Curriculum

Among Americans aged 18 and older, around 5% or 10 million are dependent drinkers, and 20% or 40 million are at-risk drinkers. Alcoholism is the leading cause of morbidity and mortality in the U.S, and more than 100,000 alcohol related deaths are reported each year. No day goes by without ED providers caring for patients with a broad range of health consequences from at-risk and dependent drinking (drinking and driving crashes, falls and head trauma, alcohol coma/poisoning, frostbite, GI bleeding, pancreatitis, neuropathy, alcohol withdrawal and seizures). Marijuana use among 10th through 12th graders was 15% in 2006. Among high school seniors, 10% used Vicodin, and 4.3% used Oxycontin. Among adults, 8% of the population used illicit drugs in the last month. The ED offers an opportunity or “teachable moment” for facilitating change and improving the care of patients with unhealthy alcohol and drug use. Yet even at our best we are often frustrated by time restraints and lack of support to do the right thing for these patients, and at our worst we can be angry and punitive because we blame patients for abusing themselves.

Motivational interviewing (MI) has been demonstrated in multiple peer reviewed studies to be an effective method to facilitate behavior change among smokers, unhealthy alcohol and drug users, and others with high risk behaviors. The BNI, Brief Negotiation Interview is an adaptation of MI to brief encounters in the clinical setting.   The acronym BNI-ART stands for brief negotiated interview and the art of referral to treatment--a new set of techniques designed to improve clinician' communications with patients about drug and alcohol use.

The curriculum consists of: 1) a slide show addressing the background, rationale and evidence for SBIRT(Screening, Brief Intervention and Referral to Treatment.); 2) a series of interactive videos demonstrating the BNI algorithm; 3) role play case scenarios for one on one practice; 4) hands on supervised practical experience in our ED; and 5) technical assistance in implementing a sustainable collaborative model to support ED staff to improve the care of patients with high risk and dependent drinking and illicit drug use.
This web site was originally funded in part by an R 25 Alcohol Education Project grant from the NIH, National Institute for Alcohol Abuse and Alcoholism, and Substance Abuse and Mental Health Service Administration. It is also supported by supported by ENA, ACEP and SAEM and a recent initiative by the Massachusetts Department of Substance Abuse Treatment. Its goal is to promote the adoption of screening, brief intervention and referral to treatment (SBIRT) among emergency department (ED) providers

The website includes educational materials that demonstrate quick and effective methods for screening, motivational interviewing and referral. These materials are derived from fifteen years experience and from peer review journals (see bibliography), Chapter 295 of Tintinalli’s Emergency Medicine: A comprehensive study guide, and from the film The Emergency Physician and the Problem Drinker by Drs. D’Onofrio, Bernstein and Bernstein.