(75) Pilot Survey of SBIRT and Sexual Activity: Outpatient Providers’ Comfort Levels Vary

Introduction: With estimates showing 25% of U.S. adolescents and adults reporting harmful substance use, screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based intervention implemented in outpatient settings. Substance use is frequently concurrent with sexual activity, such as using substances specifically to augment sexual experiences (chemsex), sex while high, or transactional sex. This pilot quality improvement project seeks to assess the training history, beliefs, and comfort levels of outpatient healthcare providers in implementing SBIRT combined with questions pertaining to sexual activity and substance use.

Methods: An adapted pilot cross-sectional survey was implemented via e-mail distribution lists to outpatient providers at a large regional academic medical center in June 2021. Recruitment was conducted by e-mail over one month, and surveys were submitted anonymously. Questions included demographic characteristics (e.g.; healthcare role, specialty, and gender identity), whether they had prior training in SBIRT, beliefs about substance use (e.g.; “Most people who become addicted to substances do not want to stop using.”), and comfort levels with SBIRT implementation (e.g.; “How comfortable do you feel assessing patients for substance use specifically related to sexual activity?”). Questions used a 4-point Likert scale. Data were analyzed using descriptive statistics and stratified by demographic and practice characteristics.

Results: Seventy-three providers responded, and 47% were aged 30-39, 82% identified as White 66% were women, and 33% were Internal Medicine providers. Overall, 59% reported receiving SBIRT training during school, training, or employment. Generally, participants report believing that substance use is a significant health issue (89%), and were either comfortable or somewhat comfortable assessing patients (85%), but less so in the setting of sexual activity (60%). Similarly, they feel comfortable or somewhat comfortable providing referral to treatment (84%). Midlevel and physician providers identified more comfort with rapport-building around substance use (χ2=0.0020) than other respondents, such as nurses, while those working in infectious disease and psychiatry reported the most comfort with assessing substance use with concurrent sexual activity (χ2=0.0330).

Conclusions: This pilot survey demonstrated feasibility and could be replicated to inform educational programming for healthcare workers. Substance use is recognized across health disciplines and outpatient settings as an important health issue worthy of screening. and healthcare workers feel comfortable in discussing substance use with patients, yet questions about actual referral patterns remain. However, SBIRT training is not universal, and comfort with assessing how sexual activity interacts with substance use is a critical area to be included. Future work should explore associated factors and potential interventions aimed at increasing comfort levels through belief exploration and advanced training in the intersection of substance use and sexual activity.

References: 1. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
2. Calsyn DA, Cousins SJ, Hatch-Maillette MA, et al. Sex under the influence of drugs or alcohol: common for men in substance abuse treatment and associated with high-risk sexual behavior. Am J Addict. 2010;19(2):119-127. doi:10.1111/j.1521-0391.2009.00022.x
3. Calleja NG, Rodems, E, Groh CJ, Baiardi J, Loewen J, Kaiser RJ. (2020) Differences in Substance Use-Related Attitudes across Behavioral and Primary Health Trainees: A Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training Investigation, Alcoholism Treatment Quarterly, 38:1, 106-125, DOI: 10.1080/07347324.2019.1604107

Diversity, Equity, and Inclusion: This pilot quality improvement survey specifically aims to increase health equity by identifying comfort levels with SBIRT and the interplay of sexual activity and substance use, where discomfort may lead to diminished identification of harmful substance use. Such behaviours are more common among sexual and gender minorities, so increasing provider comfort levels, believes, and training will increase cultural competency in LGBTQ and sexual healthcare.