Ms. A., a 48-year-old woman with a history of depression and a chief complaint of back pain, enters the ED. The patient is sweating, with hand tremors. Her blood pressure is 132/88 mmHg, pulse is 120 beats per minute, temperature is 99.9?F? respiration rate is 22 breaths per minute, and she rates her pain an 8 out of 10. If you could obtain one additional piece of information from this patient, which one would you choose?
We will argue that screening for alcohol and other drug (AOD) use should be part of every initial patient assessment. Screening for risky AOD use is vital because substance use can have physical and mental health effects, causing or contributing to illness and injury; transmitting infectious disease; exacerbating diabetes, epilepsy, back pain, and hypertension; and complicating treatment and reducing patient adherence to treatment for conditions such as asthma, depression, and schizophrenia. According to the Centers for Disease Control and Prevention (CDC), one in 10 deaths among working-age U.S. adults is attributable to excessive drinking.
The CDC reports that far more Americans consider themselves to be “regular drinkers” (51%; 12 or more drinks in the past year) than consider themselves to be “infrequent drinkers” (12.9%; 11 or fewer drinks in the past year); however, only one in six adults reports ever discussing drinking with a health professional.
As with other vital signs, a patient's level of AOD use provides nurses with information relevant to the patient's symptoms and the course of the disease (positive or high-risk screens), but also about the patient's state of wellness (negative or low-risk screens). Screening with a validated tool enables nurses to know where the patient falls on the continuum of use, abuse, and dependence and to assess the level of risk associated with her or his substance use. The Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test are valid screens that are widely used.
Nurses can use the evidence-based practice of screening, brief intervention, and referral to treatment (SBIRT) to determine a patient's level of use and risk associated with AOD use. SBIRT is an integrated, public health approach to prevention, early intervention, and referral for people with substance use disorders as well as those at risk for developing a disorder. In September 2012, the American Psychiatric Nurses Association endorsed its use in all clinical settings, with the understanding that SBIRT has the potential to reduce the risk of medical and psychiatric illnesses subsequent to excess alcohol consumption. The International Nurses Society on Addictions and the Emergency Nurses Association have also endorsed SBIRT. Alcohol screening and behavioral counseling is now recommended by the U.S. Preventive Services Task Force as a universal screen in primary care to improve patient health outcomes. And SBIRT services are reimbursable through Medicare and Medicaid in many states.
For the integration of physical and behavioral health, nursing curricula must treat substance use conditions like other chronic conditions. Nurses are well positioned to deliver patient-centered SBIRT, not only because of their ubiquity across health care settings, but also because they are consistently rated the most trusted health care professionals.
Nurse leaders and educators must commit to developing a workforce equipped to actively and collaboratively respond to the spectrum of substance use across all practice levels and settings. We must start by adding education on the continuum of AOD use, SBIRT, and prevention to schools of nursing. The integration of this knowledge into all clinical practice sites will ensure that nurses are prepared to provide safe patient care