(Note: this guest post was written by Mallori De-Salle, Outreach Coordinator and Lead SBIRT Trainer, Indiana Prevention Resource Center)
I hate thinking about what I’m not doing ‘right’ when it comes to my health. I eat pizza. I’m not overweight, so it must not be a problem. I add salt to my food (without tasting it). I don’t have high blood pressure, so it must not a problem. I drink coffee in the morning, mid-day, and sometimes in the evening. I still sleep, so it must not a problem. This is my logic when deciding if I have to make a change. If it isn’t a problem, I don’t think about the health behavior at all. So, why should I care about how much alcohol I drink, if it’s not a problem?
Does this sound familiar? It’s not a problem, so why even think about it? Is the lack of highly problematic symptoms of an illness the only way to measure the existence or severity of a health problem? Or could we as an “illness focused” culture be missing an opportunity to focus on wellness instead of lack of illness?
For decades, our healthcare system has operated under the belief that “health” is defined through the absence of symptoms. In other words, concerns aren’t addressed or even considered a problem until the symptoms can be diagnosed. But, is it possible that problems exist on a wider spectrum? Is it possible that you or I could improve our health by reducing our risks even before problems are visible? Think about using a seat belt. Most of us wear seat belts automatically. It’s a habit (thank you public health) that we no longer think about. We wear seat belts, but not because it makes us better drivers or because we plan to crash. We wear seat belts as prevention because it lowers our risk IF we experience a situation where harm is possible. Not wearing a seat belt increases your “risk” for harm, even in minor vehicle incidents and most importantly, in severe circumstances. Wearing a seat belt doesn’t remove the risk of crashing; it reduces the risk of harm WHEN a crash occurs. Seat belts lower risk for a problem that doesn’t even exist yet.
Seat belts are fairly concrete (actually they are fabric, but you understand). However, other health behaviors, such as alcohol or substance use, can be more abstract. What if we look at alcohol or substance use as a health behavior that can either increase or decrease our risk for experiencing harm, much like our current views on seat belts? Public health is back again with a new preventive practice to do just that!
SBIRT, or Screening, Brief Intervention, and Referral to Treatment, is a public health approach which changes how we view alcohol use. Instead of simply looking for indications of diagnosable problems, it examines all levels of use and how use impacts all levels of wellness. This suggests that wellness can be enhanced by understanding that health is not simply the absence of illness. SBIRT asks all patients (even the little neighbor lady down the street) annually about their alcohol or substance use. Doing so helps increase the chances that a person considers how their level of use is influencing their quality of health. SBIRT is not a diagnostic process, but instead a conversation that helps support intrinsic motivation for behaviors that support wellness and not just the avoidance of illness (in this case, addiction). SBIRT, like all other new movements, viewpoints and culture shifts (remember how people hated seat belts at first?) takes time to feel comfortable. Once it is in place, everyone starts to think, “Why haven’t we been doing this?” So, buckle up! SBIRT is taking the driver’s seat and letting us know that improving our health, wellness, and happiness is why we should care.
For more information on SBIRT or to download KHC’s toolkit for primary care providers, click here.