SP Script: Page 2 of 2 SBIRT (Adult Male, Risky Alcohol Use, Stomach Pain)

Script for Standardized Patient: SBIRT adult male, risky alcohol use, depression

Created for the University of Missouri-Kansas City (UMKC)-Screening, Brief Intervention, and Referral to Treatment (SBIRT)by Stilen, P., Gotham, H., Krom, L., & Knopf-Amelung, S. 2014.

Case name / XXXXXX XXXXXX [complete with name of your choice]
Presenting Situation / You are an adult male, presenting to an outpatient mental health clinic with stress and depression. Your primary care practitioner referred you to the mental health clinic because you reported symptoms of depression. A provider just completed an exam for depression and prescribed Wellbutrin (an antidepressant). A clinician is now coming back in the room to discuss the results of the screeners that you completed at the beginning of your visit.
Opening statement / “OK, sure.”
History of Alcohol Use / During the work week, you have 3-4 drinks after work to try to relieve stress or cheer yourself up. On Saturday and Sunday, you usually drink 5-6 beers each day, especially during football season. You estimate you have 26 drinks per week.
Allergies / None
Medicines / None
Social History / You work in a sales job, but are trying to earn your MBA online. You have been very stressed at work over the past 3 months because of pressing deadlines. You’re having difficulty finding motivation to work on your classes. You have a few friends, who you see on the weekends, with business associates for lunch and dinner 4 days per week.
Family History / You are single and currently do not have a girlfriend. You haven’t had a relationship in about a year.
SP Presentation / You are dressed in casual attire. No jacket. Your posture is closed. You are stressed about pending work deadlines andunfinished school work. You’ve been feeling depressed most days, with little energy, little interest in work or school work, insomnia, fatigue, and feelings of worthlessness. You’ve been experiencing these symptoms for about 6 months, and they have gotten worse in the past 2 months.
Response to Clinician / The Clinician should remain appropriately engaged with you throughout the encounter (maintaining eye contact, using your name to address you, listening attentively). The Clinician should ask open-ended questions and reflect back your thoughts and feelings. The Clinician should not challenge your responses to questions or tell you that you have an alcohol use disorder or addiction, use words like alcoholic, etc., or be judgmental. As long as the Clinician is engaging and non-judgmental, proceed with the scenario as written. If the Clinician becomes judgmental, argumentative, or very directive (‘you should do this…’, ‘you need to do this…’), then you can start to shut down, back-off or become resistant.

SP Script: Page 2 of 2 SBIRT (adult male, risky alcohol use, stomach pain)

If shown a graphic depicting “low-risk drinking” limits / You are surprised about the low-risk drinking guidelines the Provider discussed with you. You are surprised you are in the risky category because you had an uncle who “was a drunk” and you’re “not anything like him.” You don’t really believe that your drinking is related to your depression, but if asked, you state that your drinking has increased over the past two months…it seems to be during the same time that your depression has worsened.
If asked about pros & cons of substance use / When Asked About Pros: “Alcohol really helps me relax in the evenings and fall asleep.” You feel it is part of the fun of watching sports with your friends.
When Asked About Cons:“I don’t want to keep feeling this low.” You are behind at work and not meeting your class expectations.
If asked about your readiness to change on a scale from 0-10 / You identify yourself as 5 out of 10 on the Readiness Ruler.
If asked, “why not a lower number?”: You did not choose a number lower than 5 on the readiness scale because if your drinking is contributing to your depression, then you should probably address it. You also recognize the danger of drinking and driving.
If asked, “why not a higher number?”: You did not give yourself a number higher than 5 because you don’t really believe yet that the drinking is related to your depression. You’re not sure what else you would do to relieve stress.
If asked about a plan or next steps / If asked to develop a plan or steps to cut down or if you are shown options for how to change, you offer to decrease your alcohol use ‘a little.’ If asked to be more specific, you say you could cut down your alcohol use on week nights to no more than 2 drinks, and on the weekends to 2-4 drinks.
If asked, “how confident are you that you can change?”:You think the biggest challenge will be that your friends may give you a hard time if they notice you are drinking less. But, although drinking beer on the weekends while watching football is a “good time”, you are pretty sure you will be able to reduce the number. And, you are kind of interested to see if it really affects your depression.
You agree to a return visit in 4-6 weeks to determine if the Wellbutrin is helping your depression.

For more information, contact Project Director Heather Gotham at .

Brief Patient Bio

Patient: xxxxxxxxxxxx [complete with name of your choice]
XXXXXX [complete with name of your choice] is an adult male, presenting to a mental health clinic. He presented with stress and depression. He came to the clinic today because he was referred by his primary care practitioner who he recently saw for GERD.
Following an assessment, you diagnosed him with a major depressive disorder and prescribed Wellbutrin. Youare now coming back in the room to discuss the results of the annual questionnaire that he responded to at the beginning of his clinic visit.

Annualquestionnaire

Onceayear,allourpatientsareaskedtocompletethis

formbecausedrug and alcohol usecan affectyourhealthaswellasmedicationsyoumay take.

Pleasehelpusprovideyouwiththebestmedicalcare byansweringthe questionsbelow.

Are youcurrentlyinrecoveryfor alcoholor substance use? Yes No

For more information, contact Project Director Heather Gotham at .

Alcohol:Onedrink=12 oz.

beer

5 oz. wine

1.5 oz. liquor

(oneshot)

For more information, contact Project Director Heather Gotham at .

None1 or more

MEN: How manytimesinthepastyear have youhad5or more drinksinaday? /
WOMEN: How manytimesinthepastyear have youhad4ormore drinksinaday?

Drugs: Recreationaldrugsincludemethamphetamines(speed,crystal),cannabis(marijuana,pot), inhalants(paintthinner,aerosol,glue),tranquilizers(Valium),barbiturates,cocaine,ecstasy, hallucinogens(LSD,mushrooms),ornarcotics(heroin).

For more information, contact Project Director Heather Gotham at .

How manytimesinthe pastyear have youusedarecreationaldrugor usedaprescriptionmedicationfornonmedicalreasons?

None1 or more

For more information, contact Project Director Heather Gotham at .

One drink equals: / / 12 oz.
beer / / 5 oz.
wine / / 1.5 oz.
liquor
(one shot)
1. How often do you have a drink containing alcohol? / Never / Monthly or less / 2 - 4
times a month / 2 - 3
times a week / 4 or more times a week
2. How many drinks containing alcohol do you have on a typical day when you are drinking? / 0 - 2 / 3 or 4 / 5 or 6 / 7 - 9 / 10 or more
3. How often do you have five or more drinks on one occasion? / Never / Less than monthly / Monthly / Weekly / Daily or almost daily
4. How often during the last year have you found that you were not able to stop drinking once you had started? / Never / Less than monthly / Monthly / Weekly / Daily or almost daily
5. How often during the last year have you failed to do what was normally expected of you because of drinking? / Never / Less than monthly / Monthly / Weekly / Daily or almost daily
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? / Never / Less than monthly / Monthly / Weekly / Daily or almost daily
7. How often during the last year have you had a feeling of guilt or remorse after drinking? / Never / Less than monthly / Monthly / Weekly / Daily or almost daily
8. How often during the last year have you been unable to remember what happened the night before because of your drinking? / Never / Less than monthly / Monthly / Weekly / Daily or almost daily
9. Have you or someone else been injured because of your drinking? / No / Yes, but not in the last year / Yes, in the last year
10. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down? / No / Yes, but not in the last year / Yes, in the last year
0 / 1 / 2 / 3 / 4
Have you ever been in treatment for an alcohol problem? ⃝ Never ⃝Currently ⃝ In the past

For more information, contact Project Director Heather Gotham at .