Partnership of 5 New Hampshire schools aims to impact state’s high rate of substance abuse
Substance abuse rates in New Hampshire are significantly higher than national averages. The state has the highest synthetic opioid death rate in the country. Alcohol consumption rates in the state are also much higher than the national average. Of the more than 100,000 people in need of treatment for the disease of addiction in New Hampshire, only between four and six percent get that treatment.
A new initiative by The Dartmouth Institute for Health Policy and Clinical Practice and the New Hampshire Area Health Education Center (AHEC) is hoping to make inroads in the state’s substance abuse crisis. The initiative, known as the New Hampshire SBIRT Inter-Professional Education (IPE) Training Collaborative, includes five local colleges and universities: Antioch University New England, Franklin Pierce University, the Geisel School of Medicine at Dartmouth, MCPHS University, and the University of New Hampshire. Its focus is on training health care professionals to quickly and effectively screen for patients who are abusing, or may be at risk of abusing, drugs or alcohol using a method call Screening, Brief Intervention, Referral to Treatment (SBIRT).
SBIRT is unique in its approach in that it’s designed to identify substance abuse at risky levels, with the goal of reducing and preventing disease, accidents or injuries that might result because of someone’s use of drugs or alcohol. For example, even if someone is not physically dependent on alcohol, people who drink above the recommended guidelines—up to one drink per day for women and up to two drinks per day for men—face a number of health risks. SBIRT provides the opportunity to intervene with the “risky” drinker or “casual” drug user before their substance use leads to more serious consequences.
“Much of the focus has been at the later stages of this problem: chronic addiction, overdoses and fatalities. We want to help health care professionals concentrate their efforts at the front end,” said Kristina Fjeld-Sparks, director of NH AHEC and of the NH SBIRT IPE Collaborative, and a Dartmouth Institute MPH ’08 alumna.
People with drug and alcohol addiction come in contact with the health care system in a variety of ways, Fjeld-Sparks says, adding that her husband, an orthopedic surgeon at Dartmouth-Hitchcock Medical Center, regularly sees drug-addicted patients with joint infections and other orthopedic problems in his practice. SBIRT is designed not only to help health care professionals assess those at risk, but also to work effectively with colleagues to successfully intervene and refer patients to treatment if needed.
“There is a common misconception that health care providers —doctors, nurses, pharmacists, or others—just instinctively know how to talk to people about substance abuse, but that’s really not the case for most of us,” Fjeld-Sparks said. “After all, how would you know, if you hadn’t received enough, or any, training?”
During its first year, the collaborative has trained 303 future doctors, nurses, pharmacists, physician assistants, clinical mental health counselors, and social workers in SBIRT. The goal is to train about 1,000 students in three years (2016-2019).
John Damianos, a first-year medical student at Dartmouth’s Geisel School of Medicine, who is well-versed in SBIRT techniques, says one of the things that makes SBIRT so effective is its emphasis on non-judgmental, non-confrontational dialogue and interaction that is based on each individual’s unique circumstances.
“You’re not there to lecture patients or push information on them,” Damianos said. “Instead, you try to find out their individual story and learn more about how they think alcohol or drugs may be affecting their life.”
Each school in the collaborative has committed to incorporating SBIRT training, developed by Substance Abuse and Mental Health Services Administration (SAMHSA), into their core curriculum. They’re also working to make the training accessible to a wide array of current and future health care professionals though online training modules and inter-professional activities.
“Only a cardiac surgeon can cut into a patient’s heart and, similarly, there are certain things only a nurse can do, or only a pharmacist can do,” Damianos said. “But SBIRT is a common skill and a common language that we can all use to help someone who is interested in changing their behavior. It’s a very exciting part of being a health care professional.”
With substance use costing New Hampshire approximately $2 billion annually in lost worker productivity and earnings, health care costs, public safety and criminal justice expenses, the partners in the collaborative think training the next generation of health care professionals is a wise use of the resources and a highly effective way to get more people who need it into treatment.
“A lot of individual, community, state and federal resources are being spent on substance abuse,” Fjeld-Sparks said. “For a relatively modest investment, this effort has the potential to have a big impact on identifying substance misuse early, hopefully before the patient becomes addicted. It can save lives.”