This month, the country reeled with the loss of actor Philip Seymour Hoffman to heroin overdose, but the problem of substance use has long been an epidemic. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “In 2011, 18.9 million adults in the United States had past year substance use disorder.”
The University of Colorado College of Nursing is currently implementing a three-year $743,000 Screening, Brief Intervention and Referral to Treatment (SBIRT) training grant from the Center for Substance Abuse Treatment at SAMHSA, which aims to train current and future nurses to recognize at-risk and harmful substance use in patients before the problems become more serious.
“Ninety percent of substance use is not recognized until it gets severe,” says Mary Weber, PhD, principal investigator of the grant. It is important to educate all health professionals, including nurses, to screen early for at-risk and harmful use of substances and to exercise brief intervention and motivational interviewing techniques. This education will promote appropriate referral to treatment, and, consequentially, reduction in use. Decades of research demonstrate that identifying unhealthy substance use early and providing patients tools to reduce use can be effective in preventing the disease of addiction.
In previous years, SAMHSA has mainly funded medical schools. “This is the first time that SAMHSA is providing funds to train undergraduate nurses to look at substance use,” says Weber. “The focus is now on the influence nurses have on changing health care.”
Weber, working with Laurra Aagaard, MA, MS, Fara Bowler, MS, Paul Cook, PhD, Michael Galbraith, PhD, and Lisa Krug-Avery, MSW, is working with faculty to integrate SBIRT training into the curriculum. “The goal is not to segregate substance from health and to treat these issues as any health condition; we can do this by changing the culture of how nurses view substance use—by integrating substance use screening and motivational interviewing techniques from the first course students take.” This technique can help destigmatize the typical public view of substance use disorders, teaching nurses that substance screening, brief intervention and referral to treatment is just one of many facets to effective care.
At the undergraduate level, students begin with a health assessment course, where they are now introduced to screening and other subjective tools alongside the traditional curriculum of the course. They then continue to build skills in a safe and non-stressful environment by learning motivational interviewing and participating in simulations throughout the curriculum. The integration of substance-related simulations, interactive training, discussions and role play, according to Bowler, “will tie in with the college’s already existing clinical simulation curriculum.”
“So far, the undergraduate students have embraced substance use training because they recognize the potential for this knowledge in their future. They continue to seek the next step in the process—they want more,” Bowler notes.
At the graduate level, substance use training is tailored to the patient populations that these advanced students will likely be working with. “For example, if a student is studying in midwifery, he or she will be working with pregnant women,” Weber explains, “students will be able to have these difficult substance-use related conversations, and they are difficult conversations.”
The SBIRT program offers faculty a two-hour live class or a three-hour interactive and interdisciplinary online program, which was originally developed for care providers. Regional care providers have access to the online training program as well, and the College of Nursing’s community partner, Peer Assistance Services, is helping train interested community care providers.
The progress made since the September start is promising. Community care providers at Sheridan Health Services have already participated in the training, and there are plans to provide training to current nurses and advanced practice nurses as well as an eight-hour, free continuing education program with three hours of pharmacology, open to all nurses in rural and urban Colorado. The College of Nursing Continuing Education Motivational Interviewing event will be held on June 20, 2014.