The document discusses implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) with college students seeking counseling services to identify those with potential substance abuse issues. It proposes using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) screening tool during intake interviews. Counselors' proficiency with SBIRT would be measured against established criteria. SBIRT is shown to be an effective public health approach through studies finding decreased substance use and improved outcomes for those receiving brief interventions or treatment referrals through similar SBIRT programs. The project aims to assess counselors' ability to identify and counsel at-risk students using SBIRT.

1. Screening, Brief Intervention, Referral to Treatment
As a Harm Reduction Public Health Approach
for At-Risk College Students
by Karen V. Duhamel, DNP-c, MS, RN
Chamberlain University
Contact: duhamelkvd@yahoo.com

2. BACKGROUND
Numerous clinically-validated screening tools (CAGE, AUDIT, DAST, etc.) are available
for screening for substance abuse/dependence of college students but fall short in a
sequential approach to screening, brief intervention, and referral to treatment for students
seeking behavioral health services who may be developing or living with an undiagnosed
substance use disorder.

3. PURPOSE STATEMENT
• To assess for college counselor proficiency in the Screening, Brief Intervention, Referral to
Treatment (SBIRT) approach during intake interviews with college students seeking behavioral
health services.
• Students will complete the Alcohol, Smoking, and Substance Involvement Screening Test
(ASSIST) to indicate level of substance use involving tobacco, alcohol, prescription and illicit
drugs.
• Counselor proficiency in SBIRT will be measured against established SBIRT assessment criteria
noted in the SBIRT Proficiency Checklist – Clinical Version

4. MULTI-FACTORIAL COST OF ALCOHOL AND DRUG ABUSE IN THE U.S.
*Excessive Drinking costs U.S. $223.5 billion (Centers for Disease Control, 2014)
*Illicit Drug Use costs U.S. $193 billion (National Institute on Drug Abuse, 2015)
* SBIRT can help reduce adverse academic and health consequences for students’ at-
risk, in addition to lowered utilization of higher-level behavioral health services
through early detection/early treatment (Denering & Spear, 2012; Mekonen, Fekadu,
Mekonnen, & Workie, 2017).

6. WHAT EXACTLY IS SBIRT?
• Screening, Brief Intervention, Referral to Treatment (SBIRT) is a public health, harm
reduction initiative for individuals who may be at-risk or are living with an undiagnosed
substance use disorder
• Screening tool is clinically-validated Alcohol, Smoking, Substance Involvement Screening
Test (ASSIST)
• Recognized by national agencies such as the World Health Organization, Substance
Abuse Mental
Health Services Administration, and the National Institute on Drug Abuse
• Endorsed by The White House under former President Obama’s Administration
• Severity of risk program that clinical or non-clinical personnel can administer

8. DOES SBIRT REALLY WORK?
STUDY: Large cross-sectional RCT administered by Madras et al., (2009)
METHOD: 459,599 patients in multiple medical settings in the U.S. were screened for alcohol
and drug use at initial visit and 6-month follow-up
RESULTS: At Initial visit, 22.7% scored moderate to high for alcohol and/or illicit drug use.
Majority were recommended for brief intervention (15.9%), with a smaller percentage referred to
treatment (6.9%)
-At 6-month follow-up interview, self-reported usage of illicit drugs was down 67.7% and heavy
alcohol use was down by 38.6%
-At 6-month follow-up, patients recommended for brief intervention or referral to treatment at
initial screening reported improvement in general health, mental health, employment, housing, and
criminal behavior.

9. CONCLUSION: Individuals who screened positive for alcohol
and/or illicit drug use through SBIRT and the ASSIST tool,
reported significant decreased usage and improved lifestyle
changes at 6-month follow-up interview

10. DNP CHANGE PROJECT PICOT QUESTION
P = Population
Can college counselors who perform triage services
I = Intervention
using the Screening, Brief Intervention, Referral to Treatment (SBIRT) approach
C = Comparison
as opposed to non-use of SBIRT
O = Outcome
demonstrate proficiency in identifying and counseling at-risk students as measured by the
SBIRT Proficiency Checklist - Clinical Version
T = Timeframe
within an 8 to10-week timeframe?

11. SBIRT SEQUENTIAL PROCESS
Step 1: COUNSELOR explains purpose of SBIRT
Step 2: COUNSELOR obtains student’s permission to review results of ASSIST screening tool
Step 3: IF STUDENT agrees, counselor reviews results of ASSIST with student for tobacco, alcohol, and drug use
3.1.) IF STUDENT does not allow review of ASSIST results, counselor ends SBIRT approach and reverts back to non-
SBIRT discussion of tobacco, alcohol, and drug use
Step 4: COUNSELOR provides brief intervention through motivational interviewing for moderate to high scorers by
substance
4.1.) INCLUDES: Substance Abuse Mental Health Service Administration (SAMHSA)-recommended non-risky usage
levels for alcohol; reduction or abstinence goals for illicit/prescription drugs and/or tobacco use
Step 5: COUNSELOR assesses student's readiness to change
Step 6: COUNSELOR continues to provide motivational interviewing to empower student to self-determine next steps
Step 7: IF STUDENT scores moderate to high use for any substance, counselor and student collaboratively decide on
treatment referral for student
7.1.) Non-formal Treatment = AA, NA, CA, TA, Community Case Management, etc.; counselor provides community
resource information to student
7.2.) Formal Treatment = Referral to local hospital or outpatient behavioral health services for formal assessment
of high scorers
SBIRT process takes 5-18 minutes depending on screening results and treatment referral (MA SBIRT, 2016)

13. RISK LEVEL SCORE RANGE FOR TOBACCO AND
OTHER DRUGS
(Score range 0-12)
SCORE RANGE FOR
ALCOHOL
(Score range 0-12)
MEANING
HIGH 7‐12 9‐12 You are at high risk of health and other
problems from your current pattern of
substance use.
PROVIDE BRIEF INTERVENTION.
ATTEMPT REFERRAL TO TREATMENT
MODERATE 2‐6 6‐8 You are at risk of health and other problems
from your current pattern of substance use.
PROVIDE BRIEF INTERVENTION.
ATTEMPT REFERRAL TO TREATMENT
LOW
Five or more drinks/ (males) or 4 or more drinks (females) on
one occasion, do Brief Intervention, even if Alcohol score is low]
0 0‐5 You are at low risk of health and other
problems from your current pattern of
substance use
ASSIST RATING SYSTEM

18. DNP CHANGE PROJECT EXPECTED OUTCOMES
• 10-20% increase in positive screens
• 100% of positive screens will meet criteria for Brief Intervention (MA SBIRT, 2016)
• 10-15% of positive screens will accept Referral to Treatment
for individuals not currently receiving substance abuse
services (MA SBIRT, 2016)
• 3-5% of positive screens will meet criteria for referral for formal assessment (MA SBIRT, 2016)
• 1-3% of positive screens will accept referral for formal assessment (MA SBIRT, 2016)

19. • SBIRT is a Harm Reduction Public Health Initiative for college students at-risk for developing or
living with an Alcohol, Drug or Tobacco substance use disorder
• The ASSIST is a clinically-validated screening tool that identifies individuals at Moderate to High Risk
• Students seeking behavioral health services can benefit from the SBIRT approach of Early
detection/Early treatment
• SBIRT can be done by Anyone - clinical or non-clinical personnel
CONCLUSION

20. References
Centers for Disease Control. (2016). Deaths: Final data for 2013. National vital statistics reports, 4(2),
10-11. Hyattsville, MD: National Center for Health Statistics.
http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf
Madras, B. K., Compton, W. M., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W. (2009).
Screening, brief intervention, referral to treatment (SBIRT) for illicit drug and alcohol use at
multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol
Dependence, 99, 280–295.
Substance Abuse and Mental Health Services Administration (2011). Screening, Brief Intervention
and Referral to Treatment (SBIRT) in behavioral healthcare.
http://www.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf
WHO ASSIST Working Group (2002). The Alcohol, Smoking and Substance Involvement Screening
Test (ASSIST): Development, reliability and feasibility. Addiction, 97(9), 1183-1194.
http://www.who.int/substance_abuse/activities/assist/en/