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

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

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 a primary care clinic. You present with stomach pain and unrelenting nausea. Your symptoms are intermittently relieved by over the counter antacids and Zantac. You come to the clinic today because your pain is affecting your ability to work. Following a physical exam, you receive a prescription to alleviate the stomach pain. The clinician is now coming back in the room to discuss the results of the annual questionnaires that you responded to at the beginning of your clinic visit.
Opening statement / “OK, I guess so.”
History of Alcohol Use / During the work week, you have a drink with lunch and normally have 2-3 drinks with dinner. 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 / Over the counter antacids, Zantac, and Tums
Social History / You have a bachelor’s degree in Finance. You have been very stressed at work over the past 3 months because of pressing deadlines. Your wife enrolled in an accelerated college program a month ago which has increased the level of stress at home. You eat out with business associates for lunch and dinner 4 days per week.
Family History / You live at home with your wife and 2 children, ages 9 and 11. After several years of caring for the children at home, your wife began attending an accelerated college program. You are supportive of your wife’s decision to complete her degree. Your mother-in-law cares for your children after school on the days your wife attends classes.
SP Presentation / You are dressed in casual business attire, nice shirt and tie. No jacket. Your posture is closed. You are feeling somewhat nauseous but the Zantac you took immediately before this appointment is relieving some symptoms. You are stressed about pending work deadlines and increasing demands of your time at home. Your mother-in-law has expressed her disapproval that your 4-night/week business travel is placing an increasing strain on your family life.
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 guidelines because they seem really low to you. “I drink less than some of my friends.” You hadn’t ever been told that alcohol use could cause this level of stomach pain or be making it worse.
If asked about pros & cons of substance use / When Asked About Pros:“All my associates drink wine with meals. I would stand out if I didn’t drink wine or at least a scotch and water with them.” You feel alcohol helps you relax in the evenings and gives you an edge in negotiating business deals. You feel drinking is part of the culture of your job. You also enjoy the taste of fine wines and expensive scotch, which you pay for through a business expense account.
When Asked About Cons:“I don’t like all this stomach pain.” You are behind at work and not meeting expected sales quotas.
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 causing your health problems, then you should probably address it. Additionally, your job is important to you and you don’t want to miss any more meetings or sales quotas.
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 stomach pain. Also, you aren’t sure how it would look at work if you cut down or drank less at work meals.
If asked about a plan or next steps / If asked to develop a plan or steps to cut down or shown options for how to change, you agree to cut down, and to return to the clinic in a few weeks to determine if your new prescription is alleviating the stomach pain. “I’ll cut down on my drinking for at least a while and see how I feel.” You will not drink at lunch and will only have one glass of wine with dinner. Also, you will limit the number of beers you have on the weekend.
If asked, “how confident are you that you can change?”:You are about a 7 on the scale. You think the biggest challenge of changing your alcohol use will be that business associates may question it. You decide it won’t be so hard not drinking at lunch meetings. You’ll order a club soda and lime instead. You are determined to feel better and say, “I’ll just tell my business associates that I can’t drink when taking this new medication for this stomach problem.”
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 to 2 or 3.

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 a 43-year old male, presenting to a primary care clinic. He presented with stomach pain and unrelenting nausea. His symptoms are intermittently relieved by over the counter antacids and Zantac. He came to the clinic today because his pain is affecting his ability to work.
Following a physical exam, he received a prescription to alleviate the stomach pain. You, the clinician, are now coming back in the room to discuss the results of the annual questionnaires 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 .