Georgia Basics: Evaluation Results from Five Years of Intervention for Risky Drinking and Substance Use in Urban Emergency Departments Presented by: Gabriel P. Kuperminc, Ph.D Professor of Psychology Georgia State University

1. Georgia BASICS :
Evaluation Results from Five Years of
Intervention for Risky Drinking and
Substance Use in Urban Emergency
Departments
Gabriel P. Kuperminc, Ph.D
Professor of Psychology
Georgia State University

2. Outline
• Adult patients in urban emergency depts
• SBIRT – A public health approach to
addressing alcohol and substance misuse
• How does it work?
• Does it make a difference?
• Can it be sustained?

3. Urban Emergency Department
Patients
• Conditions of Risk
– High rates of poverty, housing instability
– Lack of consistent health care, unmet needs
– Behavioral risks (e.g., alcohol, drug use) often
associated with health concerns
• ED as “Teachable Moment”
– Failure to help patients make the connection as
lost opportunity
– When alcohol/drug use does come up, usually
focus on blaming pt for poor choices, need for
abstinence

4. What is SBIRT?
• Screening
• Brief Intervention
• Referral to Treatment
• Initiative of Substance Abuse and Mental
Health Services Administration (SAMHSA)
– Cooperative agreements with states (4 cohorts,
20+ projects to date)
– Demonstration projects intended to show
effectiveness and sustain beyond grant period

5. Georgia BASICS
• Overview
– Routine screening for risky drinking,
substance use
– Motivational Interviewing (15-30 minutes) to
discuss motivation for change, set goals
– Availability of alternatives incl. additional
therapy, referral to treatment
• Settings
– Grady Health System (Atlanta)
– Medical Center of Central Georgia (Macon)

6. Risky Drinking

7. Patient
Enters ED
Nurse
Health Educators
54% LowModerate Risk
BI
BI = Brief Intervention
BT = Brief Therapy
RT = Referral to Treatment
3 Question
Prescreen:
25% Positive
60% of positive
prescreens
receive ASSIST
Full Screen
7% High
Risk
BI + BT
32%
Screening
Feedback
7% Very High
Risk
BI+ RT
10% Sample enrolled For 6 month Follow Up

8. (Nearly) Final Numbers …
Services
Provided
Enrolled in
Study
(Tx sample)
Screening/Feedback
Brief Intervention (BI)
150,452
23,270
--728
BI + Brief Therapy (BT)
BI + Referral to Tx (RT)
Total
2,933
3,344
179,999
172
176
1,076
* Note: Pts. enrolled in study via random selection from those
receiving services.

9. Analysis Sample
Control
(N = 1737)
Intervention
( N =724)
11.94
11.88
42
42
% Female
34%
29%
% African-American
75%
73%
% Employed full/part time
34%
32%
% Unstably housed/Homeless
39%
45%
Monthly wage (average)
$885
$643
Education (years)
Age (average)
Notes:
(1) Comparison patients received screening/assessment but no services during 3month period prior to initiating service delivery.
(2) Six month follow-ups completed with appr. 50% of Comparison and 65% of
Intervention patients.

10. Reductions in Risky Drinking
• Intervention patients 46%
less likely than Controls to
report moderate/high
frequency drinking by
follow-up.
• One in four Intervention pts,
and one in five Control
patients reduced drinking
from moderate/high to low
frequency.
• Almost twice as many
Control patients as
Intervention patients
increased their drinking
frequency.
Percentage of Moderate to
Heavy Drinkers by Intervention
Status
80%
75%
70%
65%
Intervention
Control
60%
55%
50%
45%
40%
Time 1
Time 2

11. Increased Engagement in
Treatment
• Highest Risk Pts
referred to treatment
facilities in the local
community
• 15-30% of these pts.
engaged treatment by
3 months after
receiving SBIRT
services (MCCG)
• Higher than national
estimate of 5%

12. Improvements in Mental Health
• Intake scores placed
pts in lowest quartile
of U.S. population for
mental health
• By follow up
– Intervention pts
improved to 40th
percentile
– Controls declined to
7th percentile
Change in Mental Health
Composite Score by
Intervention Status
60
55
50
45
40
35
30
Interventio
n
Control
25
Intake
Follow-up

13. Improved Social Support
Networks
• Intervention and
Control Pts. similar
levels of social
support at intake
• Intervention pts.
improved slightly
• Controls declined
substantially
Perceived Social Support at 6-Month Follow-Up
2
1.5
Control
1
Intervention
0.5
0
Partner
Parents
Siblings
Other
Family

14. Potential Cost Savings
Average number of ED visits 6
months before and after target
visit
3.5
Intervention
3
Control
2.5
2
1.5
1
6 months before 6 months after
• 1-month sample (248
SBIRT; 170 controls).
• Intervention pts had 0.66
fewer ED Visits following
SBIRT services vs.
Controls
• Significant even
controlling demographic
and health related
confounds
• Cost savings may
outweigh cost of
services, esp given high

15. Conclusions
• SBIRT services make a meaningful difference
in people’s lives
– Reductions in risky drinking
– Improvements in other health outcomes
• SBIRT services link patients to the care they
need and natural support systems
– High rates of treatment engagement
– Improvements in social support resources
• SBIRT is good policy
– Reductions in ED visits and hospital admissions
point to substantial cost savings

16. Sustaining SBIRT in Georgia?
• SBIRT staff not retained at either medical center 
• BUT
– Trained workforce, including increased expertise in
motivational interviewing (MINT)
– Broad acceptance of SBIRT practice
– Universal screening for alcohol/drugs
– Interest in instituting SBIRT/SBI in other settings
• Pilot project on electronic SBI in county health dept (collab
with CDC)
• Integrating MI with linkage to care for HIV+ pts with
substance abuse (NIDA proposal)
• Mercer College of Medicine integrates SBIRT into residency
training (SAMHSA)

17. Thanks to
• Funding from Substance Abuse and Mental Health
Services Administration (SAMHSA), #TI019545
• GSU Colleagues and Students
– Jim Emshoff, Dom Parrott, Jennifer Zorland, Joanna
Akin, Lindsey Cochran, Adam Carton, Devin Gilmore, Robyn
Borgman, Nick Tarantino, NerissaGermain, Doyanne
Darnell, Natalie Wilkins, and others
• Georgia Division of Behavioral Health and
Developmental Disabilities: Steve O’Neill
• Partners at Grady Health System and Medical
Center of Central Georgia
– Too many to name!

18. Questions?