The Health Service Executive (HSE) has published the second edition of the SAOR (Screening and Brief Intervention for Problem Alcohol Use) model first introduced in 2009. Developed by O’Shea, Goff and Armstrong, SAOR II provides an evidence-based framework for screening and brief intervention (SBI) for problem substance use for application in a range of settings and with all levels of need.1 The document provides a step-by-step guide as well as outlining the context, rationale and evidence underpinning the model.

Background and context

Originally, the SAOR model was developed for the delivery of brief interventions for problem alcohol use in emergency departments and acute settings. SAOR II expands the model by making it applicable in a broader range of health, social care, social and recreational settings and for other substances in addition to alcohol.

SAOR II is underpinned by a biopsychosocial model, which understands problem substance use as the complex interaction of the individual, social and family factors, and substance-related characteristics. From this perspective, an effective response to problem substance use must involve a range of different interventions that are readily available to individuals depending on their needs and circumstances. SBI is one of a continuum of supports that may be offered. SBI aims to enhance an individual’s motivation to change substance-using behaviour. The more SBIs experienced, the greater the potential impact on a person’s motivation to change. SBI enables early intervention with at-risk groups in a variety of settings and referral onwards to specialised services as appropriate. A body of literature supports the use of SBI with those with low-to-medium alcohol problems as well as those with drug/alcohol dependence, and suggests it may also be valuable as part of a range of interventions for those receiving opiate substitution.

The use of SBI as part of a continuum of interventions reflects international and national policy and guidelines addressing problem drug and alcohol use. In Ireland, priorities of the National Drug Rehabilitation Framework (NDRF)2 and National Drugs Strategy (NDS) 2017—2015,3 which reflect the Four-Tier Model of Care,4 include ensuring that people with substance use problems can access the necessary supports close to home and at a level appropriate to their needs. Action 2.1.26 of the NDS 2017—2025 emphasises training in the delivery of SBI and onward referral to ensure early intervention for at-risk groups.

SAOR II screening and brief intervention

SAOR II is underpinned by a person-centred approach, recognising the power of the therapeutic relationship and the individual’s capacity to make positive behaviour changes. It reflects the principles of respect, care and compassion, and acknowledges the person’s autonomy in decision making. New to SAOR II is an emphasis on aspects of motivational interviewing (MI),5 which is used to express the person-centred approach. MI is ‘a form of collaborative conversation which strengthens a person’s own internal motivation and commitment to change’ (p. 39).1

The four processes of MI (engaging, focusing, evoking, and planning) are reflected in the four stages of SAOR II:

1 Establishing a supportive relationship through listening and making the person feel comfortable.

2 Asking questions to determine the existence and extent of a problem.

3 Offering assistance, guidance or advice.

4 Referring on to other specialised services as appropriate.

Using MI techniques, SBI can be provided in an extended form (20—30 minute interventions), allowing for a more extensive interaction for those with more complex needs. SAOR II can be used in any setting in the treatment continuum, regardless of the level at which care is provided.

SAOR training

Since 2012, a one-day training programme in SAOR SBI has been provided by the National SBI Project for Problem Alcohol and Substance Use in partnership with the National Addiction Training Programme. A SAOR Train the Trainer programme has also been rolled out. An eLearning resource based on the SAOR model was developed in 2017 and has enabled the model to have greater reach. A suite of SBI online training resources based on SAOR II is being prepared through the National Office for Social Inclusion and Ana Liffey Drug Project and will be available to support the delivery of training and implementation of SBI.

SAOR II is an evidence-based psychosocial intervention that aims to effect behavioural change in persons experiencing problem substance use. As an SBI, SAOR II can be one of a comprehensive set of supports that together address the context, causes and maintenance of problem substance use. SAOR II can be delivered in multiple settings and with a range of substances and levels of need.

2   Doyle J and Ivanovic J (2010) National drugs rehabilitation framework document. National Drugs Rehabilitation Implementation Committee. Dublin: Health Service Executive. https://www.drugsandalcohol.ie/13502/

3   Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017—2025. Dublin: Department of Health. https://www.drugsandalcohol.ie/27603/

4   For further details, see Reducing harm, supporting recovery (2017, p. 33).

5   Miller WR and Rollnick S (2013) Motivational interviewing: helping people change. 3rd edn. New York: Guilford Press.