Implementation of SBIRT: Focus Group Analysis of Provider Teams in Academic and Community Healthcare Settings

There is previous research that delineates the benefits and justifications for SBIRT. Specifically, the importance of early detection of substance use disorders and their resulting physical, emotional, and mental impact on society have also been affirmed by other researchers (Finnell, 2013; Ino & Cho, 2013; O'Brien, Leonard, & Deering, 2012; Young et al., 2012). These researchers noted that early detection decreases the burden of future disease (Finnell, 2013, Young et al., 2012), prevents progression to alcohol dependence (Ino & Cho, 2013), improves treatment outcomes (Young et al., 2012), and decreases the likelihood of serious consequences (O'Brien, Leonard, & Deering, 2012). Some of these serious consequences include physical, emotional, and mental aspects of the patient including increased mortality, medication, and substance use interactions (Finnell, 2013), and risky behaviors, such as drinking and driving (Sommers et al., 2013); all of which can be reduced by SBIRT implementation (Finnell, 2013, Ino & Cho, 2013; O'Brien, Leonard, & Deering, 2012; Sommers et al., 2013; Young et al., 2012). Research has also identified further benefits of SBIRT, which include the cost effectiveness of the program (Bernstein & D'Onofrio, 2013; Finnell, 2013; Ino & Cho, 2013; Young et al., 2012), the focus on treating substance use disorders as a continuum of drinking and substance behavior, the satisfaction reported by patients and families, and the strengthening of the therapeutic relationship (Ino & Cho, 2013). Over the past 25 years, Screening, Brief Intervention, and Referral to Treatment (SBIRT) has slowly become a more widely-known evidence-based method for engaging primary care patients about potential substance use issues (Substance Abuse Mental Health Services Administration [SAMHSA], 2014; Satterfield et al., 2012). Meta-analyses of randomized clinical trials confirmed SBIRT's effectiveness in reducing harmful drinking in patients presenting at primary care settings (Bertholet, Daeppen, Wietlisbach, Fleming, & Burnand, 2005; Solberg, Maciosek, & Edwards, 2008). In fact, brief interventions (i.e., 4 or fewer sessions) performed in medical settings are proven to be equally as effective as extended treatment interventions (i.e., 5 or more sessions) provided in substance use disorder specialty settings (Moyer, Finney, Swearingen, & Vergun, 2002). SBIRT has evolved to include innovations to simultaneously address co-occurring mental health problems such as depression, anxiety, and trauma-related disorders (SAMHSA, 2014). However, despite scientific advancements, dissemination efforts, and evidence related to SBIRT's success (Babor et al., 2007), experts have noted that the "uptake and implementation [of SBIRT] has been notoriously slow" (Broyles & Gordon, 2010, p. 221) and infrequently implemented (D'Amico, Paddock, Burnam, & Rung, 2005) in medical settings. Obstacles to implementing SBIRT were reported by Babor and colleagues (2007) as lack of time, training, motivation, and other organizational factors (e.g., administrative support, competing priorities). Yoast, Wilford, and Hayashi (2008) extended the barrier list to include providers' skepticism about substance use disorder treatment effectiveness, discomfort in talking to patients about substance use disorders, and perception of patients being resistant to addressing the problem. In an attempt to measure site and staff role differences when implementing SBIRT, Bohman and colleagues (2008) developed the Medical Organization Readiness for Change survey. While significant differences were revealed between emergency versus community-based settings and clinical versus administrative staff. This study, as well as the others reported above, used survey and quantitative methodology (Bohman et al., 2008). This approach, while useful, left a gap in our deeper understanding of the barriers and catalysts to SBIRT implementation, especially from the providers' perspective. …