Racial/Ethnic Differences in Alcohol and Drug Use Outcomes Following Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Federally Qualified Health Centers (original) (raw)
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Drug and Alcohol Dependence, 2009
Objectives: Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered. Design: SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a 6-month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline. Results: Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6-month follow-up (4 of 6 sites), were 67.7% lower (p < 0.001) and heavy alcohol use was 38.6% lower (p < 0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p < 0.001), mental health (p < 0.001), employment (p < 0.001), housing status (p < 0.001), and criminal behavior (p < 0.001) were found. Conclusions: SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients. Published by Elsevier Ireland Ltd.
Journal of Studies on Alcohol and Drugs, 2021
Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been effective form oderate reductions of alcohol use among participants in universal settings. However, there has been limited evidence of effectiveness in referring individualst ospecialty care,a nd the literature nowo ften refers to screening and brief intervention (SBI). This study examines documentation of substance use disorder (SUD) diagnoses in al ow-income Medicaid population to evaluate the effect of universal SBIRTonhealthcare system recognition of SUDs, afirststep to obtaining areferraltotreatment (RT) for individuals with SUDs. Method: SBIp atientd ata from Wisconsin'sInitiative to Promote HealthyLifestyles (WIPHL) were linked to Wisconsin Medicaid claims data. Ac omparison group of Medicaid beneficiaries wasidentified from amatchedsampleofnon-SBIRTclinics(total study N =1 4,856). Hierarchical generalized linear modeling wasused to assess rates of SUD diagnosis in the 12 months following receipt of SBIRTinWIPHL clinics compared with rates in non-SBIRT clinics. Analysis controlled for clinic, individual patient'shealth status, demographics, and baseline substance use diagnoses. Results: SBIRT wasa ssociated with greater odds of being diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fo urth Edition (DSM-IV), alcohol abuse or dependence as well as drug abuse or dependence over the 12 months subsequent to receipt of the screen. The overall diagnostic rate for anyD SM-IV substance abuse or dependence was9 .9% at baseline and 12.2% during the follow-up year.SBIRTpatientshad 42% (p =.003) greater odds of being diagnosed with asubstance use disorder within 12 months relative to comparison clinic patients. However, there were very fewc laimsf or specialty SUD services. Conclusions: The presence of SBIRTinaprimarycare clinic appears to increase the awareness and recognition of patients with SUDs and agreater willingness of healthcare providers to diagnosepatients with an alcohol or drug use disorder on Medicaid claims.Furtherresearch is needed to determine if thisincrease in diagnosis reflects integrated carefor SUDs or if it leads to improvedaccess to specialty care, in which case abandonment of the RT component of SBIRTm ay be premature. (J. Stud. Alcohol Drugs,
Alcoholism: Clinical and Experimental Research, 2011
The alcohol treatment field has focused on promoting screening and brief intervention (SBI) in medically based settings, particularly primary care. In this Commentary, we consider the potential unintended consequences for disparities in access to care for alcohol problems. National data show significant racial/ethnic and socioeconomic differences in the rates at which at-risk drinkers and persons with alcohol use disorders come into contact with primary care providers. This suggests that implementing SBI in mostly primary care settings could inadvertently widen the gap in alcohol-related health disparities. To ensure that all populations in need benefit from this evidence-based treatment, SBI should be considered and adapted for a wider range of service venues, including Federally Qualified Health Centers and non-medical venues frequented by racial/ethnic minorities and the uninsured. An estimated 89 percent of the 17.9 million Americans with a current alcohol use disorder (AUD) do not perceive a need for treatment and therefore do not seek care (Clark et al., 2008). This makes it essential that we extend alcohol interventions beyond specialty addiction treatment settings. Alcohol screening and brief intervention (SBI) offers an evidence-based, cost-effective approach for doing precisely that (Bradley et al., 1993; Fleming et al., 2002; Fleming et al., 2000). An SBI can be as brief as 5 to 10 minutes. It begins with assessment of an individual's alcohol use. Persons who screen positive for atrisk drinking or an AUD are advised to cut down or abstain. Those with an AUD may also be referred for further professional evaluation, or recommended for detoxification or pharmacotherapy (National Institute on Alcohol Abuse and Alcoholism, 2005). There is a strong evidence base documenting the efficacy and effectiveness of SBI in reducing heavy alcohol consumption both in the U.S. and abroad, and particularly in primary care settings (
Racial/ethnic equity in substance use treatment research: the way forward
Addiction Science & Clinical Practice
Background Opioid use and opioid-related overdose continue to rise among racial/ethnic minorities. Social determinants of health negatively impact these communities, possibly resulting in poorer treatment outcomes. Research is needed to investigate how to overcome the disproportionate and deleterious impact of social determinants of health on treatment entry, retention, drug use and related outcomes among racial/ethnic minorities. The current commentary provides recommendations that may help researchers respond more effectively to reducing health disparities in substance use treatment. We begin with recommendations of best research practices (e.g., ensuring adequate recruitment of racial/ethnic minorities in research, central components of valid analysis, and adequate methods for assessing effect sizes for racial/ethnic minorities). Then, we propose that more NIDA research focuses on issues disproportionately affecting racial/ethnic minorities. Next, techniques for increasing the nu...
Race/ethnicity and quality indicators for outpatient treatment for substance use disorders
The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 2015
Initiation and engagement, performance measures that focus on the frequency and timely receipt of services in the early stages of substance use disorders (SUD) treatment, are useful tools for assessing treatment quality differences across racial/ethnic groups. The purpose of this study was to examine whether there are racial/ethnic disparities in these quality indicators and to explore whether predictors of treatment initiation and engagement differ by clients' race/ethnicity. This study used administrative data from outpatient treatment facilities licensed by the state of Massachusetts that receive public funding. The sample consisted of 10,666 adult clients (76% White, 13% Latino, 11% Black) who began an outpatient treatment episode in 2006. Client data were linked with facility data from the National Survey on Substance Abuse Treatment Services. Multilevel regressions were used to examine racial/ethnic disparities and to explore whether predictors for initiation and engagemen...
Disparities in Completion of Substance Abuse Treatment between and within Racial and Ethnic Groups
Health Services Research, 2013
Objective. To evaluate disparities in substance abuse treatment completion between and within racial and ethnic groups in publicly funded treatment in Los Angeles County, California. Data Source. The Los Angeles County Participant Reporting System with multicross-sectional annual data (2006)(2007)(2008)(2009) for adult participants (n = 16,637) who received treatment from publicly funded programs (n = 276) for the first time. Study Design. Retrospective analyses of county discharge and admission data. Hierarchical linear regressions models were used to test the hypotheses. Data Collection. Client data were collected during personal interviews at admission and discharge for most participants. Principal Findings. African Americans and Latinos reported lower odds of completing treatment compared with Whites. Within-group analysis revealed significant heterogeneity within racial and ethnic groups, highlighting primary drug problem, days of drug use before admission, and homelessness as significant factors affecting treatment completion. Service factors, such as referral by the criminal justice system, enabled completion among Latinos and Whites only. Conclusions. These findings have implications for reducing health disparities among members of racial and ethnic minorities by identifying individual and service factors associated with treatment adherence, particularly for first-time clients.
Journal of the American Board of Family Medicine : JABFM
Rates of risky substance use and substance use disorders are high in primary-care practices, yet the adoption of universal screening and brief intervention (SBI) has been slow and uneven. This study aimed to describe SBI-related attitudes, practices, and perspectives regarding practice change among medical providers in a minority-majority state. We conducted a cross-sectional, on-line survey of a practice-based research network of medical providers serving predominantly Hispanic/Latinx and Native American patients in rural and urban settings. The main variables were clinician 1) perspectives on the need to address substance use problems in primary care, 2) current screening and intervention practices, and 3) satisfaction with and willingness to make changes to their practices. Although providers endorsed alcohol and opiate misuse to be significant problems in their practices, only 25% conducted universal screening. Providers reported focusing most of their screening efforts on those...