Health and Well-being Substance Abuse Screening
The difference of 15 minutes
Substance abuse is a public health crisis in the United States, accounting for nearly 4 percent of all reported deaths. Almost every one of those fatalities is preventable with proper care, but only 11 percent of American substance users seek treatment. Stigma, shame, and a lack of resources or motivation all interfere.
Screening for drug or alcohol abuse “is just as important as cancer screening when it comes to public health,” according to Dr. Jessica McIntyre (MD ’05). On top of her role as an associate professor in the Stritch School of Medicine, she’s a member of the Interprofessional Development Team for SBIRT@LUC, an innovative campus collaboration between Stritch, the School of Social Work, and the Marcella Niehoff School of Nursing.
The goal of the program—now in its third year, with grant support from the Substance Abuse and Mental Health Services Administration—is to train students, faculty, and other community-based professionals in a social work model known as SBIRT (Screening, Brief Intervention, and Referral to Treatment). SBIRT was developed several decades ago; the practice is used to assess the severity of substance use in a patient quickly and, through targeted motivational interviewing (in a 10-to-15-minute window), help increase awareness and identify the appropriate level of treatment.
If a motivational interview is successful, the patient will resolve their existing insecurities and develop internal motivation to make healthier choices. The interviewer, with tact and empathy, gauges how a patient is doing, both physically and emotionally, and provides facts and context about the behaviors the client is exhibiting. Especially for people who haven’t reached the threshold of addiction but whose habits are still hazardous, it’s a widely-respected tool for harm reduction. “It is practical and usable,” said Michael Dentato (PhD ’11), an associate professor in the School of Social Work and the SBIRT@LUC program co-director. “It’s easy to teach conceptually; students get it.”
Many at Loyola University Chicago would like to see SBIRT woven more deeply into the fabric of everyday medical care. To that end, faculty members are teaching students the technique in all three schools through online simulations, classroom content, and role play, sometimes with professional actors standing in as patients. Field internships are a required component of the curriculum, too. A triad of students (one from each discipline) conduct voluntary interviews with clientele from a given charity or community group, placing themselves in real-world scenarios in front of people who might need genuine assistance.
Community partners can also train their own staff using Kognito, Loyola’s interactive module. The cartoon simulator runs between 60 and 90 minutes; the subjects are three teenagers with distinct personalities and needs. If the user makes an incorrect suggestion or overlooks a key question, Kognito steps in and provides immediate feedback and guidance. Agencies with Kognito access can extend continuing education credits to interested employees, and those employees can practice the approach on their own.
Expanding a new technique
Dentato and his co-director John Orwat, also an associate professor in the School of Social Work, think the connections they’ve made with Chicago social service providers will endure. Some graduates have even been hired by the agencies they connected with through their SBIRT internships. And both are thrilled to have worked so collaboratively with Loyola departments outside their own. “We’ve really built the foundation for interprofessional practice in this project,” Dentato said. In doing so, they exposed medical and nursing students to valuable social work principles with which they might not be familiar.
“They come from a very diagnostic framework. And that makes sense! But our social workers aren’t medicalized in the same fashion. They are taught to listen, to tune in, to meet clients where they are.”—Michael Dentato (PhD ’11), associate professor in the School of Social Work
Meanwhile, back on the Health Sciences Campus, McIntyre is taking steps to introduce SBIRT into Loyola Medicine’s general intake process. Systematic screenings are now required in Loyola’s four family medicine clinics, with ambitions to expand into the Loyola health system as a whole through primary care and OB-GYN appointments. Asking simple questions without judgment makes a difference, said McIntyre. “It doesn’t take expensive pills, expensive skills, or expensive procedures.”
Since taking a more active role in SBIRT@LUC, McIntyre has even noticed a difference in her own interactions as a family medical doctor. “We always try to ask about alcohol and drugs. But we don’t do it as systematically or effectively if we don’t have tools in place,” she said. “In the last two months, when I’ve done more structured screening in my clinics, stuff has come up during visits that just wouldn’t have before.”
There are a host of warning signs to look for if you’re worried that a loved one is too dependent on alcohol or drugs, like changes in mood or appearance, dipping energy levels, dropped responsibilities at work or home, and financial mismanagement or secrecy. For those who suspect a loved one might be struggling, Loyola’s SBIRT team says that communication is crucial. There are helplines available, including one run by the state of Illinois, as well as 12-step programs that openly welcome newcomers, and medical options if the health risks are urgent. It’s impossible to force a patient or anyone to change, but the goal of SBIRT and similar programs is to continue offering encouragement and support to those who need help.