SBIRT: Stopping Addiction Before It Starts

The facts are clear: in our country, there is an imminent need for substance abuse prevention and intervention as early in the teen years as possible. A recent study in the Archives of General Psychiatry found that the 15 percent of U.S. high school students who abuse drugs and alcohol began using at 14 or 15. “When the first exposure occurs in younger versus older adolescents,” explains Professor Didier Jutras-Aswad of the University of Montreal, “the impact…seems to be worse in regard to many outcomes such as mental health, education attainment, delinquency and ability to conform to adult roles.”

We know that kids who do not develop an addiction problem by age 21 are unlikely to become addicted later on. Plus, the adolescent brain continues to develop judgment and the ability to resist foolish or dangerous behavior until around age 25, which means that the teen and young adult years are a particularly vulnerable time for the risk-taking that often characterizes them.

Phoenix House, for more than 45 years, has been dealing with the consequences of drug use and addiction, and during that time teen drug use has continued to grow while the drugs of choice are always changing. According to a Gallup poll, 48 percent of Americans in 1968 deemed drug use a serious problem in their community; by 1995, 63 percent said it was a serious problem and an additional 31 percent called it a “crisis.” As have other organizations, we have engaged in prevention efforts to try to minimize the impact of teen risk-taking and experimental attitudes towards substance use. Still, a truly effective solution has yet to be found and implemented on a national level.

Because of our commitment to prevention and early intervention, it was only natural that Phoenix House would offer Screening, Brief Intervention, and Referral to Treatment (SBIRT) programming as developed by the Substance Abuse and Mental Health Administration (SAMHSA). This protocol originated in emergency rooms, doctors’ offices, and other clinical venues and it has been proven scientifically to be an effective tool for people who have substance use issues at various stages, whether they’re thinking about using, just beginning to experiment, or have already escalated to problematic use. However, SBIRT primarily targets drinkers and drug users who are not yet chemically dependent, so that intervention can be provided before their substance use escalates to a level where extensive treatment is necessary.

Basically, SBIRT is about stopping serious substance abuse problems before they start, thereby saving lives and saving the healthcare system a great deal in preventable costs. It gets a “foot in the door” to educate and opens up a dialogue that can prevent experimentation and early use from leading to long-term damage. It also integrates substance abuse screening and treatment components into the larger-scale healthcare system, ensuring that an individual’s substance use isn’t interfering with any treatment he or she may be receiving for a medical issue such as diabetes. Overall, SBIRT has the potential to link community treatment services with a network of intervention and referral activities in medical, educational, and social service settings.

Realizing the potential to leverage SBIRT from a prevention perspective, our clinicians at Phoenix House teamed up with the Philadelphia-based Treatment Research Institute (TRI) and the University of Pennsylvania (UPENN) to develop technology that assesses teens’ and pre-teens’ risk of substance use or abuse. Seeking to build on SAMHSA’s work with SBIRT, we proceeded to introduce the delivery of SBIRT into two public schools in New York State.

We recognized that there would be many barriers to working within the school system since school funding is already scarce. So together with TRI, we funded an initial SBIRT test program at a school in Suffolk County, NY. The concept involved screening all students for substance use and abuse, evaluating results, and offering subsequent intervention if necessary. The program provided a confidential outpatient setting within the school that both students and faculty could take advantage of, and the results were extremely promising. Students were willing and excited participants. “The project has helped me in so many ways,” one student told us. “It showed me how drugs affect me and the risk that I take if I do drugs.”

As a result of our testing success, Phoenix House and TRI will implement a privately funded second phase of our SBIRT program in order to ensure support for this protocol from the key government health and education stakeholders. We believe this phase will prove that this adaptation of SBIRT can succeed with three-fold benefits (educational, medical, reduction in addiction), rendering it an extremely sensible and worthy investment.

The success of SBIRT is, and will continue to be, multifaceted. Phoenix House invested in this program because we believe in the youth of this country, and because we take it as our responsibility to promote positive change. In the words of Steve Jobs, “You have to be burning with an idea, or a problem, or a wrong you want to right. If you’re not passionate enough from the start, you’ll never stick it out.” The substance abuse crisis among teens in our country is a wrong that we want to right. We in the treatment field must have the passion to see it through.

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