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Attached you can find the PPT for reply. Two reply. Al least two referencesSBIRT Presentation #2
Yusimi Miranda
SBIRT Overview
SBIRT is a health approach that helps address alcohol and
substance use among the population.
The modality focuses on screening the condition, introducing a
brief intervention to address and referring the patient to an
organization to completely manage the symptoms (Thoele et
al., 2021).
Despite SBIRT being an approach that has been in place since
the past, it was widely recognized as a nursing approach in the
80s.
Up to date, the intervention is used in managing alcohol and
substance use among individuals.
This presentation shows its applicability in management of
mental issues.
Case presentation
A.D, a 32-year-old male, white, Mexican American patient , comes to the clinic due to his
excessive alcohol intake. He has been trying to manage this alcohol consumption, but it has
become very difficult and is affecting his personal and professional life.
Chief complaint: “Alcohol intake is disrupting my life, especially my job; I was given a warning
at work due to frequent absents, if I do not change, they are going to fire me. ”
Symptoms: A.D complains that he cannot manage his alcohol use and his family and friends are
telling him that he has a problem. Initially, he used to take drink one or two beers mostly during
the weekends , but he now takes up to eight beers most days of the week ; drinking just became
worse around fifteen months ago. He has tried to stop several times but stopping the intake
results to various withdrawal symptoms such as headaches and dizziness and he couldn’t handle
it; He has been given a warning to change by the management. A.D thought that his alcohol
management might be easy, but it is now getting out of control.
Social history: A.D was born in Mexico, but later migrated to the U.S in 2010. He lives with his
family, that is his wife and their two kids. His level of education is high school. He has not
engaged in any altercations that puts his life in danger; the patient reports having financial issues
due to low income.
Family psychiatric history: A.D grandmother was schizophrenic; she had to be prescribed longacting injections to manage the symptoms. The patient’s father died in a car accident about ten
years ago, he had history of depression , alcohol and drug use ; he lost his job due to a DUI.
Patient’s oldest brother who is now 44 years old has a history of anxiety and panic attacks.
Past psychiatric history: no past psychiatric history
Risks: Family history of alcohol use, financial problems , marital and professional issues are all
risk factors. Additionally drinking excess alcohol is associated with various risks such as
diabetes, cardiovascular, neuropsychiatric and gastrointestinal illnesses.
Screening tool used
The best screening tool to manage A.D’s condition is Alcohol Use Disorders
Identification Test (AUDIT).
This is a 10 multiple choice questions screening tool that helps providers
understand the patient drinking habit and the amount of alcohol taken in a day
(Sanchez-Roige et al., 2019).
The sensitivity and specificity of an AUDIT score 8 or higher in men, are 83%
and 90%, respectively (Sanchez-Roige et al., 2019).
Some questions asked when using this tool are:
How often do you take beer?
How many beers do you take in a typical day?
How often did you have more than six drinks over the past one year?
The patient has a score of 15 out of 40, after conducting the test. This indicates
moderate alcohol use disorder.
Brief Intervention
Motivational interviewing (MI) helps
individuals understand the things that prevents
them from achieving change and works on them
to achieve it (Fifield et al., 2019).
This process observed four main techniques,
actively listening to the patient, avoiding
judging him, motivating him and avoiding
showing him what to do (Gill et al., 2020).
During the MI session, the patient scores were
shared to help him change.
The OARS was also observed.
Open ended questions: Some questions asked
were: How do you plan to change? These
questions gave the patient an opportunity to
give their story (Haque & D’Souza, 2019).
regarding their feelings and thoughts.
Affirmations: We used affirmations such as:
It will get better, to make the patient belief in
his strategies.
Reflection: We reflected on what is said to
demonstrate empathy and understanding.
Summarizing: Everything was summarized in
2-3 sentences to correct errors in
understanding.
The following MI process was followed:
Engaging: This step involved evaluating how
prepared the patient was to change.
Focusing: This stage examined A.D goals
towards managing the change.
Evoking: Here, we evaluated A.D’s personal
reasons for change (Fifield et al., 2019).
Planning: This step involved developing
skills that would help the patient change.
Roadblocks identified.
He doubted his strategies.
He blamed his friends for his mistakes.
He was not articulate in his strategies at first.
Brief Intervention
A brief section of the session:
PMHNP Y.M : What do you think about your drinking habit?
Patient A.D: “My drinking is totally out of control doctor; I need to put some
strategies in place to manage it”.
PMHNP Y.M: That’s so good of you, everything is possible. And have you ever
worked on something else in the past?
Patient A.D: “I was able to control my anger when I was a young adult, so, I
believe that I will also work on this”.
PMHNP Y.M : And what are some of the consequences of drinking in your life?
Patient A.D: “They are plenty doctor; maybe we can summarize them into they
can cost my job and my family”.
PMHNP Y.M : Its good to understand that, since we have worked on various
areas in our sessions, we can summarize them to recap everything we talked
about.
The patient is in the preparation stage of change ; he is aware of the need for change,
and he seems eager to start working in overcoming his alcohol use issue.
Referral to treatment
Referred the patient to following organizations.
Banyan Treatment Centers – Mental Health Program. Address is 1000 NW
15th St #200, Boca Raton, FL 33486; phone number is 561-708-4667. The
organization helps patient understand addiction and how it can be managed.
A.D should be referred to the substance use department.
Miami Rehab Services; their address is 121 SW 22nd Ave, Miami, FL 3313;
their phone number is 877-740-3618. The organization will provide
rehabilitation services to the patient. It will also help the patient understand
addiction and how to manage it.
Compassion Behavioral Health. This organization is located at 1 Oakwood
Blvd #265, Hollywood, FL 33020; the phone number is 844-999-0874. The
organization would help A.D know more about alcohol use and how he can
work to manage it. Patient should be referred to the addiction treatment
department.
Evaluation of the process
The SBIRT process helped to easily maneuvered through the
whole treatment.
Its screening helped understand the patient’s severity and how
to address it.
The brief intervention used, MI, helped the patient change his
perception towards drinking and helped him change.
Based on the approach, the patient was well engaged, evoked,
and a path to recovery was planned.
The interview was very productive as the patient was able to
explore and share his feelings and thoughts about his current
alcohol use; the patient demonstrates an understanding of the
interventions and agreed to reach out to the facilities that were
provided as referrals to help him with his alcohol use problems.
Going forward, this patient is likely to fully recover from
alcohol use disorder.
References
Fifield, P., Suzuki, J., Minski, S., & Carty, J. (2019). Motivational interviewing and
lifestyle change. In Lifestyle Medicine (pp. 207-217). CRC Press.
Gill, I., Oster, C., & Lawn, S. (2020). Assessing competence in health professionals’
use of motivational interviewing: A systematic review of training and
supervision tools. Patient Education and Counseling, 103(3), 473-483.
Haque, S. F., & D’Souza, A. (2019). Motivational interviewing: the RULES, PACE, and
OARS. Current Psychiatry, 18(1), 27-29.
Sanchez-Roige, S., Palmer, A. A., Fontanillas, P., Elson, S. L., 23andMe Research
Team, the Substance Use Disorder Working Group of the Psychiatric Genomics
Consortium, Adams, M. J., … & Clarke, T. K. (2019). Genome-wide association
study meta-analysis of the alcohol use disorders identification test (AUDIT) in
two population-based cohorts. American Journal of Psychiatry, 176(2), 107118.
Thoele, K., Moffat, L., Konicek, S., Lam-Chi, M., Newkirk, E., Fulton, J., &
Newhouse, R. (2021). Strategies to promote the implementation of Screening,
Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a
scoping review. Substance Abuse Treatment, Prevention, and Policy, 16(1), 42.
(SBIRT) Presentation #2
Juan Carlos Fernandez
SBIRT Overview
❑SBIRT is a comprehensive health approach that helps individuals identify the severity and
management of substance use.
❑The approach emphasizes on the screening of a condition, introduction of a brief intervention
and referring the patient to an appropriate referral (Calleja et al., 2020).
❑Although it has been recognized as an health approach in the 1990s, this approach has been
inexistence since the 1800s.
❑Individuals used it to help people manage alcohol and other substance use.
❑This presentation shows how the health approach can be used in the management of
substance use.
Case Presentation
❑Y.D, a 34 year old Mexican American patient came to the facility to manage his cocaine addiction that started around two years ago.
❑Chief Complaint: “Cocaine is harming my health.”
❑Symptoms include: Y.D started taking cocaine around two years ago, but has been unable to stop its intake. He Says, “I sometimes sniffs,
smokes or even injects it. The patient started by a mere sniffing, but had now gone to the extent of injecting it to get long term effects.
Surprisingly, he never gets enough of it. whenever he injects a certain dosage, his body keeps asking for more. Y.D thought that it would be
easy to stop cocaine, but it is now getting out of control.
❑Social history: Y.D lives in the street. He says that his cocaine use rendered him homeless as he would not secure a job. He says, that he
was fired after failing to perform his daily tasks. Y.T also reports that he is currently single. The wife to be left him after detecting his
substance use. Although he has been taking cocaine, he has never been arrested. His friends are is fellow addicts.
❑Family psychiatric history: Y.D history shows that his father died of liver disease as a result of excess alcoholism. The grandmother also
had social anxiety disorder when she was in her forties.
❑Past psychiatric history: Y.D states that he was introduced to cocaine use when he was in his early 30s. At first, he had no addiction and
could stay up to two months without taking cocaine. However, the problem increased eventually, leading to his current state.
❑Risks: Cocaine use may be associated with various risks such as tachycardia, hypertension. Cardiac arrest or even death. The patient needs
to observe this intake to manage the possible problems.
Screening Tool Used
❑The most appropriate screening tool in this case is the Drug Use Disorders Identification Test (DUDIT). This tool helps
identify the level of drug intake and abuse depending on the ICD-10 and DSM-4 diagnostic system (Bassiony et al.,
2019).
❑It is highly valid as the sensitivity is sensitivity 93%, and its specificity is 0.91%. The tool is also highly used to
determine the severity of cocaine among adult males.
❑DUDIT scores are determined by summing the total score, with the minimum being 0 and the maximum 44.
❑Some of the questions asked are:
❑ How often do you take cocaine?
❑ Do you use only cocaine?
❑ How many injections do you take in a day?
❑ Does cocaine influence you?
❑ Over the past one year, have you felt that you long for cocaine more than before? Etc.
❑After asking all the questions, the patient scored a 32 indicating the severity of cocaine use.
❑He, therefore, needs to get treatment to manage its severity.
❑His results were also shared to help understand the need of curbing alcohol use.
Brief Intervention
❑An intervention that would help manage his condition is❑OARS was used in the Motivational Interviewing session.
Motivational interviewing (MI); this intervention address addiction ❑ Open-ended questions were used to explore the answers (Spears et al.,
by motivating individuals to change (Magill et al., 2019).
2020). Y.D needed to provide answers that were more than a mere yes or
❑It emphasizes on four main techniques, actively listening to the
patient, motivating them, avoiding judging them and positively
regarding their interventions.
❑The process also observes the following process.
no. the provider used phrases such as “Tell me about.”
❑ Affirmations were used to help the patient need to feel and believe what
he said.
❑ Reflective listening involved understanding what the patient and
provider have said. It helped clarify, manage conflicts and explore
reasons for change.
❑ Summarizing helped revisit areas that we have explored, thus, shifting
the direction of the therapy and moving forward.
❑ Engaging: Here, the provider tried to understand what brought the
patient to the clinic. In this step, we linked with the patient to understand
what was their main problem.
❑ Focusing: The step involves evaluating the goal that the patient has as❑Various road blocks were noted
well as their aspirations for change (Lozano et al., 2021). In this case,
❑ It took long for the patient to develop internal motivation.
we examined whether Y.D has a clear sense of what he wats to achieve.
❑ Evoking: This step involves evaluating whether the righting reflect pulls ❑ Developing discrepancy was a problem.
the patients to argue for the change. We anticipated the Y.D to talk about ❑ The patient did not believe in himself.
the strategies intended towards achieving change.
❑ Planning: And the last step involves exploring various strategies to
incorporate in the plan to manage the symptoms. during this process, Y.D
was allowed to explore outside support.
❑During the process, the provider kept speaking to the patient about
his scores to remind him the need of change.
Brief Intervention
The following incorporate a section of the interview:
❑Provider: As we have talked about, what are barriers that are hindering you from achieving change?
❑Y.D: I do not believe in myself. Cocaine has been controlling my life to the extent that I am not able
to do anything without taking it. So, I am reluctant that I might be unable to do anything without taking
it.
❑Provider: I totally understand your problem. I understand that once an individual becomes addicted, it
becomes difficult to leave that drug. But I still believe that you will work towards this change.
❑Y.D: Indeed, the change is crucial and I must work in all my capacity to achieve it.
❑Provider: Thank you, all the best.
Looking at the patient situation, he is in the preparation stage. He is working towards getting ready to
change.
Referral for Treatment
The patient was referred to:
❑Boca Recovery Center. Their phone is 561-771-5972 and address is 971 South Dixie Highway,
Pompano Beach, FL 33060. The organization will help the patient understand cocaine addiction
and the strategies to put in place to manage it. Visit the cocaine use department.
❑New Season Treatment Center. Their phone number is 833-365-4836 and address is 2500
Maitland Center Pkwy Suite 250, Maitland, FL 32751.the organization will help the patient
understand the impacts of substance use and how it affects an individual. They also help manage
it. The patient should visit the substance use department.
❑Genesis House – United Recovery Project. their phone is 844-398-5277, and their address is
4865 40th Way S, Lake Worth, FL 33461. This organization will help him understand substance
abuse and how to address it. Refer the patient to detox department.
Evaluation of the Process
❑SBIRT is an efficient intervention to manage substance use disorder.
❑In our case, it had and is continuing to affect Y.D positively.
❑When coming at the first visit, the patient did not understand how he will goa bout the whole
process.
❑However, he is continuing to understand the consequences of cocaine and how they can be
curbed.
❑Although he has not yet reached in the planning stage, he is in the preparation step where he
tries to prepare for the anticipated change.
❑He is also struggling to gather motivation for change.
❑Providers, therefore, needs to incorporate this intervention in their operations to manage
substance use among different cohorts.
References
❑Bassiony, M. M., Fawzy, M., Negm, M., Ibrahim, E. F., Ibrahim, D. H., Mokhtar, D., … & Saad, A.
(2019). Substance use disorders among industry workers in Egypt. Addictive Disorders &
Their Treatment, 18(4), 185-193.
❑Calleja, N. G., Rodems, E., Groh, C. J., Baiardi, J., Loewen, J., & Kaiser, R. J. (2020). Differences
substance use-related attitudes across behavioral and primary health trainees: A screening,
brief intervention, and referral to treatment (SBIRT) training investigation. Alcoholism
Treatment Quarterly, 38(1), 106-125.
in
❑Lozano, P., Butcher, H. K., Serrano, C., Carrasco, A., Lagares, C., Lusilla, P., & O’Ferrall, C.
(2021). Motivational interviewing: validation of a proposed NIC nursing intervention in
persons with a severe mental illness. International Journal of Nursing Knowledge, 32(4),
240-252.
❑Magill, M., Janssen, T., Mastroleo, N., Hoadley, A., Walthers, J., Barnett, N., & Colby, S. (2019).
Motivational interviewing technical process and moderated relational process with underage
young adult heavy drinkers. Psychology of Addictive Behaviors, 33(2), 128.
❑Spears, J., Erkens, J., Misquitta, C., Cutler, T., & Stebbins, M. (2020). A pharmacist-led, patient-centered
program incorporating motivational interviewing for behavior change to improve adherence rates
and star ratings in a Medicare plan. Journal of managed care & specialty pharmacy, 26(1), 35-41.
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