Counselor-provided SBIRT for hospitalized adults with substance misuse or disordered use: evaluating hospital utilization outcomes and economic cost

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Marcia H. McCall (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Carrie Wachter Morris

Abstract: The misuse and disordered use of alcohol and illicit drugs in the United States creates serious consequences for people and their families and communities, such as severe physical health issues (Substance Abuse and Mental Health Administration [SAMHSA], 2017a) and costs to society approaching $440 billion annually (National Institute on Drug Abuse [NIDA], 2018). Yet, few people receive the treatment they need (Grant et al., 2015; Grant et al., 2016). Instead, they overuse hospital stays and emergency care, among the most expensive medical services (Bernardino, Baird, Liu, & Merchant, 2015; Hankin, Daugherty, Bethea, & Haley, 2013). White and Kelly’s (2011) Addiction Recovery Management theoretical framework suggests that the historical partitioning of medical and mental health care hinders detection, intervention, coordination of services, and recovery from substance misuse and disordered use. Given that most U.S. citizens see a physician at least once per year (Sacks et al., 2016), a technique developed for medical settings is Screening, Brief Intervention, and Referral to Treatment (SBIRT) (SAMHSA, 2013). SBIRT by medical providers is effective for helping patients of clinics and emergency departments reduce alcohol misuse (Jonas et al., 2012; Schmidt et al., 2015), but not effective for patients with disordered alcohol use (Mdege & Watson, 2013; Schmidt et al., 2015), patients with drug use (Saitz et al., 2014), or patients admitted to medical hospitals (Mdege & Watson, 2013). Recent efforts to integrate medical and mental health care practices have incorporated SBIRT conducted by mental health professionals (Collaborative Family Health Association [CFHA], 2017). Outcomes from early investigations show promise for populations and settings not responsive to SBIRT by medical providers (Barbosa et al., 2017; Watkins et al., 2017). Professional counseling, in particular, aligns with SBIRT’s goals and guidelines (Babor & Higgins-Biddle, 2001; CACREP, 2015). Counselors endeavor to build therapeutic alliances with clients; in specialty treatment settings, this alliance predicts positive outcomes (Barber et al., 2001; Crits-Christoph, Johnson, Gibbons, & Gallop, 2013; Van Horn et al., 2015; Watts, O'Sullivan, & Chatters, 2018). Early results for counselor-provided SBIRT in an integrated care setting suggest efficacy for reducing substance use (Veach et al., 2018). This study extended the work of Veach et al. (2018) by determining if counselor provided SBIRT in integrated care settings is an effective treatment intervention, guided by Simpson’s (2004) Texas Christian University Treatment Model theoretical framework associating patient, program, and treatment factors with outcomes. The study tested three hypotheses. The first hypothesis predicted that interventions for hospitalized patients with alcohol or illicit drug misuse or disordered use were associated with fewer subsequent hospitalizations and emergency department visits. The findings were not significant but did trend in a supportive direction. The second hypothesis was that these outcomes differed by substance use type (alcohol or illicit drugs), substance use severity, and hospital clinical service unit. Significant results were found for all three covariates, including significance for counselor-provided SBIRT and alcohol use. The third hypothesis, given the substantial financial burden of substance misuse and disordered use on health care systems, predicted that counselor-provided SBIRT interventions reduced economic costs from the health system perspective. The findings supported the third hypothesis with significance, but with caution relative to inconsistency in the results. Given these findings, health system administrators, physicians, and community leaders may support integrating professional counselors into hospital units and other medical settings, raising the likelihood that people who need help with their substance misuse or disordered use actually receive it.

Additional Information

Language: English
Date: 2019
Counseling, Economic cost, Hospitalization, Integrated care, SBIRT, Substance abuse
Hospitals $x Substance abuse services
Substance abuse $x Patients $x Counseling of
Substance abuse $x Treatment $x Economic aspects

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