SBIRT-VA was developed to identify substance abuse problems among veterans applying for disability compensation for PTSD. SBIRT-VA involves assessing substance use and other risky behaviors and briefly counseling the veterans to participate in the appropriate level of care. It involves a brief intervention tailored to the veteran's level of substance use, focused on increasing insight into the role of substance use, fostering motivation to make behavioral changes, and accepting a referral to treatment. A key aspect of SBIRT is the addition of screening and VA treatment into the existing VA system for conducting Compensation examinations. SBIRT-VA provides early intervention for at-risk veterans before more severe consequences occur.
The therapist uses Motivational Interviewing methods to encourage veterans to engage in treatment. As prescribed in Motivational Interviewing, the therapist adopts a supportive, empathic stance to help veterans explore ambivalence about treatment. SBIRT-VA consists of one 60-minute intervention session conducted at the VA after the veteran has completed the Compensation and Pension evaluation. At the veteran's request, the therapist will be available for a phone session and/or repeat visit, but the focus of the intervention is on facilitating transition to treatment.
Screening, Brief Intervention and Referral to Treatment with Pain-Management advice (SBIRT-PM) adapts traditional SBIRT by targeting both pain and substance use. It begins with a pain management portion to address the Veteran's presenting complaint by explaining that pain management involves trying to improve overall functioning using physical and psychological approaches. The counselor asks the Veteran which conditions he/she has filed a disability claim for and explains VA resources available for these conditions generally and for pain management specifically. Then, as part of the combined physical and psychological appraisal, standard SBIRT is conducted. SBIRT-PM will be delivered using the Motivational Interviewing stance and techniques typical of SBIRT. Capitalizing on Veterans’ goal of relief from pain, SBIRT-PM fosters Veterans’ motivation to change and reduce substance use.
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