Substance use disorders co-occurring with other mental health disorders are common and harmful. Clinical guidelines often recommend substance use screening and brief intervention though evidence about screening practice in mental health services is limited. This systematic review of routine clinical practice in adult mental health services aims to identify (a) proportions of screening and brief intervention, (b) how they are practised and (c) their outcomes.
Methods:
We searched MEDLINE, PsycINFO and Embase and relevant Cochrane databases for articles until 31 July 2021 reporting on adults in English, regardless of geographical location. Backward snowball methods were used to locate additional articles. Screening, brief intervention and mental health services were defined. Data were extracted and variables compared related to setting, period, patient cohort, substances routine substance use disorder care pathways, and study quality was assessed.
Results:
We identified 17 articles reporting routine screening within adult mental health services. Studies in community settings mainly reported on screening for alcohol and other substance use disorders, while studies from inpatient settings reported mainly on tobacco. There was marked variation in methods and screening proportions. Only two studies reported on brief intervention.
Conclusion:
This systematic review shows marked variation in mental health services routine screening practices with early focus on alcohol but more recently tobacco screening. We suggest approaches to enhancing implementation of screening and brief intervention in routine care, particularly using electronic health records.
AgerwalaSMMcCance-KatzEF (2012) Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: A brief review. Journal of Psychoactive Drugs44: 307–317.
2.
AliRMeenaSEastwoodB, et al (2013) Ultra-rapid screening for substance-use disorders: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-Lite). Drug and Alcohol Dependence132: 352–361.
3.
American Psychiatric Association (APA) (2016) Practice guidelines for the psychiatric evaluation of adults. In: American Psychiatric Association (ed.) The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, 3rd Edition.Arlington, VA: APA, pp.15–16.
4.
American Psychiatric Association (APA) (2021) Practice guideline for the treatment of patients with Schizophrenia. In: Treatment of Patients with Schizophrenia, 3rd Edition.Washington, DC: APA, p.21.
5.
BaborTFDelBocaFBrayJW (2017) Screening, brief intervention and referral to treatment: Implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Addiction112: 110–117.
6.
BaborTFMcReeBGKassebaumPA, et al (2007) Screening, brief intervention, and referral to treatment (SBIRT) toward a public health approach to the management of substance abuse. Substance Abuse28: 7–30.
7.
BahorikALSatreDDKline-SimonAH, et al (2017) Alcohol, cannabis, and opioid use disorders, and disease burden in an integrated health care system. Journal of Addiction Medicine11: 3–9.
8.
BartelsSJ (2015) Can behavioral health organizations change health behaviors? The STRIDE study and lifestyle interventions for obesity in serious mental illness. The American Journal of Psychiatry172: 9–11.
9.
BushKKivlahanDRMcDonellMB, et al (1998) The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine158: 1789–1795.
10.
ChanYFHuangHSieuN, et al (2013) Substance screening and referral for substance abuse treatment in an integrated mental health care program. Psychiatric Services64: 88–90.
11.
COCE (2006) Definitions and terms relating to co-occurring disorders. Center for Substance Abuse Treatment, C. O. C. E., Substance Abuse and Mental Health Services Administration, and Center for Mental Health Services (ed.). DHHS Publication No. (SMA) 06-4163. Rockville, MD: US Department of Health and Human Services.
12.
CollinsLMNahum-ShaniIAlmirallD (2014) Optimization of behavioral dynamic treatment regimens based on the sequential, multiple assignment, randomized trial (SMART). Clinical Trials11: 426–434.
13.
CurrySJKristAHOwensDK, et al (2018) Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US preventive services task force recommendation statement. JAMA320: 1899–1909.
14.
DeenikJCzosnekLTeasdaleSB, et al (2020) From impact factors to real impact: Translating evidence on lifestyle interventions into routine mental health care. Translational Behavioral Medicine10: 1070–1073.
15.
Department of Health (2019) National Alcohol Strategy 2019–2028. Canberra, ACT, Australia: Commonwealth of Australia.
Department of Veterans Affairs (DVA) (2021) VA/DoD Clinical Practice Guideline for the Management Of Substance Use Disorders. Washington, DC: DAV.
18.
EPPIC (2016) Australian Clinical Guidelines for Early Psychosis, 2nd Edition.Melbourne, VIC, Australia: Orygen, The National Centre of Excellence in Youth Mental Health.
19.
FelkerBHawkinsEDobieD, et al (2008) Characteristics of deployed operation Iraqi freedom military personnel who seek mental health care. Military Medicine173: 155–158.
20.
FioreMJaénCBakerT, et al (2008) Treating Tobacco Use and Dependence: (2008) Update (Clinical Practice Guideline). Rockville, MD: US Department of Health and Human Services, Public Health Service.
21.
FrostMCGlassJEBradleyKA, et al (2020) Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction115: 668–678.
22.
GahmGALucenkoBA (2008) Screening soldiers in outpatient care for mental health concerns. Military Medicine173: 17–24.
23.
GilbodySPeckhamEBaileyD, et al (2019) Smoking cessation for people with severe mental illness (SCIMITAR+): A pragmatic randomised controlled trial. The Lancet Psychiatry6: 379–390.
24.
GlasgowREEmontSMillerDC (2006) Assessing delivery of the five ‘As’ for patient-centered counseling. Health Promotion International21: 245–255.
25.
GlassJEAndréassonSBradleyKA, et al (2017) Rethinking alcohol interventions in health care: A thematic meeting of the international network on brief interventions for alcohol & other drugs (INEBRIA). Addiction Science & Clinical Practice12: 14.
26.
GlassJEHamiltonAMPowellBJ, et al (2015) Specialty substance use disorder services following brief alcohol intervention: A meta-analysis of randomized controlled trials. Addiction110: 1404–1415.
27.
GoodrichDMiake–LyeIBraganzaMZ, et al (2020) Quality Enhancement Research Initiative. QUERI Roadmap for Implementation and Quality Improvement. Washington, DC: Veterans Health Administration Office of Research and Development, Health Services Research and Development.
28.
GrahamHLCopelloAGriffithE, et al (2016) Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings. Acta Psychiatrica Scandinavica133: 298–309.
29.
GryczynskiJMcNeelyJWuLT, et al (2017) Validation of the TAPS-1: A four-item screening tool to identify unhealthy substance use in primary care. Journal of General Internal Medicine32: 990–996.
30.
GuiseJMChangCButlerM, et al (2017) AHRQ series on complex intervention systematic reviews – paper 1: An introduction to a series of articles that provide guidance and tools for reviews of complex interventions. Journal of Clinical Epidemiology90: 6–10.
31.
GurilloPJauharSMurrayRM, et al (2015) Does tobacco use cause psychosis? Systematic review and meta-analysis. The Lancet Psychiatry2: 718–725.
32.
HepnerKAPaddockSMWatkinsKE, et al (2019) Rates and impact of adherence to recommended care for unhealthy alcohol use. Journal of General Internal Medicine34: 256–263.
33.
HidesLCottonSMBergerG, et al (2009) The reliability and validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in first-episode psychosis. Addictive Behaviors34: 821–825.
34.
HuddlestoneLSohalHPaulC, et al (2018) Complete smokefree policies in mental health inpatient settings: Results from a mixed-methods evaluation before and after implementing national guidance. BMC Health Services Research18: 542.
35.
HumeniukREHenry-EdwardsSAliRL, et al (2010) The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for Use in Primary Care. Geneva: World Health Organization.
36.
JorgensenKBNordentoftMHjorthojC (2018) Association between alcohol and substance use disorders and psychiatric service use in patients with severe mental illness: A nationwide Danish register-based cohort study. Psychological Medicine48: 2592–2600.
37.
KanerEFSBeyerFRMuirheadC, et al (2018) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Systematic Review2: CD004148.
38.
KarnoMPRawsonRRogersB, et al (2021) Effect of screening, brief intervention and referral to treatment for unhealthy alcohol and other drug use in mental health treatment settings: A randomized controlled trial. Addiction116: 159–169.
39.
KellyMPNoyesJKaneRL, et al (2017) AHRQ series on complex intervention systematic reviews-paper 2: Defining complexity, formulating scope, and questions. Journal of Clinical Epidemiology90: 11–18.
40.
KristAHDavidsonKWMangioneCM, et al (2020) Screening for unhealthy drug use: US preventive services task force recommendation statement. JAMA323: 2301–2309.
41.
LappinJMThomasDCurtisJ, et al (2020) Targeted intervention to reduce smoking among people with severe mental illness: Implementation of a smoking cessation intervention in an inpatient mental health setting. Medicina (Kaunas)56: 204.
42.
LiXGuoXFanX, et al (2021) Sequential multiple-assignment randomized trials to compare antipsychotic treatments (SMART-CAT) in first-episode schizophrenia patients: Rationale and trial design. Schizophrenia Research230: 87–94.
43.
MalhiGSBellEBassettD, et al (2021) The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian and New Zealand Journal of Psychiatry55: 7–117.
44.
MinkoffKCovellN (2019) Integrated Systems and Services for People with Co-Occurring Mental Health and Substance Use Conditions: What’s Known, What’s New, and What’s Now?Alexandria, VA: National Association of State Mental Health Program Directors.
45.
MorganVAWaterreusAJablenskyA, et al (2012) People living with psychotic illness in 2010: The second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry46: 735–752.
46.
MoyAJSchwartzJMChenR, et al (2021) Measurement of clinical documentation burden among physicians and nurses using electronic health records: A scoping review. Journal of the American Medical Informatics Association28: 998–1008.
47.
National Institute for Health and Care Excellence (NICE) (2011) Coexisting Severe Mental Illness (Psychosis) and Substance Misuse: Assessment and Management In Healthcare Settings. Manchester: NICE.
48.
OgrincGDaviesLGoodmanD, et al (2016) SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety25: 986–992.
49.
OkoliCTCSengS (2019) Correlates of tobacco use and consumption among hospitalized psychiatric patients. Western Journal of Nursing Research41: 1121–1136.
50.
ØstergaardMLDNordentoftMHjorthøjC (2017) Associations between substance use disorders and suicide or suicide attempts in people with mental illness: A Danish nation-wide, prospective, register-based study of patients diagnosed with Schizophrenia, Bipolar Disorder, Unipolar Depression or Personality Disorder. Addiction112: 1250–1259.
51.
PageMMcKenzieJEBossuytPM, et al (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ372: 71.
52.
PatnodeCDPerdueLARushkinM, et al (2020) Screening for unhealthy drug use: Updated evidence report and systematic review for the US preventive services task force. JAMA323: 2310–2328.
53.
Plana-RipollOMuslinerKLDalsgaardS, et al (2020) Nature and prevalence of combinations of mental disorders and their association with excess mortality in a population-based cohort study. World Psychiatry: Official Journal of the World Psychiatric Association (WPA)19: 339–349.
54.
Plana-RipollOPedersenCBHoltzY, et al (2019) Exploring comorbidity within mental disorders among a Danish National Population. JAMA Psychiatry76: 259–270.
55.
PleverSMcCarthyIAnzolinM, et al (2020) Queensland smoking care in adult acute mental health inpatient units: Supporting practice change. Australian and New Zealand Journal of Psychiatry54: 919–927.
56.
ProchaskaJJGillPHallSM (2004) Treatment of tobacco use in an inpatient psychiatric setting. Psychiatric Services55: 1265–1270.
RadiganMLIHMillerGASmallingM, et al (2016) Sustaining screening of key health risk factors in New York State Mental Health clinics after implementation of the health indicator initiative. Psychiatric Services67: 425–430.
59.
RANZCP (2015) Keeping Body and Mind Together: Improving the Physical Health and Life Expectancy of People with Serious Mental Illness. Melbourne, VIC, Australia: The Royal Australian and New Zealand College of Psychiatrists.
60.
ReillyJMeurkCHeffernanEB (2020) What approaches are used to identify and treat individuals with substance use disorders in adult specialist mental health services, and how effective are they?PROSPERO. Available at: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=162105
61.
RichardsJEShortreedSMSimonGE, et al (2020) Short-term risk of suicide attempt associated with patterns of patient-reported alcohol use determined by routine AUDIT-C among adults receiving mental healthcare. General Hospital Psychiatry62: 79–86.
62.
RiesRKYuodelis-FloresCRoy-ByrnePP, et al (2009) Addiction and suicidal behavior in acute psychiatric inpatients. Comprehensive Psychiatry50: 93–99.
63.
RushBUrbanoskiK (2019) Seven core principles of substance use treatment system design to aid in identifying strengths, gaps, and required enhancements. Journal of Studies on Alcohol and Drugs18: 9–21.
64.
SaitzR (2014) Screening and brief intervention for unhealthy drug use: Little or no efficacy. Frontiers in Psychiatry5: 121.
65.
SaraGEBurgessPMMalhiGS, et al (2014) Cannabis and stimulant disorders and readmission 2 years after first-episode psychosis. The British Journal of Psychiatry: The Journal of Mental Science204: 448–453.
66.
SatreDWolfeWEisendrathS, et al (2008) Computerized screening for alcohol and drug use among adults seeking outpatient psychiatric services. Psychiatric Services59: 441–444.
67.
SaundersJBAaslandOGBaborTF, et al (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction88: 791–804.
68.
ScaturoDJLeSureKB (1985) Symptomatic correlates of alcohol abuse as a presenting problem. Journal of Clinical Psychology41: 118–123.
69.
SocíasMEVolkowNWoodE (2016) Adopting the ‘cascade of care’ framework: An opportunity to close the implementation gap in addiction care?Addiction111: 2079–2081.
70.
SohalHHuddlestoneLRatschenE (2016) Preparing for completely smoke-free mental health settings: Findings on patient smoking, resources spent facilitating smoking breaks, and the role of smoking in reported incidents from a large mental health trust in England. International Journal of Environmental Research & Public Health13: 25.
71.
SpearSTillmanSMossC, et al (2009) Another way of talking about substance abuse: Substance abuse screening and brief intervention in a mental health clinic. Journal of Human Behavior in the Social Environment19: 959–977.
72.
SterneJACSavovićJPageMJ, et al (2019) RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ366: l4898.
73.
TaylorGMcNeillAGirlingA, et al (2014) Change in mental health after smoking cessation: Systematic review and meta-analysis. BMJ348: g1151.
74.
VendettiJAMcReeBGDelBocaFK (2017) Development of the SBIRT checklist for observation in real-time (SCORe). Addiction112: 34–42.
75.
WhitingDLichtensteinPFazelS (2021) Violence and mental disorders: A structured review of associations by individual diagnoses, risk factors, and risk assessment. The Lancet Psychiatry8: 150–161.
76.
WhitingPRutjesAWReitsmaJB, et al (2003) The development of QUADAS: A tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Medical Research Methodology3: 25.
77.
WhitingPFRutjesAWWestwoodME, et al (2011) QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Annals of Internal Medicine155: 529–536.
78.
WilliamsARNunesEVBisagaA, et al (2019) Development of a cascade of care for responding to the opioid epidemic. The American Journal of Drug and Alcohol Abuse45: 1–10.
79.
WuCYChangCKRobsonD, et al (2013) Evaluation of smoking status identification using electronic health records and open-text information in a large mental health case register. PLoS ONE8: e74262.
80.
WyePMStockingsEABowmanJA, et al (2017) Effectiveness of a clinical practice change intervention in increasing the provision of nicotine dependence treatment in inpatient psychiatric facilities: An implementation trial. BMC Psychiatry17: 56.
81.
YuanCTMcGintyEEDalcinA, et al (2022) Scaling evidence-based interventions to improve the cardiovascular health of people with serious mental illness. Frontiers in Psychiatry13: 793146.
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