Substance Use Disorder Education: A Statewide Assessment of Core Content in Nursing Schools

Of individuals who need treatment for substance use disorder (SUD), 12.6% do not receive it. One reason for this failure to treat is an inadequately prepared health care workforce, including nurses. To establish a state-wide baseline of SUD curricular content, we collected information about topics taught and barriers to teaching important topics using an anonymous survey sent to all 55 nursing programs in Indiana. Topics deemed important were taught more frequently, such as opioid withdrawal (60.6%). Lack of expertise was more commonly reported as a barrier than lack of time (25.3% vs. 7.1%). Findings suggest that nursing students in Indiana are not taught requisite content related to SUD. We have provided pragmatic recommendations to enhance content in schools of nursing and address lack of expertise among faculty. Leaders need to actively evaluate and augment the content of their curriculums to include SUD. [Journal of Psychosocial Nursing and Mental Health Services, 61(9), 15-23.].

Utilization of Nurse-Administered Screening, Brief Intervention, and Referral to Treatment in a Brief Psychiatric Inpatient Unit

BACKGROUND

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been established as an effective screening tool for providing interventions for patients with risky substance use.

OBJECTIVES

The objectives of this project were to train and coach staff nurses in the use of SBIRT, offer SBIRT to all admissions of a brief psychiatric inpatient unit, and decrease readmission rates.

DESIGN

Using the Iowa Model for Implementing Evidence-Based Practices, SBIRT was implemented on the unit. Data were collected on the frequency of patients offered SBIRT and readmission rates.

RESULTS

Fifty-nine percent of all admissions were offered SBIRT. The average readmission rates decreased by 18.3% for the first 2 months of implementation and by 67.5% for Days 16-31 postdischarge.

CONCLUSIONS

SBIRT is an effective tool for nurses on psychiatric units to address substance use and to decrease readmission rates.

A Process Evaluation of a Substance Use Brief Intervention for Adolescents in a Psychiatric Inpatient Program

The present study represents a two-phase process evaluation of the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) on an adolescent psychiatric inpatient unit. The first phase analyzed uptake efforts using chart review data, which revealed that 158 (16.8%) of 942 hospitalized patients (Mean age = 15.81, SD = 1.24) were eligible to receive the brief intervention; however, only 30 (19%) adolescents received the intervention, 15 (9.5%) declined treatment, and 113 (71.5%) were never offered. The second phase involved directed content analyses of clinical staff and providers’ perceived facilitators and barriers to the implementation. Qualitative findings revealed that providers and staff accepted and agreed with the use of the brief substance use intervention, though perceived time constraints, competing demands, and insufficient staffing interfered with implementation across disciplines. Barriers included patients’ length of stay and competing treatment priorities. Several recommendations emerged including, utilization of non-clinical staff, a clear administration protocol, and the use of computer-based interventions. Findings from the present study shed light on the need to consider alternate or more streamlined substance use treatments such as computerized approaches and focus on ways in which protocol can be modified to fit the needs within an acute, short-term setting.

Nurse-Led Delivery of Brief Interventions for At-Risk Alcohol Use: An Integrative Review

BACKGROUND: Nurses are in key positions to reduce the global burden associated with alcohol, yet many are ill-prepared to screen for alcohol use and intervene accordingly. The purpose of this integrative review was to identify best practices for educating nurses to work with patients who are at risk for alcohol-related adverse consequences, implement alcohol screening, and deliver alcohol brief interventions (ABIs). AIMS: To identify and synthesize findings from randomized control trials of ABIs delivered by nurses to patients identified through screening to be at risk because of alcohol use. METHOD: The results of 11 published randomized control trials identified from a multi-database search were synthesized. RESULTS: The Alcohol Use Disorder Identification Test was used for alcohol screening in more than half of the studies. Most of the ABIs were based on motivational interviewing and delivered in 30 minutes or less. While there was limited information on the characteristics of nurses who delivered the interventions and how nurses were prepared to deliver the ABIs, the exemplar was a full day workshop teaching nurses on an evidence-based framework for the ABI. All studies measured alcohol consumption as an outcome, yet few used rigorous methods for obtaining this self-reported data. CONCLUSIONS: A 1-day workshop is recommended as an educational modality to prepare nurses to implement the Alcohol Use Disorder Identification Test for identification of persons who are at risk because of alcohol use, deliver a structured brief intervention in less than 30 minutes, and utilize a standard measure of alcohol consumption for evaluation.

Nursing: Addressing substance use in the 21st century

Over the past two decades, there has shift from focusing on the most severe end of the substance use continuum to earlier detection of persons who are at risk given the consequences associated with alcohol and other drug use. In 2017, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) undertook the development of core competencies for specific disciplines addressing substance use in the 21st century. This article presents the core competencies for nursing in accord with the 16 standards of practice and performance for nursing. The competencies for the registered nurse and the advanced practice nurse are intended to inform and guide nursing practice with a focus on prevention, intervention, treatment, and recovery supports for persons who are affected by substance.

Screening, Brief Intervention, and Referral to Treatment: Implementation Into an RN-BSN Curriculum

Background: The incidence of alcohol and substance misuse continues to be a problem in the workplace. Methods: A partnership between two universities and a federal agency implemented SBIRT (Screening, Brief Intervention, and Referral to Treatment) into a three-credit, 7-week online Community and Environmental Health Course for licensed nurses earning their Bachelor of Science in Nursing degree. SBIRT is an early intervention, targeting nondependent substance users before needing specialized treatment. Findings: Over seven semesters, 119 students completed the SBIRT curriculum. We observed a significant increase in knowledge about standard drink sizes and recognizing the most reliable alcohol use questionnaire (Alcohol Use Disorders Identification Test [AUDIT]). Students perceived themselves as competent in assessing patient readiness to change, making the best treatment decisions, and referring patients for appropriate care. Most students found significant value of SBIRT in their current practice setting. Conclusion/Application to Practice: The SBIRT curriculum was found to be a valuable tool for nurses in screening and referring patients to care who are at risk of alcohol and drug misuse. It is important for occupational health nurses to learn the necessary skills for assessing workers for alcohol and drug misuse. The occupational health nurse is encouraged to practice their skills at every patient encounter for purposes of refining their skills. Employers are concerned about drug and alcohol misuse in the workplace and occupational health nurses are the optimal group to intervene with workers who need assistance.

Distance Versus On-Site Educational Strategies for Competency-Based Screening, Brief Intervention, and Referral to Treatment Education

BACKGROUND

Although the individual and public health consequences of alcohol and drug use are substantial, nursing education programs generally lack content on addiction. The goal of this evaluation was to compare the initial outcomes of on-site versus distance methods for training graduate nurse practitioner students in Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use.

METHOD

A nonrandomized two-group pretest-posttest design was used to compare knowledge, attitudes, and skills learning outcomes between on-site (n = 45) and distance (n = 18) family or adult/geriatric Master of Science in Nursing nurse practitioner students receiving SBIRT training.

RESULTS

Overall, students increased their knowledge, attitudes, and confidence about screening and intervening with patients who use substances; showed a high level of skills in conducting a brief intervention to motivate patients to reduce their substance use; and were highly satisfied with the education provided. Counseling confidence and gains in knowledge were similar across groups. Compared with distance students, on-site students reported significantly more positive attitudes about their role adequacy, role legitimacy, and role support for intervening with alcohol use and about their role support for intervening with drug use. On-site students had greater training satisfaction, but distance students' skills assessed through standardized patient interactions were significantly better.

CONCLUSIONS

Both on-site and distance training were effective instructional methods to increase SBIRT knowledge and skills. However, differences in attitudes, training satisfaction, and skills demonstration should be taken into account when designing addiction training using distance technologies.

An Environmental Scan of the Role of Nurses in Preventing Fetal Alcohol Spectrum Disorders

Nurses are in an ideal position to talk to their patients of reproductive age about alcohol use and encourage the prevention of alcohol-exposed pregnancies. Effective conversations can be efficiently included in the clinical encounter to identify alcohol misuse and offer appropriate follow-up. This report presents results of an environmental scan of resources relevant to nursing professionals and nurses' role in addressing alcohol misuse. Gaps in nursing education and practice guidelines with regard to defining the nursing role in preventing alcohol-exposed pregnancies were revealed. Findings identified a need to promote adoption among nurses of evidence-based preventive practices to prevent alcohol misuse.

Substance Use Disorder Screening Capacity Lags Behind Depression Screening Capacity in Community Health Centers

Despite their prevalence, screening for depression and substance use disorder (SUD) is often not routinely practiced in primary care. This study uses a survey of community health centers to identify characteristics associated with depression and SUD screening. In 2010, 76.9% of federally qualified health centers routinely screened for depression, and about half of health centers (54.1%) routinely screened for SUDs. Higher Medicaid caseload and region were associated with routine screening for both depression and SUDs. SUD screening was also associated with the percent of total staff comprised of behavioral health specialists, electronic health record (EHR) adoption, urban location, and higher uninsured caseload. Implications include the need to build SUD screening capacity, encourage the use of standardized screening tools, and monitor SUD screening capacity in health centers in the future.

Quality Metrics and Systems Transformation: Are We Advancing Alcohol and Drug Screening in Primary Care?

OBJECTIVE

To examine the influence of Oregon's coordinated care organizations (CCOs) and pay-for-performance incentive model on completion of screening and brief intervention (SBI) and utilization of substance use disorder (SUD) treatment services.

DATA SOURCES/STUDY SETTING

Secondary analysis of Medicaid encounter data from 2012 to 2015 and semiannual qualitative interviews with stakeholders in CCOs.

STUDY DESIGN

Longitudinal mixed-methods design with simultaneous data collection with equal importance.

DATA COLLECTION/EXTRACTION METHODS

Qualitative interviews were recorded, transcribed, and coded in ATLAS.ti. Quantitative data included Medicaid encounters 30 months prior to CCO implementation, a 6-month transition period, and 30 months following CCO implementation. Data were aggregated by half-year with analyses restricted to Medicaid recipients 18-64 years of age enrolled in a CCO, not eligible for Medicare coverage or Medicaid expansion.

PRINCIPAL FINDINGS

Quantitative analysis documented a significant increase in SBI rates coinciding with CCO implementation (0.1 to 4.6 percent). Completed SBI was not associated with increased initiation in treatment for SUD diagnoses. Qualitative analysis highlighted importance of aligning incentives, workflow redesign, and leadership to facilitate statewide SBI.

CONCLUSIONS

Results provide modest support for use of a performance metric to expand SBI in primary care. Future research should examine health reform efforts that increase initiation and engagement in SUD treatment.

A comparative review of guides for implementing alcohol screening and brief interventions into trauma and primary care settings

The likelihood that a patient is currently using alcohol is high across all health care settings with almost one in four persons in the United States aged 12 years or over reporting excessive drinking on at least one occasion in the past 30 days. Screening and brief intervention (SBI) is an evidence-based approach to help decrease alcohol-related harm among persons seeking health care. The Centers for Disease Control and Prevention and the Committee on Trauma, American College of Surgeons, have provided guidelines for implementation of an SBI program within a health care organization. This column provides a comparative overview of three of these guides. These guides provide practical information to help nurses and other health care providers with the planning and implementation of alcohol SBI into routine practice.

Screening, brief intervention, and referral to treatment and the role of nursing

The first article is a good starting place for building an SBIRT program. It provides a good overview of the evidence and explains SBIRT as defined by SAMHSA. It should only serve as a starting point since it leaves questions unanswered. It does not clearly explain how to actually do each part of SBIRT. Other resources, such as National Institute on Alcohol Abuse and Alcoholism’s guide to clinicians or the American College of Surgeon’s guide, are recommended reading prior to implementing SBIRT. The major issue appears to be the lack of clear evidence that referral to treatment actually results in positive long-term outcomes for those with a substance use disorder. In addition, the development of an SBIRT program in an institution should utilize an interdisciplinary approach with a nurse lead program as a promising alternative to a hierarchical program that requires physician oversight.

Addressing substance use in primary care

Problematic use of alcohol, tobacco, and other drugs, including prescription medications, contributes to increased risk for injury, illness, suffering, and premature death across the lifespan. Nurse practitioners can positively impact the health of patients, their families, and communities by addressing substance use and related disorders in primary care settings.

Providing information about the neurobiology of alcohol use disorders to close the 'referral to treatment gap'

Only a small proportion of the 18 million Americans who could benefit from alcohol treatment actually receive it. Disseminating information on the neurobiological base of alcohol disorders may be useful in removing the prevailing barriers to accepting a referral to alcohol treatment. Nurses, guided by a set of clinical strategies known as screening, brief intervention, and referral to treatment, can be instrumental in closing this treatment gap.

Expanded roles and responsibilities for nurses in screening, brief intervention, and referral to treatment (SBIRT) for alcohol use

It is the position of the International Nurses Society on Addictions and the Emergency Nurses Association that nurses in all practice settings be prepared to deliver screening, brief intervention, and referral to treatment, or SBIRT, to identify and effectively respond to alcohol use and related disorders across the lifespan.