Got a question? The doctor is in!
Q. Why is WIPHL needed?
Q. Is abstinence the only measure of success in fighting alcohol and drug abuse?
Q. What is motivational interviewing and why is it used in WIPHL?
Q. Why is cultural competence such an integral part of WIPHL?
Q: What is the role of the health educator?
Q. How were participating clinics selected for WIPHL?
Q. Does WIPHL provide treatment?
Q. Does WIPHL cover the cost of treatment for patients who don't respond to brief interventions?
Q. What is the status of federally funded SBIRT programs nationwide?
Q. What are the barriers preventing SBIRT services from being offered on a more widespread basis?
Q. What can citizens do to get SBIRT services in their area?

Got a question? The doctor is in!
Clinical director Richard Brown, MD, MPH, is happy to respond to questions of general interest about WIPHL. Some may be posted on our Frequently Asked Questions. E-mail him care of info@wiphl.org with the subject line: FAQs.

Q. Why is WIPHL needed?
About one in four Wisconsin residents have a problem with alcohol or drug use. Diseases and accidents related to substance abuse make it the fourth leading cause of death in our state. Wisconsin regularly lands at the top or near the top of national statistics relating to high-risk and heavy drinking. And yet only 10 to 20 percent of Wisconsin residents in need of help for substance abuse receive that assistance. WIPHL is here to fill that gap and address what has become a leading public health problem in our state.

Q. Is abstinence the only measure of success in fighting alcohol and drug abuse?
Abstinence is only one measure of effectiveness of interventions or treatment. For alcohol- or drug-dependent patients, abstinence is the safest option, since a little drinking or drug use may trigger excessive drinking or drug use and negative health and social consequences. Although many dependent patients do not attain lasting abstinence after treatment, many will manifest other kinds of improvement. They may drink or use drugs less frequently and in smaller amounts. They may have fewer and less severe relapses. They may enjoy a greater sense of health and well-being, improved quality of life, and stronger relationships with family members and friends. They may suffer fewer health, social, legal, and financial consequences of their drinking or drug use. For non-dependent individuals who are drinking or using drugs in risky or harmful ways, abstinence may not be necessary to prevent or eliminate negative health and social consequences. When abstinence is considered the only marker of success, the benefits of intervention and treatment are vastly underestimated.

Q. What is motivational interviewing and why is it used in WIPHL?
Motivational interviewing, or MI, is a respectful, empathic, patient-centered and strength-based philosophy of promoting behavior change. Motivational interviewers give advice very sparingly and never give direction. They initially help individuals decide whether they'd like to change their alcohol or drug use by having them consider the advantages and drawbacks of their use in light of their goals and values. For individuals who decide that they'd like to make a change, motivational interviewers help them decide how they'll go about changing. They offer a framework for thinking about a change plan, and they offer options to consider but always leave the decisionmaking to the patient. We use these methods because ample research and our own experience has shown that they are effective for many individuals and are well-received by all individuals.

(Further reading: Motivational Interviewing: Preparing People for Change, by William R. Miller and Stephen Rollnick, The Guilford Press, 2002.)

Q. Why is cultural competence such an integral part of WIPHL?
First, let's define culture. One definition of culture is that it is the invisible filter--including one's past experience, racial and ethnic background, gender, age, socioeconomic status, employment, and other demographic attributes--through which individuals interpret all experience.

So why is culture so important to WIPHL? Because our requests that patients complete brief screens, see health educators, and discuss their personal health habits come to each patient through that filter of their culture. Individuals of various cultures may have different views about the appropriateness of discussing certain topics with certain individuals. Individuals of various backgrounds may understandably have more or less trust of certain professionals and institutions. In different cultures, people may attach different meanings and importance to drinking or drug use. For example, some cultures view all drinking or drug use as evil, while other cultures regard certain kinds of drinking or drug use as important to religious practice or routine social interaction. At WIPHL, we strive to have all of our staff and partners develop and continually improve their cultural competence so that they are able to understand how best to reach the diverse patients who might possibly benefit from our services.

Q: What is the role of the health educator?
WIPHL health educators are extremely important to the success of this project. Health educators provide brief feedback and referral for patients who use tobacco, have a sedentary lifestyle, don't eat the recommended amounts of fruits and vegetables, or are underweight or overweight. Health educators also provide all alcohol and drug full screening, intervention, and referral services. Most of our health educators have bachelor's degrees and at least two years of human services experience. Those without bachelor's degrees were selected for their skills in relating to patients of particular cultural backgrounds. Some health educators have master's degrees and counseling experience. All were selected carefully for their empathy toward diverse patients who are drinking or using drugs in risky or harmful ways and their personal compatibility with motivational interviewing principles. All received three weeks of intensive training, including training in following written and computerized screening and intervention protocols that previous research has shown are effective. All demonstrated proficiency on a written final examination and in observed interviews with standardized patients. To ensure that patients receive high quality care, all health educators participate in weekly conference calls and case reviews, and all regularly submit for review by a supervisor audiotapes of their sessions with patients--with their patients' written permission. If patients decline to give permission to have their sessions audiotaped, they are still eligible to receive services.

Q. How were participating clinics selected for WIPHL?
Clinics were selected for their diversity in geographic location, population density (urban, suburban, rural) and patients (age, gender, race, ethnicity, and socioeconomic status) as well as their readiness to take advantage of the resources the WIPHL project could bring to them and their patients.

Q. Does WIPHL provide treatment?
WIPHL does not directly provide treatment, but WIPHL helps individuals obtain treatment. WIPHL-affiliated clinics and WIPHL-funded health educators at these clinics provide screening, intervention, and referral services. Health educators recommend treatment to all alcohol- and drug-dependent patients. Such patients who are interested in treatment are either referred directly to treatment or are referred to a central WIPHL treatment liaison, who helps patients find and gain entry into the treatment program that best fits their needs, preferences, and constraints.

For alcohol- and drug-dependent patients who would like treatment but cannot afford it, WIPHL can provide funding for treatment at certain treatment programs. About $1.9 million--15 percent of WIPHL's $12.6 million of funding--is set aside for this purpose. To qualify for WIPHL treatment funding, individuals must be registered patients of WIPHL-affiliated clinics, see WIPHL-funded health educators at those clinics, have symptoms of alcohol or drug dependence, and have no other way to pay for treatment.

Q. Does WIPHL cover the cost of treatment for patients who don't respond to brief interventions?
Yes. Often patients understandably will wish to try to manage their alcohol or drug issues on their own. Only when they realize that self-help is not working will many patients seek treatment. WIPHL is glad to cover the cost of treatment for individuals who first try self-help but later desire professionally administered treatment that they cannot afford.

Q. What is the status of federally funded SBIRT programs nationwide?
Wisconsin is one of 10 states with an SBIRT grant ("SBIRT" stands for Screening, Brief Intervention, and Referral to Treatment). California, Illinois, New Mexico, Pennsylvania, Texas, Washington, and the Cook Inlet Tribal Council received SBIRT grants in 2003. Colorado, Florida, Massachusetts, and Wisconsin received their grants in 2006. As of May 2007, more than a half million Americans received services via SBIRT projects. For more information, visit http://sbirt.samhsa.gov, the SBIRT site of the federal Substance Abuse and Mental Health Services Administration and Center for Substance Abuse Treatment.

Q. What are the barriers preventing SBIRT services from being offered on a more widespread basis?
There are several barriers. Most healthcare professionals have never received training to administer SBIRT services. Because many healthcare professionals do not recognize alcohol and drug problems when they are early and most responsive to interventions or treatment, many remain pessimistic about their ability to help.

Q. What can citizens do to get SBIRT services in their area?
SAMHSA may be announcing the availability of additional SBIRT grants in 2008. Announcements of new grant opportunities appear at http://www.samhsa.gov/grants.

General medical settings also are encouraged (and may decide) to offer SBIRT services without grant funding. If such settings are hesitating because of lack of reimbursement, they may be interested to know that:

• The Center for Medicare and Medicaid Services allows Medicaid programs to reimburse for alcohol and drug screening and intervention services;

• New CPT (Current Procedural Terminology) codes were announced by the American Medical Association in November 2007;

• Large employers and health insurers, who purchase health care in bulk, are increasingly recognizing the value of SBIRT services for their employees or subscribers. Eighty-seven out of 150 plans recently surveyed by the National Business Coalition on Health will pay for substance use screening and brief intervention services. These plans include AETNA and CIGNA nationwide and Anthem Blue Cross and Blue Shield ( in 11 states).

Citizens can encourage health care purchasers to demand that their health care providers consistently administer SBIRT services. Information on the benefits of such services for health care purchasers, providers, and patients appears at www.ensuringsolutions.org.