FUNDAMENTALS COURSE CSAM 2014 – OTTAWA SBIRT in Primary Care Settings Dr. Ginetta Salvalaggio MSc MD CCFP FCFP Assistant Professor, University of Alberta Department of Family Medicine Research Director, Inner City Health and Wellness Program, Edmonton, AB
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FUNDAMENTALS COURSE
CSAM 2014 – OTTAWA
SBIRT in Primary Care Settings
Dr. Ginetta Salvalaggio MSc MD CCFP FCFP
Assistant Professor, University of Alberta Department of Family Medicine
Research Director, Inner City Health and Wellness Program, Edmonton, AB
"How many times in the past year have you had X or more
drinks in a day?" (where X is 5 for men and 4 for women)
“How many times in the past year have you used an illegal
drug or used a prescription medication for nonmedical
reasons?”
FUNDAMENTALS COURSE
CSAM 2014 – OTTAWA
FUNDAMENTALS COURSE
CSAM 2014 – OTTAWA
Screening: one step further
AUDIT
CAGE
TICS
TACE / TWEAK in pregnancy
CRAFFT in adolescence
If the screen is positive: further questions
◦ Quantity: regular use, weekly amounts, maximum amount consumed in the past
month
◦ Consequences: medical, financial, social, legal
◦ Evidence of withdrawal, tolerance, use despite harm
FUNDAMENTALS COURSE
CSAM 2014 – OTTAWA
Now what? Brief Intervention
Negative screen: • Acknowledge healthy decisions
• Feedback on health effects of low risk drinking and drug use abstinence
Positive screen: FRAMES • Feedback: Give feedback on the risks
and negative consequences of alcohol and substance use. Seek the client's reaction and listen
• Responsibility: Emphasize that the individual is responsible for making his or her own decision about his/her alcohol or drug use
• Advice: Give straightforward advice on modifying alcohol and drug use
• Menu of options: Give menus of options to choose from, fostering the client’s involvement in decision-making
• Empathy: Be empathic, respectful, and non-judgmental
• Self-efficacy: Express optimism that the individual can modify his or her alcohol or substance use if they choose
Miller WR, Sanchez VC. Motivating young adults for treatment and lifestyle change. In G. Howard (ed.), Issues in Alcohol Use and Misuse in Young Adults. Notre Dame, IN: University of Notre Dame Press;1999.
FUNDAMENTALS COURSE
CSAM 2014 – OTTAWA
Assessing Readiness to Change
Readiness to change scale
Confidence to change scale
Prochaska & DiClemente. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice 1982:19,276-88
“On a scale from 0 to 10, where 0 is not at all ready and 10 is very ready, how ready are you to ______ your marijuana use right now?”
“Wow, so you are_______% ready, great”
0 1 2 3 4 5 6 7 8 9 10
Not at all Very
Ready Ready
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“On a scale from 0 to 10, where 0 is not at all confident and 10 is very confident, how confident are you right now that you can meet your goal of ________ ?”
“What might take you from a ___to a____in your confidence?”
0 1 2 3 4 5 6 7 8 9 10
Not at all Very
Confident Confident
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FUNDAMENTALS COURSE
CSAM 2014 – OTTAWA
Matching Brief Intervention to the Stage
of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Raise doubt- increase the patient’s perception of
the risks and problems with current behavior
Tip the balance- evoke reasons to change, risks of
not changing; strengthen the patient’s self efficacy