Implementing the NIAAA Guide in Primary Care Clinics

After two years, it finally feels like things are coming together. Allina Health continues to be a great place to try out new ideas for addressing alcohol and pain, across hospitals and clinics. I've been able to recruit up to three primary care clinics in the SBIRT+ project, which is focused on addressing alcohol in primary care. (SBIRT+ stands for Screening, Brief Intervention and Referral to Treatment, Plus Point of Service Care. Point of service care reflects treatment for alcohol dependence (not just at-risk drinking) in primary care. The NIAAA Clinician's Guide uses this model.) Allina is also developing a collaborative care model at a pilot clinic and I expect to be involved in that effort, which is focused on coordination of care and reduction in preventable hospitalization for patients with complex chronic illnesses. Heavy drinking is common among people with chronic diseases who demonstrate high cost and poor outcomes. To reach the goals of reducing costs and improving outcomes requires addressing drinking and other co-morbidities such as depression in addition to improving care for their other chronic medical conditions.

This is a very ripe time for new ideas. Health care clinicians are disillusioned with the time-limited rehab system, where there is only one option that doesn't change even after repeatedly showing lack of effectiveness. They want guidance on what to do next. They are intrigued by the NIAAA Guide's clear guidelines for addressing heavy drinking across the spectrum of severity (from risk drinking to functional dependence to severe recurrent dependence) and by medical treatment options, especially anti-relapse medications. Contrary to what many in the addiction treatment field believe, doctors and other primary care clinicians want very much to help but have pretty much been told to "leave it to the addiction experts," which for the most part means counselors alone, and for relatively short periods. However, the patients spend much more time in primary care than they do in any treatment programs.

In the last week, I've presented SBIRT+ at two primary care clinics, and in the next week I'll be talking to two or three more. I'll fill you in as I go.

MW