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.

HSA hidden fees with hospital clinics

My insurance from my employer changed this year.  I went from standard insurance to and HSA, or health savings account.  These plans offer the insured to save pre-tax money toward medical expenses.  There is no co-pay when you see a medical provider, but rather the costs are run through the insurance company's fee schedule and reduced according to what they would normally pay.  Then this is the amount the insured pays.

So, I went to a dermatologist (whom I had seen before when I had traditional insurance with a $20.00 co-pay) to get some of my fair Irish skin treated and the doctor happened to be associated with a hospital, MetroHealth, in Cleveland, Ohio.  Her office was in a building across the street from the hospital.  I was her office for 15 minutes tops.  I received a bill from her for $120.07.  No problem with that.  Then I received a bill from the hospital for facility services, apparently because they own the building and it was in a treatment room in their building (looked like an ordinary patient exam room seen in any other doctor's office), for $324.00!

The reason I went to this dermatologist again was that she was listed as an in-network provider by my insurance company, Anthem, and she seemed like a good physician.  There was no indication from Anthem, on their website listing providers, that there would be an additional fee for seeing a physician who is in a clinic near a hospital.  There was no indication at the doctor's office that there would be additional charges.  Since I had traditional insurance coverage the first time I saw this doctor, there was no way I could have known if my insurance company was paying a higher fee.  This is a hidden fee, and people with HSA's should be aware of it.

If you have an HSA account, I caution you to check with any doctor associated with a hospital, whether there will be additional facility charges prior to making an appointment.

Inspiration from 2 documentaries

I happened to pick up "American Drug War" from the library the other day.  It is a documentary on the cause and effect of licit and illicit drugs in American society.  There is excellent insight into the funding of the drug problem in the US and how crack became so big with the help of certain CIA connections.  Sure, you could say it is a conspiracy theory, but if we can track a package of mail ordered socks from one end of the country, we can sure detect every drug coming in from outside the country.  Otherwise, someone would have smuggled more bomb making materials into the US and used them by now.  I sincerely believe we allow a certain amount of drugs in by looking the other way and taking a cut.  Somebody is making some money somewhere.  Most likely the feds.  It is in their best interest to keep people drugged and dumbed down and/or in prison so there are fewer people to interfere with their agenda.  The prison system in the US is a huge money maker that feeds the upper class and government.  The fastest growing drug of abuse besides marijuana and alcohol, is prescription drugs... in particular, opioids.  The number one prescribed drug in the US is hydrocodone with acetaminophen (generic Vicodin).  Basically it is a pain killer that can be found on any corner and almost every bathroom medicine cabinet.

The other movie I saw was "Waiting for Superman" which is about the failure of the US school system.  Simply put, we are looking at dumbing down people to maintain status quo.  There is too much money to be made by making people working class and scraping by, so they can't get the free time or energy to take on the system.  Plus, many (is not most) of the kids who drop out get involved in the drug trade as users or suppliers, and then feed the aforementioned correctional complex.  Most teachers are overwhelmed and have no time or inclination to learn how to do a better job.  They get comfortable and do just enough to get by until tenure kicks in and then they are set till retirement.

So the comparison of the two films shows how the greed for money and power, fuels both situations.  The government isn't going to stop drugs from being made readily available to anyone who wants them, so they can stay in a stupor, and then busts enough to fill the prisons till they are bursting.  The feds also don't want educators to get any better at their job, lest they produce someone smart enough to realize they are being had.  And one by one, as they drop out of school and become criminals or lead an unfulfilling life, they go to the corner dealer, corner liquor store, or just walk into the bathroom and open the medicine cabinet and get a drug to sooth them because fighting back against the greedy power mongers takes too much effort.  We have never made them work hard before, so we know they don't stand a chance to muster up the energy to get politically involved much less march on Washington.

Starting today

So... the journey of a thousand words starts with the first... syllable??  Huh?

Well, so much for that.  I just need to get some more reality in my life and hopefully it will spill over into anyone's life who reads this.

Disclaimer: I wasn't an English or writing major, so typos and grammar are excused.  They are actually the real deal anyway.  It is who I am... a part-time perfectionist.  Hopefully never going full-time.  I just don't know where I would find the time to be perfect.

So, I am first and foremost a person who is in recovery from alcohol and drug abuse.  In order to keep it real and not hide behind the secrets, I need to share that.  It really helps me keep everything in perspective.

I am also a pharmacist, a lawyer, a social worker and a drug counselor.  All of these professions work in concert. as most people with drug or alcohol problems have had legal involvement, and many have pharmacology questions as they begin the recovery process.

My blog will focus on substance abuse treatment as it encompasses biological/pharmacological and legal/incarceration concerns.  I will address everything from new drugs of abuse, chemical dependency treatment models (including the use of pharmacological agents) to the legal ramifications of substance abuse and the interaction of punishment vs. treatment.

So that is my intro and first step/syllable...  feel free to comment and... above all... keep it real...