Med student and Scaife alumna Miranda Greiner brings motivational interviewing, SBIRT to her work in Kansas
Every time Miranda Greiner volunteered as a student physician at the JayDoc Free Clinic in Kansas City, KS, she encountered at least one patient struggling with addiction.
The longer she volunteered, the more she marveled at the prevalence of addiction and mental illness in the general patient population. But by the end of her first year at the University of Kansas Medical School, she had received little training on how to address addicted patients.
Her experience is not unusual. Research shows that despite the enormous costs to individuals and society from substance use disorders, the average four-year medical school devotes a total of only 12 hours of curricular time to them.
For Greiner, one patient in particular—a 62-year-old man suffering from complications due to cardiovascular disease—compelled her to learn more about what she could do for patients in a primary care setting.
“As I looked through his medical history, I noticed that no one had addressed his binge drinking yet,” she said.
The patient regularly consumed 12 to 14 beers per day on weekends or during vacation time.
“I discussed the matter with him, but later reflected that I’d like to learn how to approach addictions within clinical settings.”
In 2012, Greiner enrolled in IRETA’s Scaife Advanced Medical Student Assistantship in Alcohol and Other Drug Dependency, which she saw as the perfect opportunity to expand her knowledge of addiction and mental illness.
Held each summer since 1995, the three-week program offers medical students nationwide a wide range of training on addiction treatment and recovery.
“In most medical schools, [addiction training] is a special lecture covering an hour or so of content. The time allocated is not sufficient for students to learn the etiology of the disease, let alone learn how to intervene,” said Dr. Holly Hagle, director of the National SBIRT ATTC at IRETA.
“I see physicians frustrated after working with patients battling addiction disorders. Often they mention how these patients are difficult and non-adherent. Yet, I know that research shows a simple screening can lead to improved health outcomes for patients with addiction disorders.”
The Scaife program is an intense learning experience. Students accepted into the program attend lectures, work directly with patients in treatment and recovery, and accompany resident physicians on rounds in psychiatric facilities.
Greiner’s major takeaway from the program is that a brief screen for harmful substance use can have a profound impact on patients’ care.
“Simply screening for addiction disorders can be the first step in directing the patient towards the necessary care,” Greiner said.
Research shows that physicians often have negative and pessimistic views about these disorders and do not routinely screen patients in general practice for them.
“I see physicians frustrated after working with patients battling addiction disorders. Often they mention how these patients are difficult and non-adherent. Yet, I know that research shows a simple screening can lead to improved health outcomes for patients with addiction disorders,” Greiner said.
She said that universal screening is particularly important because “substance disorders are independent of sociodemographic variables and can be seen in all populations.”
Screening, Brief Intervention and Referral to Treatment (SBIRT) has now become a natural part of the way Greiner practices at the JayDoc clinic, a student-led free health clinic that serves the underinsured or noninsured patient population.
“I do not interview one patient now without screening for addictive disorders and providing information about risks associated with substance use,” she said.
And SBIRT works particularly well at JayDoc because doctors are allowed to take time with patients.
“The clinic offers a unique opportunity to begin addressing these issues because as a student physician I can spend anywhere from twenty minutes to an hour seeing one patient, “she said.
She’s found that educating fellow students about validated screening instruments and brief interventions can help.
“The evidence-based SBIRT practices that I learned in the Scaife program are great to share with those who are hesitant to address such issues,” Greiner said, acknowledging that prior to the Scaife program even she did not find screening techniques to be very effective and was unsure how these related to better health outcomes.
Greiner said learning about effective SBIRT techniques has forever changed the way she practices medicine.
“Even though a patient comes across as non-adherent to treatment recommendations for a substance use disorder, simply meeting with them and using motivational interviewing skills is a step toward helping them–whether they choose to come back [for treatment] or not.”
Miranda Greiner is a second-year medical student at the University of Kansas. She plans to focus on integrative medicine with training in the Complementary and Alternative Medicine (CAM) program after her residency training. She is currently considering furthering her training in addictions and later applying it within the U.S. and internationally.
