'Asking' but Not 'Screening': Assessing Physicians' and Nurses' Substance-Related Clinical Behaviors

Screening, brief intervention, and referral to treatment (SBIRT) is a promising public health approach for problematic substance use. A core component of SBIRT is the use of formal screening tools to categorize a patient's likely level of risk in order to provide an appropriately-matched service. Training in formal screening is included in many SBIRT training programs, but infrequently is emphasized.

To assess pre-training levels of SBIRT-related clinical behaviors, including screening, this study examined a secondary dataset collected from internal medicine residents and graduate nurse practitioner students.

Learners (n = 117) completed 13 self-report items assessing use of SBIRT-related behaviors. Researchers used exploratory factor analysis to identify underlying concepts in the questionnaire, then used mixed ANOVA to compare mean frequency of utilization of each factor (asking, screening, and intervening) by academic program.

Learners reported asking about substance use frequently, intervening some of the time, and infrequently using formal screening tools. Interaction and between-academic-program effects were significant but small.

Prior to SBIRT training, most clinical practitioners reported asking patients about substance use, but few reported regularly using formal substance use screening tools. This may have implications for the importance of SBIRT training as part of curricular work, and for the internal content foci of SBIRT curricula.