Understanding the characteristics of research participants is crucial to ensuring sample representativeness and generalizability of findings to broader patient groups with substance use disorders. Using anonymous computer-administered health survey data, the present study had a unique opportunity to compare patients who chose to participate in an RCT for heavy/problem drinking or drug use (N=713; consenters) with those that chose not to participate (N=625; non-consenters). The sample was 40% male, 76% African American, and had a mean age of 45.2 years. Using multivariate regression, the most parsimonious model found older age, unemployment, prescription misuse, positive screen for drug problems (CAGE), having a grandmother with an alcohol problem, trouble falling asleep (past 30 days), health professional recommendation to go on a diet, and feeling unsafe due to a previous partner were all associated with consenting to participate. The present study provides benchmark data on sample representativeness in a clinical trial of SBIRT.

Indiana University-Purdue University Indianapolis (IUPUI) / More than 20 million people in the United States have a substance use disorder, resulting in negative individual and societal outcomes. An evidence-based intervention, Screening, Brief Intervention, and Referral to Treatment (SBIRT), involves screening patients to assess for substance use and then providing a brief intervention and referral to treatment when indicated. This evidence-based intervention is underutilized in healthcare settings. The purpose of this dissertation was to contribute to the body of evidence regarding the implementation of SBIRT in healthcare settings. Specifically, the aims of this dissertation were to 1) provide an overview of the evidence regarding the use of implementation strategies to facilitate the implementation of SBIRT, 2) describe implementation of SBIRT by nurses in acute care hospitals, and 3) examine individual and organizational characteristics associated with the intra-organizational adoption of SBIRT. To review the literature, a scoping review was completed on 18 articles that met the inclusion criteria. The review found that leaders often train and educate stakeholders to facilitate the implementation of SBIRT, but less attention has been given to adapting the intervention or engaging patients. Additionally, implementation efforts led to increases in screening, but the evidence regarding the effect on brief intervention is inconclusive, and evidence regarding referral to treatment is scarce. Eighteen nurses participated in a qualitative descriptive study of the implementation of SBIRT, and data were analyzed using content analysis. Participants identified barriers and facilitators associated with the nurses’ attitudes and beliefs about SBIRT, organizational factors, and patients’ response to the SBIRT process. Participants indicated that SBIRT was a useful intervention that was best implemented by providing a clear process and incorporating SBIRT into an established workflow. To examine factors related to intra-organizational adoption of a tool to screen patients for substance use, two hundred twenty-two nurses participated in a crosssectional study. Results of this study indicate that training and the perception of peer usage of the intervention were significantly related to individual nurses’ use of the intervention in practice. The findings of this dissertation can inform research and practice regarding the implementation of SBIRT in healthcare settings.

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Purpose The Johnson City Downtown Day Center (JCDDC) provides integrated inter-professional primary care, mental health, and social work case management services to homeless and under-served persons who have difficulty accessing traditional systems. Because of the exponential rise in substance abuse in the Appalachian region, the JCDDC providers and staff initiated SBIRT as recommended standard of care, as endorsed by SAMHSA, United States Public Health Services Task Force, and the National Institute on Alcohol Abuse and Alcoholism. The JCDDC has two mechanisms by which patients can choose to participate in substance abuse treatment: SMART Recovery, and psychiatric nurse practitioner (NP) referrals. The purpose of the project evaluates use of SBIRT at the JCDDC by determining process of (1) referral and (2) follow-up rates of those who received SBIRT; analyzing outcomes by measuring numbers of: (1) screens administered; (2) brief interventions; (3) positive screens; (4) referrals to either SMART Recovery or to the psychiatric NP; (5) participation in one follow-up. Review of Literature: Approximately 6.4 million people, or 2.4% of the U.S. population 12 years and older, currently misuse prescription medications. There is an undeniable and tangible correlation between the chronic disease of substance use disorder and unstable housing or homelessness (de Chesnay & Anderson, 2016). Similarly, substance use disorder was found to be much more common in people facing homelessness than in people who had stable housing (National Coalition for the Homeless, 2009). Substance Abuse and Mental Health Services Administration (SAMHSA) has been the most significant funding source for SBIRT proliferation in the United States. Despite a demonstrated need for substance abuse services among this vulnerable population, people who are homeless have substantially greater barriers to obtaining treatment and often go without. Summary of Innovation or Practice The current SBIRT process includes use of DAST-10 and AUDIT tools. Evaluating clinic processes and outcomes in vulnerable populations who have inconsistent erratic follow-up is challenging. However, new ways of understanding patterns and incremental outcomes is essential to addressing clinic practice that can impact outcomes in vulnerable groups. Implications for NPs The heterogeneity of the homeless population is often precipitated by a host of complicating factors including co-occurring mental illness, multiple chronic conditions, unstable income, and lack of transportation. Therefore, the importance of finding effective, cost-conscious processes that are population specific and patient-centered is essential for future research and policy. The inter-professional model of care also informs future practice by evaluating the feasibility of administering all of the elements of SBIRT in a single facility.