Current prEvents  in Times Argus – March 17, 2017
Addressing Alcohol and Drug Use in Medical Settings

By Hillary Montgomery, MA, AAP and Barbara Gramuglia, MS, AAP are Emergency Department SBIRT Clinicians with Central Vermont Medical Center.

The SBIRT (rhymes with “expert”) program at Central Vermont Medical Center (CVMC) is an initiative that enables health and safety screening of patients over age 18, with an emphasis on substance use.

Screening, Brief Intervention, and Referral to Treatment (SBIRT), is a comprehensive, integrated, and cost-effective public health approach to early intervention and treatment for persons with or at risk of developing substance use disorders.

In 2014, CVMC received a five-year federal grant to implement SBIRT in the emergency department, which has since screened more than 17,000 patients. A second, state-funded grant allowed CVMC-affiliated primary care offices to provide SBIRT services, and in 2016, CVMC began offering SBIRT to support inpatient services. CVMC’s SBIRT staff is made up of master’s level substance abuse clinicians who ask patients for permission to talk, and then help them understand their risk.

Using a model of client-centered care that promotes change, clinicians share the results of a screening with the patient and raise potential and existing health concerns associated with the patient’s use of alcohol or drugs. Patients are asked about the pros and cons of alcohol and drug use to help them think about its role in their lives. These conversations create an opportunity for patients to consider whether their use is in line with their values and goals. For many patients, an SBIRT screening is the first time they have been asked about their use in a non-confrontational manner.

Substance misuse is highly correlated with mental health disorders, such as depression, anxiety, trauma, etc. Recovery is typically characterized by slips and relapses. The more often a person tries to quit, the more likely they are to be successful. Even if they opt not to attempt recovery now, SBIRT clinicians can “plant seeds” that may take root later.

The majority of patients screened at CVMC are at low-risk for health problems related to alcohol. While for some people—including those taking certain medications, with health problems, or women who are pregnant—alcohol is risky in any amount, others are considered at low risk if they abide by these guidelines:

  • Men between 18 and 64 and in good health: no more than 14 standard drinks in a week, with a maximum of 4 in any one day.
  • Men 65 and over and in good health: no more than 7 drinks in a week, with a maximum of 3 drinks in any one day.
  • Women in good health who are not pregnant: no more than 7 drinks in a week, with a maximum of 3 drinks in any one day.
  • A “standard drink” depends on the alcohol content of what’s in your glass. General guidelines are 12 oz. of mass-production beer, 8 oz. of craft beer, 5 oz. of wine, or a single 1.5 ounce shot of liquor.

Patients who score with a moderate use disorder are offered SBIRT Brief Treatment (BT), which consists of up to 12 one-on-one counseling sessions using a cognitive behavioral model. SBIRT clinicians offer Brief Treatments on the CVMC campus, outside of the Emergency Department.

Patients identified as having problematic or high-risk use are offered information about treatment options and assistance connecting with those services: SBIRT clinicians help patients contact treatment facilities to navigate the admission process, and make referrals to facilitate admission. Oftentimes, patients want support from other people in recovery; in these situations the Turning Point Center can be a positive connection.

As the program continues in its fourth year, the focus continues to be on identifying and treating risky alcohol and drug use, and helping patients who use tobacco to explore options for quitting.


Turning Point Recovery Center of Central Vermont:

802-479-7373,, 489 North Main Street, Barre

802 Quits smoking cessation help:


Central Vermont Substance Abuse Services:

802-223-4156, Emergency: 229-0591,

Washington County Mental Health Services:


Washington County Youth Service Bureau:


Current PrEvents is produced by the Central Vermont New Directions Coalition, Montpelier, Vermont, in collaboration with the Washington County Youth Service Bureau, as part of the Partnership for Success grant from the Vermont Department of Health.