What Is SBIRT?
Screening, Brief Intervention, and Referral (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention to individuals at-risk for developing substance abuse disorders. Unlike traditional substance abuse treatment which focuses only on individuals with a substance abuse disorder diagnosis, screening and brief intervention has been shown to reduce alcohol consumption and/or drug (AOD) use in a significant number of at-risk non-dependent users.
SBIRT has been proven to reduce overall healthcare costs while significantly improving the quality of healthcare provided. The goal of screening and brief intervention is to reduce risk related to consumption, to eliminate high-risk alcohol and other substance use, and to increase motivation for behavior change, up to and including referral to specialized AOD treatment services.
How Does Screening, Brief Intervention and Referral Work?
SBIRT provides tools within a variety of settings needed to identify, and intervene, as well as refer individuals to treatment, thus reducing the associated adverse effects on health, family, and society:
- Screening quickly assesses the individual’s level of risk from use of substances and identifies the appropriate level of intervention.
- Brief Intervention focuses on increasing an individual’s insight and awareness regarding their personal level of use of substances and evokes motivation toward behavioral change – a short, one-on-one, counseling session
- Referral to treatment provides individuals identified as needing more extensive treatment with access to specialty care.
Research shows that a brief intervention, usually delivered using a motivational interviewing technique, is the most effective practice for reducing low and moderate risk of AOD use. Effective brief intervention is matter-of-fact and non-confrontational, and involves providing educational materials and individualized feedback on screening results, offering choices on how to make changes, emphasizing the individual’s responsibility for changing behavior, and conveying confidence in their ability to change. Inclusion of follow-up, usually in the form of a phone call, increases intervention effectiveness. Individuals at highest risk are invited to accept a referral for further assessment and treatment.
Is SBIRT Effective?
Research studies consistently show that SBIRT changes the course of many patients’ harmful drinking and other substance use, encourages them to stop smoking, and reduces the number of hospital admissions for traumatic injuries, drinking and driving, alcohol-related injuries, and substance-related health problems. The “mainstreaming” of screening and brief intervention into health care settings destigmatizes substance use disorders by treating them as we do other chronic illnesses. The cost benefit in reduced traumatic injuries alone is estimated at $3.81 for every $1 spent on screening and brief intervention, for an annual nationwide net savings close to two billion dollars ($2,000,000,000).
Where Is SBIRT Provided?
Screening and brief intervention are effective in a variety of settings. Its effectiveness has been proven particularly in hospital emergency departments and trauma centers treating individuals with alcohol-related injuries. SBIRT has also been shown to be effective in primary care settings, where it is incorporated into other routine medical assessments such as measuring blood pressure. Similarly, pregnancy check-ups present an opportunity when a substance using woman is open to making changes so that her baby can be born healthy. Nearly half of all pregnancies are unplanned, highlighting the need for health professionals to routinely inquire about alcohol and other drug consumption by women of childbearing age.
Colleges and universities serve the 18-24 year-old population that reports higher alcohol and other drug use than any other age group. With screening and brief intervention for students, feedback on alcohol and other drug use in relation to their peers, sometimes called social norms education, is an especially effective component of SBIR. SBIR can also be utilized in Student Assistance Programs in high-school settings, where screening tools developed specifically for teens have been effective in addressing substance use issues.
Why Is SBIRT Needed?
In California, the use of alcohol and other drugs extracts a tremendous price – with long-term consequences for individuals, families, and society as a whole. One of every four of us has a close relative suffering from addiction. One in five Californians reports binge drinking (five or more drinks within a few hours) and nearly one in 10 reports illicit drug use. The costs of substance use and abuse are enormous and include increased health care burdens, premature mortality, reduced productivity and quality of life, crime, suicide, domestic violence, child abuse, fetal alcohol spectrum disorders and incalculable pain. Through screening and brief intervention in hospital emergency rooms, trauma centers, primary care centers, and other community settings, we can reduce the negative consequences of the use and abuse of alcohol and other drugs.
SBIRT Toolkit:
This toolkit is intended for behavioral and medical healthcare providers, educators, employers and service providers that are interested in learning about, developing, implementing, and/or providing SBIRT services. This toolkit is separated into sections to make it easier to identify materials that will be useful in specific settings.
Overview – Screening and Brief Intervention: Making a Public Health Difference :
·This 27 page report from Join Together provides an overview on SBI, and discusses barriers to expanded utilization and makes recommendations on ways to boost understanding and use of this important tool. Screening, Brief Intervention, and Referal (SBIRT)
SBIRT in Specific Settings: This section provides screening tools, information and materials to help with implementing SBIRT in specific settings.
- SBIRT in Medical Healthcare Settings (link to following:)
- This Resource Guide is intended to provide clinicians serving adult populations in general medical settings with the screening tools and procedures necessary to conduct screening, brief intervention, and/or treatment referral for patients who may have or be at risk of developing a substance use disorder. NIDA Screening for Drug Use in Medical Settings)
- SBIRT Implementation Toolkit for the Emergency Department Settings (link to following:
- The Emergency Nurses Association Injury Prevention Institute developed this toolkit. It provides information, materials, and tools – including, but no limited to, a manual, Powerpoint presentation, and videos – for implementing SBIRT.
http://www.ena.org/IQSIP/Injury%20Prevention/SBIRT/ToolKit/Pages/toolkit.aspx
- SBIRT Implementation Toolkit for Trauma Patients
- This 16 page guide developed by the American College of Surgeons Committee on Trauma provides tips for planning and implementing an SBI program; a description for screening methods and different screening instruments; as well as the components of a brief intervention. http://www.facs.org/trauma/publications/sbirtguide.pdf
- SBIRT In Primary Care Settings
- A six page scholarly article about the significance of implementing alcohol screening and brief intervention programs in the primary care settings published in the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) quarterly, peer-reviewed scientific journal, Alcohol Research & Health. http://pubs.niaaa.nih.gov/publications/arh28-2/57-62.pdf
- The SBIRT Oregon Method for Primary Care Clinics: SBIRT Oregon project is funded by the Centers for Substance Abuse Treatment, under the Substance Abuse and Mental Health Services Administration. http://www.sbirtoregon.org/index.php
- Bridges to Care – Toolkit for Engaging Pregnant Women
- This link to Contra Costa County Health Services Bridges to Care toolkit gives health care providers tools, including screening and brief intervention, to engage pregnant women who use alcohol and drugs in prenatal care. http://cchealth.org/groups/psap/bridges.php
- SBIRT Toolkit for College and University Campuses
- This toolkit was produced by the U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA). It provides guidance for conducting a screening and brief intervention; the AUDIT instrument for screening; as well as descriptions of the effects of alcohol and lower-risk drinking strategies. http://www.friendsdrivesober.org/documents/SBI_College.pdf
- SBIRT in the Workplace
- This toolkit was developed by Ensuring Solutions to Alcohol Problems at the George Washington University Medical Center. It provides methodologies and tools for SBI, guidance on how to refer employees to treatment and other services, and methods for keeping track of progress and outcomes. http://www.ensuringsolutions.org/solutions/solutions_show.htm?doc_id=450551&cat_id=963
- SBIRT in the Criminal Justice System
- A nine page scholarly article about the significance of implementing alcohol screening and brief intervention programs in the criminal justice system published in the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) quarterly, peer-reviewed scientific journal, Alcohol Research & Health. http://pubs.niaaa.nih.gov/publications/arh28-2/85-93.pdf
- American Public Health Association SBIRT Manual
- The purpose of this manual is to provide public health professionals, such as health educators and community health workers, with the information, skills, and tools needed to conduct SBI. http://www.adp.ca.gov/SBI/pdfs/Alcohol_SBI_Manual.pdf
- Video Screening and Brief Intervention
Studies in SBIRT: This section provides data and research from studies on the impact of providing SBIRT services.
- UCLA Mental Health ASSIST Implementation
- The research reported here is based on experiential evidence from clinicians who administered the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) screening tool and brief intervention to college students at UCLA Counseling and Psychological Services (CAPS), which participated in a 3-year SAMHSA services grant to implement SBI services on a college campus. http://www.adp.ca.gov/SBI/pdfs/UCLA_Mental_Health_ASSIST_Implementation.pdf
- Medicaid Cost Outcomes
- The Washington State Screening, Brief Intervention, and Referral to Treatment (WASBIRT) Project compares the changes in Medicaid costs for clients who received at least a brief intervention through the WASBIRT Project, and clients who did not receive an intervention through the program. http://www.ncbi.nlm.nih.gov/pubmed/19927016
- Current Research on Screening and Brief Intervention and Implementations for State Alcohol and Other Drug (AOD) Systems
- Prepared by the National Association of State Alcohol and Drug Abuse Directors (NASADAD), this 16 page brief provides a compilation of selected findings in SBI and an examination of the implications for administrators of AOD treatment systems. http://www.adp.ca.gov/SBI/pdfs/SBI_NASADAD_research.pdf
Screening Tools:
- This document on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed by the World Health Organization (WHO) and an international team of substance use researchers as a simple method of screening for hazardous, harmful and dependent use of alcohol, tobacco and other psychoactive substances.
Brief Intervention:
- This document on brief intervention for substance use was developed by the World Health Organization (WHO); together with the ASSIST guidelines for use manual, this manual presents a comprehensive approach to screening and brief intervention which is tailored to the specific circumstances of primary care.
Motivational Interviewing:
- This publication from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) provides information on research, results, and the promise of motivational interventions. It also describes different motivational interventions that can be used at all stages of change, from precontemplation and preparation to action and maintenance.
Motivation for Change and Alcoholism Treatment
