The impact of SBIRT and dedicated alcohol and drug counseling for domiciled and homeless patients in the emergency department

Objectives Evaluate the impact of a new program of SBIRT by a dedicated certified alcohol and drug abuse counselor (CADC) for emergency department (ED) patients. Methods A year-long prospective, longitudinal study of patients identified by their treating clinician and referred to the CADC, who conducted SBIRT, motivational interviewing, and outpatient referral. Demographics, encounter details, and additional ED visits were recorded. Results There were 294 patients, 39% with psychiatric concerns, 34% with alcohol/drug-related issues, or 27% with medical illness/injury. The most common substance use disorders were alcohol (40%) and methamphetamine (27%). For patients with high rate of recidivism, the average number of visits 6 months pre- and post-intervention decreased 67%. Homeless patients accounted for 45% and were more likely to be placed into a recovery program than domiciled patients (OR = 2.34). Despite screening positive, 45% of total patients were not given a discharge diagnosis related to substance use disorder by their treating clinician. Conclusion A new program of SBIRT by a dedicated CADC had a positive impact, providing a much-needed service that did not previously exist. This type of program has potential to decrease ED utilization, crowding, and length of stay for patients with substance use disorders.