Linking substance abuse treatment and public health: Identification and early intervention in STD clinics

Issue: Twenty percent of New York City (NYC) Sexually Transmitted Disease (STD) clinic patients screened positive for alcohol or other drug (AOD) abuse but less than 2% reported receiving treatment. Description: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice to identify and intervene with risky AOD users in general health-care settings. Project LINK, a Substance Abuse and Mental Health Services Administration funded program, pioneered the SBIRT model in free urban STD clinics. Between 2008-2012, Project LINK screened 151,452 patients in three NYC STD clinics: 15,706 received brief interventions, 882 received referrals to formal AOD services, and 2,146 received referrals for mental health or social service programs. Between SBIRT intake and six month follow-up, reports of AOD abstinence increased from 1.2% to 19.4%, injection drug use decreased by 35%, and unprotected sex decreased by 31%. Lessons Learned: SBIRT can be successfully implemented in STD clinics. Linking AOD early intervention with STD services elucidates the connection between substance use and risky sexual behavior that can facilitate STD transmission. Recommendations: The model has been adapted to target at-risk users in addition to dependent users, and to provide multiple intervention sessions for patients needing additional support. Project LINK's success has led to SBIRT expansion to six high-volume NYC STD clinics and to emergency departments that serve a large number of patients from the military community in Fort Drum, NY. Future research should examine whether SBIRT is associated with decreased rates of STD/HIV acquisition.