Implementation of Screening, Brief Intervention, and Referral to Treatment in a Rural Outpatient Behavioral Health Clinic

Substance use disorders are associated with significant disability and mortality in the United States. Treatment for substance use disorder is effective; however, screening is not a common practice in medical or psychiatric outpatient clinics. At a rural ambulatory behavioral health clinic, patients were not being screened for alcohol and drug misuse despite recommendations by the U.S. Preventive Services Task Force and the National Institute of Drug Abuse. This quality improvement project aimed to provide screening, brief intervention, and referral to treatment training for providers for new adult patients 18 and older presenting for initial medication management with the Alcohol Use Disorders Identification Tool (AUDIT) and Drug Abuse Screening Tool (DAST). Data were collected using a chart review to identify the incidence of patients with a positive AUDIT or DAST score and to identify if appropriate brief interventions were conducted or referrals placed. Fifty-two patients were screened. Seven patients had a positive DAST screening, four scored a one but <3, and two scored >3, representing substance use, and someone using substances at this level has experienced negative effects. Evaluation of the AUDIT tool screening identified five patients with a score of >8, representing harmful consumption or likelihood of dependence. Outpatient clinics should train all providers on the proper technique for screening, brief intervention, and referral to treatment with reliable and valid tools for patients seeking care to meet the U.S. Preventive Services Task Force and the National Institute of Drug Abuse recommendations to identify at-risk patients.