The results of research into the causes and effects of addiction are rarely transformed into clinically applied practices. While advances have been made in the development of opioid antagonists and agonists, much of the protocol used in addiction medicine is more policy-oriented than the results of experimental studies (Babor. Boca & Bray, p. 110). Addiction is such a complex and multifaceted disorder, with so many comorbid conditions, that the transition from theory to practice is particularly complicated. The country is currently undergoing an epidemic of abuse and misuse of opioid drugs such as heroin, oxycodone, and fentanyl that is crippling to the social and economic structures of many communities. It is urgent that the addiction science community work as efficiently as possible to contribute clinically applicable tools toward the prevention and treatment of the devastation of addiction.

Babor, Del Boca and Bray (2017) constructed a study to evaluate the usefulness of a diagnostic and concentrated treatment protocol in the outcome of treatment for addiction. The basis for the Screening, Brief Intervention and Referral to Treatment (SBIRT) formed when the shame-based views of addiction as a moral weakness were yielding to the theory that alcoholism (specifically) was a disease or disorder. Screening tools were developed to identify individuals at high risk for dangerous drinking and a wider spectrum of health providers, such as primary care doctors, became involved in the diagnosis and treatment of addiction disorders. The World Health Organization (WHO) had success with brief intervention (BI), which supported the use of correctly timed minor interventions in altering participants’ abusive use of alcohol. The success that the WHO has recorded with the use of BI on mitigating addictive behavior has led to the implementation of early and brief intervention programs in many countries. In 2003, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) awarded grants for the evaluation of the efficacy of SBIRT in six states and an indigenous community (Babor, Del Boca & Bray, 2017, p. 111).

Participants who screened positive for treatment in the SBIRT program cohorts formed a specific demographic picture. The participants tended to be white, middle-aged and female. Alcohol was the substance of choice for the majority of participants (74.4% in cohort 1 and 80% in cohort 3), although illegal substance use was also high (41.8% in cohort 1 and 45.8% in cohort 3), with, of course, some overlap between the two (Babor, Del Boca & Bray, 2017, p. 112). It is important to gain an idea of who is motivated to utilize a program like SBIRT, both to shape community outreach to the correct audience and to be able to gauge the impact of the intervention upon the overall health of the community. Of course there are almost certainly confounding factors that influence the demographic characteristics of the participants; further study and additional study should remove some of these from the analysis.

In the initial implementation of the SBIRT programs, the seven grant recipients established the protocol in an assortment of health provider sites, in order to integrate addiction and abuse treatment into various general healthcare spectrum. In addition to evaluation of effects in individual centers, a cross-site study was initiated by SAMHSA which compared outcomes, cost, and content of the program at different locations. Investigators used a mixed method approach to measuring the values of these three variables. Additional methodological approaches were taken to evaluate the degree of adherence to the SBIRT protocol by providers and the amount of time actually spent (real time) on various SBIRT activities (Babor, Del Boca & Bray, 2017, p. 113).

While no causal connection between SBIRT and mitigated substance use and abuse could be established from the results of this study, statistically significant drops in measures of alcohol and drug use were found post-treatment. SAMHSA recorded participant data about substance use and abuse at admittance, discharge, and six months following discharge for each participant. These data indicate a significant reduction in the use of alcohol and drugs (72% and 80% respectively). Although the study design lacked certain features necessary to disproving a null hypothesis, such as a control group, investigators were able to use modeling statistics to control for data anomalies, and experience an appropriate degree of confidence in the correlations.

The SBIRT program was designed to screen large numbers of individuals who are at risk for substance use and abuse, identify those that need further evaluation, and provide an intensive and efficient treatment protocol that appears to be effective. Over the course of the first two cohorts’ administration of SBIRT, more than one million patients were screened, with a significant percentage of these being referred for treatment (Babor, Del Boca & Bray, 2017, p. 115). SAHMSHA has funded 3 cohorts using SBIRT, and plans to continue supporting its implementation and evaluating its effectiveness. If SBIRT can provide a cost effective, quick and successful method of treating substance abuse disorders, then it should receive support from the mental health community. Professionals in the counseling community will welcome a rigorous and solidly-based program to use in the struggle to rescue patients from the hell that is substance abuse and addiction.