A few years ago, I spent an instructive Saturday evening in the emergency department at Denver General Hospital. As the hours passed, ambulances began bringing in people who had been injured as a result of using drugs or alcohol. Some were so out-of-control that they had to be strapped to gurneys for their own safety. One man’s blood alcohol level was so high that nurses treating him couldn’t believe he was still alive.
That evening brought home to me the reality of what numerous studies have shown: Between 50 percent and 75 percent of expensive emergency department visits are related to substance abuse. Drugs, alcohol and tobacco also contribute to more than 70 diseases and lead to expensive, long-term health problems.
The numbers are worrisome. A 2002 Harvard study, for example, ranked Colorado second in severity among the states for overall substance abuse, fifth for alcohol and 13th for drugs. A study by the National Center on Addiction and Substance Abuse at Columbia University showed that Colorado spends $202 million a year on health problems related to substance abuse.
Statistics such as these led the federal government to establish SBIRT (Screening, Brief Intervention and Referral to Treatment), which was brought to eight health care facilities in Colorado in 2006. In the metro area, the program is being implemented at St. Anthony Central Hospital, Littleton Adventist Hospital, Denver Health and its clinics, and a clinic in Englewood.
The goal of SBIRT is to identify people before they become addicted to alcohol, tobacco or drugs, then to counsel them and encourage healthier behaviors.
Leigh Fischer, program manager for SBIRT Colorado, says the program screens every adult patient with five quick questions. If a patient’s answers show use of illegal or prescription drugs, over-use of alcohol, or tobacco use of any kind, the “brief intervention” portion of the program kicks in. A health educator counsels the patient about the health consequences of substance abuse and refers him or her to helpful resources. Patients who appear to be addicted are referred for specialized treatment, with financial assistance provided for those who lack insurance.
From 2006 through April 2007, SBIRT screened 30,000 Coloradans. Only about 3 percent scored at the high end of the spectrum. Twenty-two percent reported that they used tobacco in some form, while another 22 percent scored in the “moderate” range for use of alcohol, illicit and/or prescription drugs.
Prescription drugs are included in the screening because the abuse of prescription drugs has been “stealthily but sharply rising,” especially among women and teenaged girls, according to the National Center on Addiction and Substance Abuse.
“Patients seem hesitant about bringing up this topic themselves,” she said, “but research shows that they want their health care provider to ask” about drug, alcohol and tobacco use. And, according to Fischer, more than 20 clinical trials across the U.S. show that SBIRT makes a difference.
In Colorado, SBIRT contacts 10 percent of “positive” patients six months after they receive counseling. Fischer says the patients have reported a 50 percent reduction in alcohol use, and a 62 percent overall drop in use of illegal drugs.
In Washington state, where hospitals in six counties adopted the SBIRT approach with disabled Medicaid patients, researchers found that the program could save the state government up to $2.8 million per year in avoided emergency department visits and hospitalizations.
The federal grant under which SBIRT operates in Colorado will expire in 2011. Despite Colorado’s severe budget problems, this is one common-sense preventive program that policymakers and insurance companies may want to support when federal funding ends.
Susan Thornton (smthornton@aol.com) served 16 years on the Littleton City Council, including eight years as mayor.
