motivational interviewing is magic,” Campbell said. It makes people feel empowered to make choices.
It’s very different from telling a young person: “If you do that, you’re going to die.” Instead, “you get them thinking,” she said.
In the YouthBuild pilot program, 15 local affiliates used SBIRT, with a total of 270 young people participating, according to the report “DOL and HHS Work Together to Address Youth Substance Use.” The screening questionnaires showed that 91 of the youth had no risky alcohol or drug use, while 179 did, the report said.
Among the latter, 108 participated in a brief intervention conversation, 56 took part in several brief intervention conversations, six had brief treatment and nine were referred to other treatment, the report said.
Most YouthBuild students who use substances are not “addicts,” said YouthBuild consultant Pat McNeil in a 2013 presentation. Instead, they have risky behaviors and habits that may lead to addiction, she said. But those who abuse drugs are unlikely to be able to complete YouthBuild successfully.
At YouthBuild, young adults work toward their high school equivalency diplomas while they learn job skills. The organization, which receives funding from the Department of Labor, also places young people in jobs. Drug use can create problems and hamper a young person’s ability to succeed in the job.
Each YouthBuild affiliate has its own policy around drug use by participants, said Helen Whitcher, senior director of technical assistance at YouthBuild USA.
Some affiliates are hands-off, others drug-test their participants.
Programs that work closely with unions may want to make sure young people go into union apprenticeship programs drug-free, Whitcher said.
SBIRT is a preventive approach, she said, and it helps YouthBuild to encourage and support positive behaviors.
“It enables us to help programs feel secure on their drug and alcohol policy and be consistent,” she said.
YouthBuild has received a new three-year grant from the Hilton Foundation to put SBIRT in a total of 130 programs and approximately 3,900 youth.
Through the pilot program YouthBuild also developed a list of best practices. They include:
- Build relationships with students (and their family) early on.
- Provide drug education seminars for all students.
- Staff training and cross-training are a must.
- Do not use drug testing to screen out applicants.
Campbell, with the Georgia Council on Substance Abuse, agrees on the importance of training when using SBIRT. She calls it “absolutely key” for screening and interviewing. But SBIRT is not limited to professionals.
“We want to train young people in recovery [from drug or alcohol addiction] to do screening and interviewing” to provide peer-to-peer support, she said.
Research done in medical settings shows that the SBIRT approach is as effective in addressing risky alcohol use as a flu shot is for preventing the flu, according to the Institute for Research, Education and Training in Addictions.
SBIRT used in doctors’ offices and other health care settings has reduced hazardous drinking in patients, according to SAMHSA.
It reduces drug and alcohol use in the short term and may have significant long-term benefits, according to SAMHSA and the Office of National Drug Control Policy.Researchers reported in the publication Drug and Alcohol Dependence that a brief motivational intervention aided abstinence from heroin and cocaine six months later.
One characteristic of SBIRT it that it provides universal screening, rather than focusing only on those considered at risk of addiction.
When SBIRT is used, 7 to 9 percent of the people screened need treatment, Campbell said.
It’s a valuable tool for use with young people, she said.
“Ninety percent of adults with substance abuse disorders started using before age 18,” she said.
The preventive nature of SBIRT is very important, Campbell said; much of the money spent on drug and alcohol addiction is spent on treatment and too little on prevention.
She would like to see SBIRT in lots of places, ranging from school-based health clinics to organizations like the Boys & Girls Clubs, she said.
If that happens, “what you’re going to see is a reduction in risky use,” she said.
All kids can benefit, she said.
“The beauty is that you catch kids doing the right thing” and reinforce them, she said.
The video below by the Institute for Research, Education and Training in Addictions explains "What is SBIRT?"