Screening and Brief Intervention (SBI)

Screening and Brief Intervention (SBI), or Screening, Brief Intervention, and Referral to Treatment (SBIRT) are a relatively new method of early intervention in drug and alcohol abuse.  The Commonwealth of Pennsylvania has an SBI program administered by the Institute for Research, Education, and Training in Addictions (IRETA).  SBIRT is a SAMHSA program.


SBI is roughly considered to be any attempt by a health care professional, not necessarily a drug counselor, to assist a person recognize their patterns of substance abuse.  The final result may not be abstinence, but rather any decrease to normal levels, or levels which are not resulting in consequences to the person or his immediate circle of contacts (e'g', family problems work related problems etc, as a result of the substance abuse.)  This method of decreased use is sometimes referred to as harm reduction.  The main goal is to reduce the level of substance intake and consequently allow the person to lead a relatively normal life.  A good example of SBI would be an emergency room nurse or physician discussing the benefits of decreased alcohol consumption to a person recently involved in an accident related to their drinking.  The main idea here is the age old "strike while the iron is hot" principle.  When the patient is in the ER and feeling remorseful and ashamed, they are more vulnerable to suggestion and insight to the effects of their substance consumption.  The intervention may end there, or the nurse may refer the patient to a social worker for another 2 or 3 sessions of anywhere from 5 to 60 minutes each.


SBIRT, on the other hand, adds the treatment component.  The intervention is just the beginning and the client is then referred to a drug counselor for a more in-depth assessment and determination of the patients long-term needs regarding formal treatment, education and aftercare.  Now, obviously, the main goal is catching a patient in the early stages and preventing long-term damage.  This is not always possible and many people ignore repeated warnings from not only family members but professionals alike.


The importance of SBI and SBIRT should not be understated.  Many studies indicate they are as effective as long term residential treatment.  The main point is to not stop attempting to intervene in a persons substance abuse.  They are not the only ones who will suffer.  Even innocent bystanders can be affected adversely by a random act under the influence.

Alcohol is more dangerous than any other drug

The fact that alcohol was recently tagged as the most dangerous drug by a group of British Scientists, is nothing new (Boston Globe article, 11/1/10).  Alcohol, merely by its wide ranging use, has always been the most abused drug known to man.  The fact that it is legal certainly helps, but the advertising done by the beverage alcohol companies helps push it far into the lead as the most consumed mind and mood altering substance.  Of course, the second and third most dangerous drugs are heroin and crack respectively, but the second most abused drug is marijuana.

Recently, news outlets have been focused on marijuana, whether for medicinal use or outright legalization as was attempted and failed in California (Proposition 19).  Marijuana is certainly making a move on alcohol as a highly abused substance, but trails alcohol by about 100 million users each month (NIDA, 2008 report).  Marijuana has many excipients that are known carcinogens.  Unfortunately, there have been no in-depth studies on these compounds as there is no funding in it because marijuana can't be marketed to make someone a lot of money due to its quasi-illegal status.  It will inevitably be legalized and then money can be made, but I still doubt anyone will point out the deleterious effects of the other ingredients in pot.  Who wants to cast a shadow over their product?  Just take a look at the tobacco companies.

Alcohol on the other hand has been studied and dissected to a great degree, but you never hear about it due to the lobbying of the beverage alcohol companies.  We don't see diseased livers as a result of alcohol abuse as predominantly as we did charred lungs from smoking.  Alcohol is too accepted and no one suffers from second-hand drinking.  They certainly suffer from the behavior of the alcohol abuser, but that gets swept under the rug due to alcohol's venerated status.  It will take more exposure by the main stream media regarding the over-arching and devastating effects of alcohol consumption before the alarms will be sounded and alcohol gets taxed more, not prohibited (we tried that), and the money used for treating the disease of alcoholism.

Bottom line is that alcohol is the most dangerous AND expensive drug in the world.  Expenses range from: under-production at work due to hangovers, work absences, bankruptcy, divorce, car accidents, theft, assault, sexual assault, liver disease, heart disease, brain disease, to name just a few.  Alcohol abuse costs society more than cancer, heart disease and diabetes combined (NIDA, 2008 report).  All tolled, these expenses cost more than $400 billion a year.  America needs to wake up and increase taxes on beverage alcohol, just like we did to tobacco products, to help pay for the damage that is caused by this drug.  We need to stop the beverage alcohol lobbyists from controlling lawmakers at the expense of everyones health and pocketbook.  Unfortunately, the legislators may be one of the industries best customers.  Call your legislator today and ask him or her to sponsor a bill to double or triple alcohol taxes.  You may help save a life.