SBIRT Outcomes in Houston: Final Report on InSight, a Hospital District-Based Program for Patients at Risk for Alcohol or Drug Use Problems


  • The InSight Project Research Group

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      The InSight Research Group acknowledges the efforts of the writing team: Richard Spence (Chair), Thomas Bohman, Vicki Waters, Mary Velasquez, Kirk Von Sternberg, Lynn Wallisch, Albert Yeung, Alan Pittman, and Mary S. Cook. The InSight analysis team for this report is also recognized: Thomas Bohman (Chair), Kirk Von Sternberg, Lynn Wallisch, and Albert Yeung. The InSight project research group composition: Richard Spence, PhD, Tom Bohman, PhD, Mary Marden Velasquez, PhD, Kirk Von Sternberg, PhD, Lynn Wallisch, PhD, Albert Yeung, MSSW, Mary S. Cook, MSSW, and Alan Pittman, MSSW (University of Texas at Austin); James Bray, PhD, Alicia Kowalchuk, MD, Vicki Waters, MS, PA-C, and Katie McQueen, MD (Baylor College of Medicine).

Reprint requests: Richard Spence, Addiction Research Institute, School of Social Work, University of Texas, 1717 West 6thStreet, Suite 335, Austin, Texas 78703; Fax: 512-232-0613, E-mail:


Background:  Screening, Brief Intervention, and Referral to Treatment (SBIRT) services have been implemented as the standard of care for patients in the Harris County Hospital District (HCHD). The present analysis addresses alcohol and drug use for patients admitted over a 39-month period from July 1, 2005 through September 30, 2008.

Methods:  Patients were screened for alcohol and drug use at medical admission. Those who were positive received further assessment and were transitioned to receive services as appropriate. A sample of consenting patients who were positive and received services was contacted at 6 months for a follow-up interview. Using an intent-to-treat (ITT) protocol, the analysis included all patients who were assigned for follow-up, including those with completed follow-ups as well as those who could not be contacted at follow-up. Patients not contacted at follow-up were assumed to have maintained their baseline drug and alcohol consumption levels.

Results:  Of 59,760 patients who were screened by generalists (primarily nurses, physicians, and medical care technicians), 15,241 (26%) were positive and received further assessment and services. The 6-month follow-up interview completion rate was 66%. The ITT sample consisted of all 1,937 patients who were assigned for follow-up. There was an overall reduction in the number of patients reporting any days of heavy drinking from 70% at intake to 37% at 6-month follow-up and a reduction in the mean number of days of heavy drinking from 7.8 days at intake to 4.1 days at follow-up. The number of patients reporting any days of drug use was 82% at intake versus 33% at follow-up, and the mean number of days of drug use declined from 8.3 days at intake to 4.2 days at follow-up.

Conclusions:  The results were consistent with but of greater magnitude than most other studies reporting positive outcomes for SBIRT patients. Drug use and heavy alcohol use were found to decrease substantially from admission to follow-up. This finding holds good for all levels of drug or alcohol misuse severity, with the highest severity patients showing the largest decreases. Future studies are needed to control for potential regression to the mean effects and to develop improved understanding of differences in outcomes by race/ethnicity.