Conducting SBI

Screening tests are a first-line defense in the prevention of disease. Screening for alcohol problems can take place in a wide variety of populations and settings. Research shows that a number of good screening instruments are available that can be tailored to specific audiences and needs. Detecting alcohol abuse and dependence early in the course of disease enables people to get the help they need through a brief intervention or by a referral to treatment. (NIAAA, 2005)

Who Can Conduct an SBI

On college campuses, screening and brief interventions can be conducted by any number of staff.

• As primary care givers, nurses and doctors can include screening and brief interventions as part of each patient’s visit to the student health center.
• Counseling center staff can use the screening tool during intake sessions with students.
• Residence Life Department staff will find the SBI process helpful when dealing with residents who experience trouble adjusting to college life or who violate campus alcohol policies.
• Judicial officers or peer courts can require a student to complete the screening process as part of campus sanctions for alcohol policy violations.
• Academic advisors and faculty who meet with students who are having difficulty in their classes may use the SBI toolkit to help students assess whether alcohol abuse is interfering with their academic success.
• The SBI toolkit can be incorporated into wellness and health risk appraisal programs conducted by wellness, fitness, or recreation center staff.
• Athletic coaches and trainers can use the SBI toolkit to discuss alcohol issues when a student athlete violates campus and athletic policies or simply does not achieve their full athletic potential.

When to Conduct an SBI

Ideally, screening can be used as a standard procedure for all visits to college health and counseling centers. Screening can also be done as a special event, such as National Alcohol Screening Day, which takes place in early April each year. Students can also be referred for screening as a result of an alcohol-related policy violation. First-year students can be screened as they enter college to encourage non-drinkers to continue their abstinence until they are legally of age and to encourage students who have initiated alcohol use prior to arriving to carefully consider the consequences of alcohol consumption. All screening activities should take place in a confidential setting and results should be treated as confidential information.

It is important to conduct an SBI is when students begins to talk about negative events they are experiencing that may be related to alcohol abuse. A student may talk to a campus professional or another student about how the student is missing classes, failing tests, got into a fight, is feeling depressed, is in trouble with the law or the campus administration. Relationship problems with roommates, friends, or significant others can indicate an alcohol problem. Students may visit the health center with injuries from falls or fights or with health problems that may indicate that students are not properly caring for their health.

Before you offer SBI, be sure to review all material in this kit. Create a list of campus and community resources for students who are experiencing alcohol abuse issues. If your
campus does not offer substance abuse counseling, contact local substance abuse treatment agencies to find out what they offer and how students can access their services. Include local mutual help groups, such as Alcoholics Anonymous, in the list of resources. Check your campus confidentiality procedures to see if students need to fill out additional forms before they are screened.

SBI Steps

The SBI process is a non-judgmental, non-threatening approach that provides feedback in a respectful manner. It is not your job to change the students; it is the students’ job to decide if and how they will change. Your job is to ask questions and express concerns you may have in a nonjudgmental manner. Here are steps you can follow:

1. Administer the AUDIT: If it is during a formal meeting or appointment, have the student complete the AUDIT screening tool, preferably before meeting with the counselor or health care professional. The questionnaire takes about two minutes to complete. If the issue of alcohol use surfaced during a more casual conversation, ask the students if they would be willing to complete a short questionnaire and talk with you about the good and not-so-good aspects of their drinking.
2. Invite the student to discuss the results: Thank the student for filling out the AUDIT. Ask the student’s permission to discuss the results of the questionnaire. Clearly explain your level of confidentiality, what information will be reported or recorded, and any limitations to confidentiality.
3. Score the AUDIT: Scoring the AUDIT takes about a minute. Each of the 10 questions receives a score of 0 to 4. The maximum possible score is 40. For college students, a score of 6 or more is an indicator of risky drinking while a score of 8 or more is a strong indication of hazardous or harmful drinking in adult populations (Walters and Baer, 2006). See Appendix A for more scoring information.
4. Discuss Scoring: If the AUDIT results indicate heavy drinking or drinking-related problems, discuss your concerns with the student and ask him/her about their own concerns. Walters and Baer (2006) suggest using the elicit-provide-elicit (E-P-E) format:

   Elicit readiness and interest: “Tell me what you enjoy about drinking,” and “What are some of the not-so-good things about drinking?”

   Provide clear information or feedback: “The questionnaire you completed suggests that you may be putting yourself at risk for problems. Would it be all right for me to provide you with some information about alcohol and its effects?”

   Elicit the student’s interpretation or reaction: “What do you think you’d like to do about this? On a scale of 1 to 10, with 1 being not ready and 10 being very ready, how ready are you to make a change?”

   It is not unusual for students to resist talking about their alcohol use or discussing how they might change their use. In SBI, it is important to roll with the resistance and not directly confront the student. “Ultimately, it is your decision whether or not to make changes to your drinking. I can share with you some ideas to decrease the not-so-good outcomes of drinking.”

5. Develop a Plan: If the student indicates interest in making a change, provide options for lower-risk alcohol consumption and discuss a plan of action. You can mention that the dietary guidelines for Americans define moderate drinking as no more than one drink a day for most women and no more than two drinks a day for most men (USDA, 2000). If the student is under 21, discuss the legal consequences of consuming alcohol underage. You can put the emphasis on the student’s personal choice by using statements and questions such as, “Some students have found these suggestions helpful. Which of these do you think might work for you?”

If the student doesn’t indicate a desire to change, use a reflection statement to elicit further information and discussion with the student: “Sounds like you don’t feel the need to make any changes to your drinking right now. What would have to happen for you to consider making a change? If you were to decide to make a change, what strategies do you think you would try?” If the student chooses not to talk about change, provide him or her with a resource sheet and ask if you can follow up with them in a week or two.

6. Schedule a Follow-Up: Summarize for the student what has been discussed during the session and encourage him or her to review the handouts (see Appendices C, D, and E) you have provided. Let the student know that you and others are available to provide assistance and support. Tell the student that you want to follow up either in person or by phone and set a specific time to do so. When you do follow up, be sure to support the student’s efforts to cut down or abstain and offer additional support.

When to Make a Referral

The AUDIT is a screening tool that can be used to educate students about the effects of their drinking. It is not designed to be a diagnostic tool and cannot determine alcohol dependence. Each student is unique and each screening session will be different. Counselors and health providers are encouraged to rely on their clinical judgment and expertise when deciding to refer a student for further evaluation. Babor and Higgins-Biddle (2001a, 2001b) recommend considering a referral for further evaluation and treatment if any of the following are present:

• The student scores 20 or more on the AUDIT screening test
• The student scores below 20 on the AUDIT but they are not appropriate for brief intervention because:
  • The student is strongly suspected of having an alcohol dependence syndrome;
  • The student has a prior history of alcohol or drug dependence or liver damage;
  • The student has prior or current serious mental illness; or
  • The student has failed to achieve his or her goals despite counseling.

Providing Feedback

The BACCHUS Network is interested in your comments and suggestions on this tool kit. Your feedback will be used to improve the kit and our services to college and university campuses. Please complete the short feedback form in Appendix C and fax it to 303-871-0907 or send it to:

Ann Quinn-Zobeck, Ph. D.
Director of Alcohol Abuse and Impaired Driving Prevention Initiatives
The BACCHUS Network
PO Box 100430
Denver, CO 80250-0430
ann@bacchusnetwork.org

Your responses are greatly appreciated.

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