RESEARCH SPOTLIGHT

The effects of screening brief intervention referral to treatment (SBIRT) training on health professional trainees’ regard, attitudes, and beliefs towards patients who use substances.

Published in: Substance Abuse

By: Lukowitsky et al., 2021

WHAT WAS THE STUDY ABOUT?

This study evaluated the attitudes and beliefs of healthcare trainees towards people who use substances, and assessed the effect of training in SBIRT (a stepped-care approach to managing substance use) on those attitudes and beliefs.

Specifically, the researchers assessed whether individuals with substance use disorders were stigmatized more than those with other medical conditions, and whether the effects of SBIRT training would mitigate those differences. The authors also assessed whether there were differences between health disciplines and explored whether training would lead to an increase in adoption of psychosocial model, rather than a disease model of addiction.

WHAT DID THEY DO?

The researchers identified 461 individuals enrolled in undergraduate healthcare degrees across the United States to participate in the study. Healthcare professional trainees identified were limited to physician assistants, nurse practitioners, pharmacists, psychiatry residents, and psychology pre-doctoral interns.

All participants were asked to complete a battery of questionnaires which assessed attitudes towards alcohol and alcohol problems, attitudes of medical staff towards those using other drugs, beliefs about the nature of substance use disorders, and stigma and low regard towards substance use. After completing the initial survey battery, participants were then invited to complete a 7-hour training program in SBIRT, which included an online learning component, in-person didactics and standardized role-play. All consenting participants were required to complete the online training program as part of their current study curriculum. In order to measure the effect of SBIRT training, participants were then asked to complete the same survey battery after 30-days post-completion of training. A total of 172 participants completed the follow-up survey.

WHAT DID THEY FIND?

In terms of how patients were regarded, at baseline (i.e., pre-training), results showed that the lowest overall regard was shown towards substance dependent patients, compared to those with depression and those with type-2 diabetes. However, results also showed that SBIRT training was associated with a significant increase in regard for substance dependence, but no changes were found for diabetes and for depression. These results suggest that having knowledge about how substance dependence works is an important step in improving how individuals with substance use disorders are perceived.

In terms of attitudes and beliefs, SBIRT training was associated with significantly more positive beliefs about alcohol and other drugs, including domain specific beliefs about role adequacy, motivation, role related self-esteem and job satisfaction. While increases in scores for role legitimacy were found from baseline to post-training for alcohol, no differences were found for other drugs. These results suggest that individuals who received SBIRT training became more aware of the importance of their role within the healthcare sector to address individuals’ substance use disorders, as well as their own capacity to help manage problems.

In terms of differences between health disciplines, there were some interesting findings to unpack, and far too many to summarize here. However, some interesting differences were:

At baseline, psych trainees reported higher regard for individuals with depression than pharmacy students, who in turn had higher regard for patients with type-2 diabetes than medical students, but there were no differences in regard towards patients with substance use among any group, as all groups held substance dependence in the lowest regard.

The lowest regard for individuals with substance use was found among physician assistants and nurse practitioners, and the highest regard among psych trainees.

At baseline, pharmacy trainees’ beliefs about alcohol were much more negative than all other trainees on a number of belief domains.

At baseline, psych trainees had the highest levels of positive beliefs about drug use compared with all other trainees on almost all domains; the same pattern was found at post-test.

Overall, trainees were more likely to endorse a psychosocial model of substance use disorders compared to the disease model at baseline and post-test.

Nurse practitioners were more likely than others to hold a disease model at baseline, and physician assistants and pharmacy students were more likely than psych trainees and medical students to hold the disease model. Overall psych students had the highest likelihood of holding a psychosocial model of belief.

IN THE AUTHORS WORDS:

“We find this result to be very encouraging as it suggests that while there is an opportunity to help health care students feel more adequately prepared to work with this population, to help them feel more motivated, to derive self-esteem and work satisfaction and, to provide them with more support, by and large students in a wide variety of clinical disciplines feel that working with and intervening around substance use is a legitimate part of their clinical work. This is important as one of the primary goals of SBIRT training is to encourage all future clinicians to screen and provide brief interventions for substance use and not to solely rely on specialists to treat this patient population”

WHAT DO WE LIKE ABOUT THIS RESEARCH?

This research is exactly why we push so hard for undergraduate training in screening, brief intervention and referral to treatment (SBIRT) for substance use disorders. The stigma and negative attitudes and beliefs towards substance use and substances users is pervasive and has been difficult to break down. This research empirically demonstrates that some of the barriers to treatment for those with substance use disorders can be prevented by adequately equipping the future healthcare workforce with the tools and strategies to deal with patients in their respective fields. Early identification and intervention for individuals with substance use issues is pivotal to more positive treatment outcomes in the future.

Oftentimes, we find referrals for substance use made to specialist AOD services are unnecessary, which can be burdensome for clinicians working in those services. While a stepped-care approach to identifying and treating substance use disorders is important, and referrals to specialist AOD services are crucial for individuals using substances at high-risk levels, individuals with low- or moderate-risk levels of substance use (as determined by the ASSIST, for example) are more than capably managed with by clinicians working in primary healthcare. It is therefore crucial that the primary healthcare workforce is adequately equipped with the knowledge and skills to ask questions and comfortably manage the responses of individuals using substances.

WHAT OPPORTUNITIES DOES THIS RESEARCH PRESENT?

Again, this research presents a key piece of understanding of the benefits and importance of adequate training of healthcare workers in the management of substance use disorders. However, there were some limitations of this study which may require the tempering of conclusions. First, the study did not include a control group, and as we know with screening itself, it is therefore impossible to determine whether raised awareness of beliefs, attitudes and regards was enough to improve outcomes. In other words, simply by surveying participants about their beliefs and attitudes might have forced them to introspect – causing an effect, rather than the training itself. Future research might seek to investigate this possibility. Second, relatedly, it is difficult to account for potential demand characteristics in this study. 30-days is a relatively short turnaround, and one might suspect that many of the student trainees in this study, having either run or participated in studies themselves, may have been implicitly aware of the purpose of the study and may have answered more favourably second time around. Again, more rigorous methodologies, including randomization and a no-intervention or placebo control group would allow researchers to draw firmer conclusions about the efficacy of SBIRT training in this way. Nevertheless, this study shows early empirical promise for the effectiveness of SBIRT training for individuals working in a broad range of primary and specialist AOD healthcare services.

If you want to know more about screening, brief intervention and referral to treatment and how we might be able to assist your workforce in developing the skills and capacity to deal with substance use disorders, visit our Portal

If you have patients that use substances, and want to know where to send them for more information, you can ask them to visit our consumer website

While there, they can also download our free smartphone apps to keep track of their substance use, and find important tips and tricks about cutting down and quitting.

You can read the full report of trial study here