Kaiser Permanente researchers are leading an international effort to use a promising population health approach
When teens are experimenting with alcohol and drugs — particularly if they have sadness or anxiety — it is essential to counsel them before the substance use goes too far. Medical teams can help, using a method supported by Kaiser Permanente research.
The technique is called SBIRT — screening, brief intervention, and referral to treatment. The idea is to screen young people in pediatric or primary care clinics to identify problem substance use. The medical team can follow up with a conversation (the brief intervention part) and refer the patient to treatment if needed.
A team with the Kaiser Permanente Division of Research has been studying SBIRT and found benefits with pediatric patients, who had less risk of a later mental health problem if they were in a pilot SBIRT program.
Now the team is leading a global effort to expand the use of the technique with young patients aged 10 to 24. They want to make SBIRT’s use consistent across countries (details of the brief intervention may vary), and to identify gaps in research. This effort is led by the Youth Special Interest Group of INEBRIA (the International Network on Brief Interventions for Alcohol & Other Drugs).
The group just published a “roadmap” document in the Journal of Adolescent Health that identifies ways to use SBIRT more widely and consistently around the world. Two of the lead authors of the paper are DOR Research Scientist Stacy Sterling, DrPH, MSW, and Staff Scientist Verena Metz, PhD. They answered questions about the roadmap and SBIRT’s potential.
Why is it important to apply this technique to younger patients?
Sterling: Alcohol and drug use are related to the top 3 causes of mortality and morbidity in adolescence — suicide, homicide, and accidents and injuries. Young people may be motivated by circumstances in their own lives as well as by bigger societal factors, such as the COVID-19 pandemic. Reaching people in adolescence, before their experimentation has become established substance use, can make a huge difference in reducing their risk of harm and poor outcomes.
Metz: There’s a lot of potential to intervene early and change a patient’s trajectory completely. It’s very rewarding to work with an age group who you can help in such a substantial way.
How can SBIRT be used with young people?
Sterling: There is more evidence for SBIRT — and it is more established — in adult populations. At Kaiser Permanente Northern California, for instance, SBIRT is used routinely in adult primary care.
But there is now plenty of evidence that it is effective with young people as well. They use alcohol differently from adults. Rather than coming home from work and having a glass or two of wine, young people are more opportunistic drinkers; they may encounter it at a party, and are more likely to binge drink. And super-binge drinking is increasingly common in adolescents. So, there are unique issues in using SBIRT with younger people in terms of what is developmentally appropriate and how we measure successful outcomes, such as educational attainment.
In the U.S., we see SBIRT being used mostly in medical settings. But in other countries, the technique may be used in other settings such as schools and community centers. It’s important to acknowledge all the ways the technique may be used so the methods and training are consistent, and we are all talking about the same thing when we say SBIRT.
What did you want to accomplish with this research roadmap?
Sterling: This was really a call to arms to move the field forward, to identify research gaps, and work on consistency.
What are some of your main suggestions?
Metz: The roadmap identifies some areas that research could focus on and fill in gaps. So, for instance, much of the evidence for SBIRT use with adolescents is in U.S. and European populations, with gaps for different racial and ethnic groups. The evidence base also doesn’t differentiate how the technique works in different ages or genders.
It would be good to compare how SBIRT effectiveness may differ according to where it is carried out — in a medical setting versus a community setting, for instance, and in low- and middle-income countries. We also need to better understand the effect of heterogeneity across groups: in girls versus boys, for example, in various racial and ethnic groups, and among sexual minority youth. Finally, we also identify a need to specify the best outcomes measures that are appropriate to adolescents.
How would you like to see this document used?
Sterling: It’s important to come to consensus on the screening method we are using. In the paper we include a list of the most-used screening tools used around the world, and they vary. We need to provide clinicians and others working with young people with validated, consistent screening questionnaires. This is both to ensure SBIRT is being used in the most reliable way, supported by research findings, and to assist researchers in collecting data that is also consistent from study site to study site.
Metz: Our project entailed some logistical challenges working with colleagues across 6 time zones. But the fact that our co-authors are experts from across the world ensured that our publication truly is international. The authors are among the best in the SBIRT field globally and represent different cultural backgrounds, working and study conditions, experiences, and challenges. We hope that colleagues across the world will find our roadmap useful.
Additional co-authors included Andrea H. Kline-Simon, MS, and Agatha Hinman, BA, of DOR; Sharon Levy, MD, MPH, Sion Kim Harris, PhD, CPH, and Elissa R. Weitzman, ScD, of Harvard Medical School; Marcus Bendtsen, PhD, of Linkoeping University in Sweden; Sidharth Arya, MD, of Pt BDS University of Health Sciences in India; Joel Msafiri Francis, MSc, PhD, of the University of the Witwatersrand in South Africa; Abhishek Ghosh, MD, of the Postgraduate Institute of Medical Education and Research in India; Dagmar M. Haller, MD, PhD, of the University of Geneva in Switzerland; Tracy L. McPherson, PhD, of NORC at the University of Chicago; Shannon Gwin Mitchell, PhD, of Friends Research Institute in Baltimore; Dorothy Newbury-Birch, PhD, of Teesside University in the United Kingdom; Samir Kumar Praharaj, MD, DPM, of Kasturba Medical College in India; and Paul Toner, PhD, of the University of Dundee in the United Kingdom.
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