Screening, Brief Intervention and Referral to Treatment, or SBIRT, is a public health approach to screen patients for substance use issues and address patients at risk for substance use disorders.
SBIRT is a standardized public health intervention that aims to quickly screen patients for substance use disorders and provide the appropriate level of treatment.
Integrating Substance Use Treatment and Primary Care
The Institute of Medicine’s 1990 call for integrated substance use treatment with medical care led to the current SBIRT model. The SBIRT intervention is designed to link community-based screening for substance use disorder and brief interventions to referral to treatment, filling the gap between primary prevention and intensive treatment for people with active substance use disorders.
The Substance Abuse and Mental Health Services Administration, or SAMHSA, has funded SBIRT programs in a variety of settings to promote increased screening for substance use disorders and care integration. Experts believe that integrating substance use prevention and treatment with primary care treatment may reduce the stigma surrounding substance use for patients when reporting their use patterns with their primary care providers.
The SBIRT intervention has 4 main components:
Screening: 4 standardized questions that assess the severity of use and identify appropriate levels of care.
Brief Intervention: Increase patient awareness of substance use and assess motivation for change.
Brief Treatment: Series of sessions focused on motivating patients to change substance use patterns.
Referral to Treatment: Patients with high levels of substance use are referred to specialty care.
Every patient that receives an SBIRT will undergo screening and depending on their screening score, patients will either receive a brief intervention, brief treatment, or a referral to treatment.
Benefits of Administering the SBIRT
There are many benefits of the SBIRT intervention that are attractive to providers and federal organizations. For one, SBIRT programs are easy to implement in the primary care setting and can be adapted for other settings like emergency care and dentistry.
SBIRTs can also reduce the risk of physical trauma from substance use and decrease substance use severity. SBIRTs also reduce overall healthcare costs because they identify patients with moderate substance use issues before they need expensive specialized treatment. Providers are incentivized to perform the SBIRTs because they are billable under public and private insurance policies.
Does the SBIRT work?
There is strong evidence that SBIRT is effective in primary care settings and for assessing alcohol use, but inconsistent evidence that it is effective in emergency care settings and for assessing illicit drug use. A UNC Greensboro and RTI International study measuring substance use outcomes of more than 17,000 patients in SBIRT grant programs found a statistically significant reduction in alcohol use, heavy drinking and illicit drug use 6 months after SBIRT administration.
Brief interventions are effective for alcohol use and brief treatments are effective for illicit drug use. Brief interventions are far more cost-effective because they only require a short conversation about the risks of substance use, while brief treatments require a series of motivational interviewing sessions. The SBIRT is less effective in emergency care settings, but still shows a small reduction in low to moderate drinkers and a reduction in repeat ED visits in adolescents and adults.
Overall, brief interventions delivered in the ED had a short-term effect in reducing at-risk drinking. The SBIRT intervention is by no means a perfect tool for assessing substance use disorders, but it is a cost-effective way to address substance use issues for patients.
Outside the Huddle
Screening, Brief Intervention, and Referral to Treatment (SBIRT) | SAMHSA
Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review | PubMed
Reviewed by Geetika Rao, MPH | Edited by Nidhi Mahagaokar, MPH | Fact checked by Chris Yang