MOSBIRT: Brief Substance Abuse Interventions in Trauma Centers

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MOSBIRT: Brief Substance Abuse Interventions in Trauma Centers

The Department of Mental Health, Division of Alcohol and Drug Abuse has been awarded a five year grant to support the development of the Missouri Screening, Brief Intervention, and Referral and Treatment (MOSBIRT) services in targeted areas of the state. The Missouri Institute of Mental Health has been charged with implementing the project.

Bob Bondurant was asked to participate as one of the “MOSBIRT Champions” on a committee charged with supporting the goals of the project. Bob chose to support this worthy effort because the focus of the project is early identification of substance use and abuse. Education and identification of the early warning signs of substance abuse is also a major goal of the MPHP.

Many people with alcohol or drug problems seek health care services in hospital emergency rooms which are often ill equipped for identifying and treating such problems. The project introduces practices for screening, brief intervention, brief treatment and referral to treatment to staff of hospital emergency rooms and other general medical settings to assist them in identifying persons at risk for or diagnosed with substance use disorders. It seeks to target usage which precedes the stage of abuse or addiction.

There have been several studies supporting the concept of this program. One study, “Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis”, published in Annals of Surgery, Volume 241, Number 4, April 2005 concluded that “screening and brief intervention ... is cost-effective and should be routinely implemented”. The authors found reduced health expenditures which saved $3.81 for every $1.00 spent on screening and intervention. They also asserted that “the potential net savings could approach $1.82 billion annually” if interventions were routinely offered nationwide.

Another study appearing in Drug and Alcohol Dependence, found an almost 68 percent reduction in illicit drug use over a six month period among people who had received SBIRT services. The authors of the report also found that SBIRT reduced drinking among participants. The rate of heavy alcohol use was reduced by 39 percent at the six month follow up session. In this study other improvements were also noted such as fewer arrests, improved housing and employment, as well as fewer emotional problems and improved overall health.

A third study which appeared in Alcoholism: Clinical and Experimental Research in February of this year reported on the beneficial effect of a very brief version of motivational interviewing with individuals “not particularly motivated to reconsider their drinking, and who are generally considered to be hardcore drunk drivers. Nonetheless, the results underscore how, in the right hands, even very brief psychosocial interventions can have important and enduring effects in individuals who are often seen as impervious to change.”

Thus far thousands of screenings have taken place in Missouri, primarily at one facility, the Cox North Emergency Room, which began implementation in March of 2009. Other sites include University Hospital’s ER and Student Health in Columbia, Grace Hill Neighborhood Clinics in St. Louis, and possibly additional sites over time. The project which was awarded $12.3 million dollars will last five years.

Additional information on the project is available at the website.