Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus): A Novel Interprofessional Training for Rehabilitation Science Professional Students.

IMPORTANCE: With the increasing amount of substance use-related health conditions in the United States, it is important for rehabilitation science professionals to receive screening and prevention training. OBJECTIVE: To describe and examine the preliminary effectiveness of a novel educational program, Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus), that combines traditional SBIRT training with new modules for cannabis, stimulant, and opioid use. DESIGN: Prospective, cohort design. SETTING: Academic institution. PARTICIPANTS: One hundred eighty-one rehabilitation science graduate students. INTERVENTION: SBIRT-Plus curriculum. OUTCOMES AND MEASURES: Outcomes included satisfaction with training, perception of interprofessional training, attitudes, knowledge, and stigma, as assessed with the Readiness for Interprofessional Learning Scale, Alcohol and Alcohol Problems Perception Questionnaire, Drug and Drug Problems Perception Questionnaire, Knowledge Screening Scale, and two stigma instruments. RESULTS: Most students (>80%) expressed satisfaction with their training, would recommend the training to a colleague, and believed that the training would influence and change the way they practiced with patients at risk for substance use disorders. Students' attitudes and knowledge increased from pre- to post-training, and stigma perceptions were significantly reduced. CONCLUSIONS AND RELEVANCE: SBIRT-Plus is an evidence-based interprofessional training that is feasible to implement in graduate-level education programs. Integrating SBIRT-Plus into professional graduate programs may be an optimal and low-cost model for training rehabilitation health care professionals. Plain-Language Summary: Screening, Brief Intervention, and Referral to Treatment Plus (SBIRT-Plus) is an evidence-based interprofessional training that can be easily adopted in curricula to train professional students about the importance of screening for substance use disorders.

Psychometric evaluation of a contemporary version of the drug and drug problems perception questionnaire.

BACKGROUND: More than 20 years ago, the Drug and Drug Problems Perception Questionnaire (DDPPQ) was developed to examine healthcare providers' attitudes and perceptions towards individuals who use drugs. In alignment with recommended terminology respectful of this patient population, the 20-item measure was revised using person-centered language. Therefore, this study aimed to examine the psychometric properties of the person-centered DDPPQ (PC-DDPPQ) version among undergraduate nursing students. METHODS: Exploratory and confirmatory factor analyses were used to examine the PC-DDPPQ factor structure using a cross-sectional design. A convenience sample of 400 students from two nursing schools located in the Northeast and Mid-Atlantic regions of the US participated in the study. The sample (N = 400) was divided equally between the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA). RESULTS: After applying principal axis factoring (PAF) with oblique (Promax) rotation, the EFA yielded a five-factor, 20-item structure that explained 70.0% of the variance. The CFA revealed that the final model, derived from the EFA, which yielded a 19-item, five-factor structure adequately fit the data (Comparative Fit Index (CFI) = 0.959, the Tucker-Lewis Index (TLI) = 0.951 and Root Mean Square Error of Approximation (RMSEA) = 0.058). CONCLUSIONS: Except for one item (item #14), the five-factor structure aligned with the original 20-item version. This study contributes to promoting the use of a more appropriate and less stigmatizing language among healthcare providers working with patients who use drugs.

Factors Associated with Nurses' Motivation to Provide Care for Patients with Alcohol Use and Alcohol Use-Related Problems.

BACKGROUND: There is a high human and economic cost associated with alcohol use and alcohol use-related problems. Nurses have a pivotal role in addressing the needs of this patient population. Purpose: The study aimed to examine the correlation between nurses' demographics/background characteristics, personal attitudes, professional attitudes, and their motivation to provide care to patients with alcohol use and alcohol use-related problems. METHODS: A descriptive, cross-sectional correlational design was utilized. Nurses were recruited from four Southwestern Pennsylvania hospitals. The study variables were examined using questionnaires that explored nurses' demographic/background characteristics, their personal and professional attitudes, and motivation to care for patients with alcohol use and alcohol use-related problems. RESULTS: The sample included 234 nurses. Demographic/background characteristics were identified as associated with nurse's alcohol use-related motivation, including gender, primary work setting and specialization. Previous personal experience with alcohol use-related problems (nurses themselves or co-workers), familiarity, perceived dangerousness, fear, social distance, personal responsibility beliefs and disease model were also associated with nurses' alcohol use-related motivation to care for these patients. In addition, all professional attitudes were associated with nurses' motivation toward caring for patients with alcohol use and alcohol use-related problems. CONCLUSIONS: The study revealed that certain demographic/background characteristics and personal and professional attitudes were associated with nurses' motivation to provide care to this patient population. This study provides the foundation for future studies aimed at exploring predictors of nurse's motivation to care for patients with alcohol use and alcohol use-related problems.

Advanced practice nursing students' perspectives of learning screening, brief intervention, and referral to treatment in interprofessional settings.

ABSTRACT: Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to early intervention for substance use through universal screening. Utilization of SBIRT was taught in an interprofessional setting to nurse practitioner, nurse anesthetist, and dental hygiene students through integrated educational grant projects. A qualitative analysis was done across 10 SBIRT data sets collected over 4 years. The researchers used a nominal group consensus method to review the data, and six themes were identified. Results showed that students desired more training on motivational interviewing techniques. Furthermore, students identified that to effectively work interprofessionally, students must be exposed to such collaboration throughout their professional educational programs.

Personal and professional attitudes associated with nurses' motivation to work with patients with opioid use and opioid use-related problems.

Background: Opioid use and opioid use-related problems contribute significantly to increased morbidity rates and premature deaths as well as an increased economic burden. Nurses have key roles in providing care to this patient population; however, they often report low motivation toward working with these patients. Examining personal and professional attitudes associated with nurses' motivation to work with this population can present a valuable opportunity to enhance their willingness to intervene at an earlier stage when patients do not have a diagnosable opioid use disorder. Methods: A descriptive, correlational design was used. Nurses were recruited from four hospital settings in Southwestern Pennsylvania. Data on nurses' demographic/background characteristics, personal attitudes, professional attitudes, and motivation related to working with patients with opioid use and opioid use-related problems were collected via a paper/pencil survey and analyzed using linear regression. Results: A sample of 234 nurses were included in the final analyses. Personal attitudes associated with nurses' motivation included personal experience with a family member related to alcohol and/or other drugs, and stigma perceptions (familiarity, perceived dangerousness, fear, social distance and personal responsibility beliefs). Professional attitudes associated with nurses' motivation included working experience with substance use (SU), SU education as continuing education or other educational resources, role security, therapeutic commitment, role responsibility, and self-efficacy. Conclusions: This study's findings provide valuable information regarding the bivariate relationships between nurses' personal attitudes, professional attitudes, and motivation to work with patients with opioid use and opioid use-related problems. The study provides a base for future studies aimed at developing interventions to enhance nurses' motivation to work with this patient population particularly related to preventing the progression of opioid use to a diagnosable disorder.

Executive Summary of the American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management.

: The American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management provides guidance on the identification and management of alcohol withdrawal in adults with varying degrees of syndrome severity. The guideline addresses both ambulatory and inpatient care and considers special patient populations. The Guideline was primarily developed following the RAND/UCLA Appropriateness Method (RAM), a process to determine the appropriateness of a set of clinical procedures. This process included a review of gray and empirical literature published between January 2012 and October 2017. Nineteen existing guidelines, 112 reviews, and 150 research studies were used to develop draft guideline statements that were assessed by a panel of physicians experienced in withdrawal management and representing a diverse range of settings and patient populations. Recommendations were included in the Guideline where consensus on appropriate clinical practice was identified by the panel. Areas where additional research would provide valuable information for determining best practices were highlighted.

Psychometric Properties of the Person-Centered Version of the Alcohol and Alcohol Problems Perceptions Questionnaire (PC-AAPPQ).

AIMS: Given the importance of addressing provider attitudes toward individuals with unhealthy alcohol use and the current emphasis on person-centered language to help decrease stigma and mitigate negative attitudes, the aim of this study was to evaluate the psychometric properties of a contemporary version of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) that uses person-centered language and addresses the spectrum of alcohol use. METHODS: The authors created a person-centered version of the AAPPQ (PC-AAPPQ) and conducted a cross-sectional study of its psychometric properties in academic settings in the Northeastern United States. The PC-AAPPQ was administered to 651 nursing students. Reliability analysis of the new instrument was performed using the total sample. Only surveys with complete data (n = 637) were randomly split into two datasets, one used for the exploratory factor analysis (EFA) (n = 310) and the other for confirmatory factor analysis (CFA) (n = 327). RESULTS: Compared to all the models generated from the EFA, neither the original six-factor structure nor the five-factor structure was superior to any of the other models. The results indicate that a seven-factor structure with all 30 items is the best fit for the PC-AAPPQ. CONCLUSIONS: The PC-AAPPQ represents a positive effort to modernize the four-decade-old AAPPQ. This 30-item instrument, which adds one additional subscale, offers a means to assess providers' attitudes using respectful wording that avoids perpetuating negative biases and reinforces efforts to affirm the worth and dignity of the population being treated.

Substance Use and Exposure to Adverse Childhood Experiences in Undergraduate and Graduate Nursing Students[Formula: see text].

BACKGROUND: Substance misuse remains a public health crisis and contributor to morbidity and mortality. The nursing workforce is not immune to the impacts of substance misuse as rates are thought to mirror those of the general population. Additionally, as substance misuse often begins in adolescence or early adulthood, prevalence of misuse among practicing nurses highlights the fact that students are also at risk. OBJECTIVES: The purpose of this study was to examine rates and patterns of substance use and adverse childhood experience (ACE) exposure among nursing students while also examining associations between substance use and ACE exposure. METHOD: This study utilizes a cross-sectional and descriptive design through the provision of email surveys to nursing students. Email surveys consisting of the Alcohol Use Disorders Identification Test, the Drug Abuse Screening Tool 10-item survey, the ACE Questionnaire, and a demographic inquiry were distributed via Qualtrics survey software. RESULTS: A total of 662 individuals participated in the survey, the majority of whom self-identified as female, were undergraduate students, and were between 18 and 21 years. Moderate- to high-risk alcohol use was identified in 20% of students, while moderate- to high-risk drug use was identified in 3.6% of students. More than half of students endorsed exposure to at least one ACE. Significant associations were found between the Drug Abuse Screening Tool 10-item survey and the ACE Questionnaire. CONCLUSIONS: The results of this study have significant implications for nursing educators and must inform groundwork for the development of policies and interventions that are evidence based, nonpunitive, and trauma informed.

Screening, brief intervention, and referral to treatment (SBIRT) education of residential care nursing staff: Impact on staff and residents.

Approximately 40% of older adults drink alcohol. Older adults living in community care residences are a vulnerable population at risk for alcohol use related problems especially for those age 65 years and older who are taking medications, have health problems, and have risky alcohol consumption. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach for individuals at risk for alcohol use disorders. A quality improvement project evaluated SBIRT education effects on nursing staff knowledge and attitudes related to alcohol use, and resident alcohol use. The staffs' SBIRT knowledge and alcohol related attitudes increased significantly. The staff documented SBIRT intervention 231 times in three months' post training.

Can Screening, Brief Intervention, and Referral to Treatment Education and Clinical Exposure Affect Nursing Students' Stigma Perception Toward Alcohol and Opioid Use?

BACKGROUND: Alcohol and/or opioid stigma perceptions are barriers to screening, brief intervention, and referral to treatment (SBIRT) implementation. AIM: To examine SBIRT education and clinical exposure efficacy at decreasing nursing students' stigma perceptions toward caring for patients affected by alcohol and/or opioid use problems. METHOD: A single-sample, pretest-posttest design with N = 124 nursing students. The students had a 1.5-hour SBIRT education session and a 12-week clinical experience with some patients who had alcohol and/or opioid use problems. RESULTS: The participants' stigma perceptions improved toward patients who had alcohol and/or opioid use problems. CONCLUSIONS: SBIRT education and clinical exposure may provide a basis for promoting understanding of alcohol and/or opioid use-related stigma and can be used as an intervention to decrease some of stigma's negative effects.

Integration of Medication-Assisted Treatment Information for Opioid Use Disorders Into a Graduate Nursing Curriculum.

PURPOSE: The United States is in the midst of an unprecedented public health crisis, with annual morbidity and mortality data related to opioid use consistently increasing and appearing more worrisome. To mitigate such consequences, it is critical that those with opioid use disorders are provided with and have access to evidence-based treatment modalities. METHODS: The project utilized a course scaffolding approach to integrate a comprehensive substance use framework into an advanced practice nursing curriculum, with an emphasis on medication-assisted treatment as part of an advanced pharmacology course required for licensure. RESULTS: Students' knowledge assessment increased significantly, from an average of 2.82 to 3.78 out of 5 items, t(217) = -10.31, p < .01. CONCLUSIONS: Educators and academic administrators must be steadfast in their resolve to include substance use, and specifically opioid use, education into all areas and levels of nursing study.

Effect on Dental Hygiene Students of a Substance Use Simulation Conducted with Nursing Students.

Dental professionals have an opportunity to screen for substance use, provide targeted feedback based on patients' oral health, provide patient education, and refer for further assessment as needed. The aim of this study was to assess the impact on dental hygiene students of an interprofessional Screening, Brief Intervention, and Referral to Treatment (SBIRT) educational intervention with standardized patients as a tool for initiating discussions on alcohol and drug use with patients. Starting in 2015, dental hygiene students in two classes at the University of Pittsburgh participated with nursing students in one and a half hours of didactic instruction followed within a ten-week period by SBIRT simulation scenarios utilizing standardized patients, with subsequent debriefing of students by faculty. Students' attitudes were assessed before and after the didactic session and immediately after the SBIRT simulation, using the Alcohol and Alcohol Problems Perceptions Questionnaire and the Drug and Drug Problems Perceptions Questionnaire. All 67 dental hygiene students in the program at the time participated in the educational intervention and surveys. The results showed significant positive changes in role security, defined as the acceptance of SBIRT delivery as part of their role identity as dental hygienists, following the intervention. This study found that the IPE intervention with dental hygiene and nursing students improved the dental hygiene students' attitudes through using SBIRT.

Changing BSN Students' Stigma Toward Patients Who Use Alcohol and Opioids Through Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training: A Pilot Study.

BACKGROUND: Stigma associated with substance use is considered a barrier to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) and assisting patients to receive appropriate treatment. OBJECTIVES: To test the efficacy of SBIRT education and training in changing undergraduate nursing students' attitudes about working with patients who have problems with alcohol and opioid use. DESIGN: A sample of 49 undergraduate nursing students were surveyed, using five subscales, at three time points. RESULTS: After a 15-week semester that included (a) SBIRT education and (b) weekly clinical experiences with patients who had alcohol use problems the undergraduate nursing students' stigma decreased as measured by three of the five subscales. The students' attitudes toward working with patients who had opioid use problems exhibited favorable change as measured by four of the five subscales. CONCLUSION: SBIRT education and training for undergraduate nursing students might help mitigate some of their stigma toward working with patients who have mild to moderate alcohol and opioid use problems.

An Environmental Scan of the Role of Nurses in Preventing Fetal Alcohol Spectrum Disorders.

Nurses are in an ideal position to talk to their patients of reproductive age about alcohol use and encourage the prevention of alcohol-exposed pregnancies. Effective conversations can be efficiently included in the clinical encounter to identify alcohol misuse and offer appropriate follow-up. This report presents results of an environmental scan of resources relevant to nursing professionals and nurses' role in addressing alcohol misuse. Gaps in nursing education and practice guidelines with regard to defining the nursing role in preventing alcohol-exposed pregnancies were revealed. Findings identified a need to promote adoption among nurses of evidence-based preventive practices to prevent alcohol misuse.

Creative Learning Through the Use of Simulation to Teach Nursing Students Screening, Brief Intervention, and Referral to Treatment for Alcohol and Other Drug Use in a Culturally Competent Manner.

INTRODUCTION: Cultural competency is an integral component in undergraduate nursing education to provide patient-centered care and addressing patients' cultural differences. Students need to consider the prevalence of alcohol and other drug use/misuse in patients from all cultures. This project combines cultural competency education, simulation, and educating students to use screening, brief intervention, and referral to treatment for alcohol and other drug use. METHOD: Culturally diverse simulation scenarios were developed and used in the simulation lab with students to reduce stigma surrounding other cultures while learning an evidence-based practice to screen and intervene with patients who use/misuse substances. RESULTS: Results show students value simulation and 91% of the students felt that they were able to apply culturally competent knowledge after the simulation experience. DISCUSSION: Cultural competency principles can be embedded in teaching the broader evidence-based practice of screening, brief intervention, and referral to treatment with undergraduate students. This is a replicable teaching methodology that could be adapted in other schools of nursing.

Undergraduate Nursing Students' Perceptions of Individuals With Drug Use Problems: Confirming the Factor Structure of the Drug and Drug Problems Perception Questionnaire.

The Drug and Drug Problems Perception Questionnaire (DDPPQ) is a multidimensional instrument that measures healthcare providers' attitudes toward working with patients who use drugs. Five- and six-subscale versions of the DDPPQ have been published. Although the reliability of the DDPPQ subscales was reported to be satisfactory, the factor structure of either version was not validated by a confirmatory factor analysis. The aim of this study was to examine the internal factor structure of the 22-item DDPPQ instrument using a sample of undergraduate nursing students. This study was a secondary analysis that utilized baseline data from the Addiction Training for Nurses using Screening, Brief Intervention, and Referral to Treatment Program. The DDPPQ was administrated during the undergraduate nursing students' junior year in a single university setting in southwestern Pennsylvania. A sample of 473 students was used in this study. The sample was split equally to conduct both principal component analysis (n = 237) and confirmatory factor analysis (n = 236). On average, the sample had a mean age of 22.9 years and was predominantly female (87.2%) and Caucasian (90.9%). A principal component analysis revealed that a five-factor structure had the best fit after the removal of two items. Reliabilities of the five subscales ranged from α = .696 to α = .904. Thus, a five-factor structure with removal of Items 9 and 19 is recommended when using the DDPPQ with undergraduate nursing students.

Exploring medical students' conceptions of substance use: A follow-up evaluation.

BACKGROUND: Despite the devastating impact of alcohol and other drug involvement and misuse within society, medical students still receive very limited exposure to these issues. The Scaife Advanced Medical Student Fellowship in Alcohol and Other Drug Dependency, offered by the Institute for Research, Education and Training in Addictions for over 10 years, offers a unique, 3-week intensive educational experience, including didactic, observation, and experiential learning in these topics to first-year medical students. The goal of this project was to evaluate the impact of the Scaife Fellowship on medical students' attitudes toward patients with alcohol and other drug involvement 1 to 5 years after completion of the experience. METHODS: Past Scaife students and individuals who applied but did not attend were located and recruited to participate in an online attitude survey. RESULTS: Results indicated that Scaife Fellowship students largely retain their sense of role security around working with patients with alcohol and other drug involvement at the follow-up time point. Although therapeutic commitment or the motivation to work with these patients decreased for drug use, the decrease was smaller than that typically noted in the literature. The group of comparison students showed lower scores on both subscales at the evaluation time point compared with Scaife students. CONCLUSIONS: A three-week experiential program significantly improved medical students' Role Security and Therapeutic Commitment toward working with patients with substance use disorders. Moreover, the positive effects gained from the program were sustained over time.

Appropriate Use of Drug Testing in Clinical Addiction Medicine.

: Biological drug testing is a tool that provides information about an individual's recent substance use. Like any tool, its value depends on using it correctly; that is, on selecting the right test for the right person at the right time. This document is intended to clarify appropriate clinical use of drug testing in addiction medicine and aid providers in their decisions about drug testing for the identification, diagnosis, treatment, and recovery of patients with, or at risk for, addiction. The RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) process for combining scientific evidence with the collective judgment of experts was used to identify appropriate clinical practices and highlight areas where research is needed. Although consensus panels and expert groups have offered guidance on the use of drug testing for patients with addiction, very few addressed considerations for patients across settings and in different levels of care. This document will focus primarily on patients in addiction treatment and recovery, where drug testing is used to assess patients for a substance use disorder, monitor the effectiveness of a treatment plan, and support recovery. Inasmuch as the scope includes the recognition of addiction, which often occurs in general healthcare settings, selected special populations at risk for addiction visiting these settings are briefly included.

Educating Emergency Department Registered Nurses (EDRNs) in screening, brief intervention, and referral to treatment (SBIRT): Changes in attitudes and knowledge over time.

Alcohol and other drug (AOD) diagnoses in the ED co-occur with injury-related presenting conditions including: falls, motor vehicle accidents, poisonings, and both intentional and unintentional injuries. Clinical attention to ED admissions resulting from hazardous AOD use can significantly improve patient care and reduce high cost utilization of ED visits and treatment. The EDRN-SBIRT project is designed to improve the knowledge and attitudes of ED nurses working in a large academic medical center to identify and address risky AOD use as it relates to an ED visit. ED nurses' knowledge and attitudes toward patients with AOD use can be improved through SBIRT education. SBIRT education can establish an evidence-based standard of nursing practice to improve healthcare outcomes, but it must be reinforced with ongoing ED review and supportive educational sessions until practice is firmly established.