Screening, Brief Intervention, and Referral to Treatment (SBIRT) Model

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach and framework to identify and deliver early intervention and treatment to people with substance use disorders, like opioid use disorder (OUD). The three major components of SBIRT are:

• Screening to quickly assess the severity of substance use and identify the appropriate level of treatment.
• Brief intervention to focus on increasing insight and awareness regarding substance use and motivation toward behavioral change.
• Referral to treatment to provide those identified as needing more extensive treatment with access to specialty care.

Using SBIRT, rural programs can quickly identify individuals who meet the criteria for OUD and refer them to treatment programs.

SBIRT is most commonly used in the primary care setting to help identify patients in need of treatment for OUD and other substance use disorders. An annual exam or an acute care visit can present an opportunity to implement SBIRT and initiate medication for opioid use disorder (MOUD) treatment. SBIRT can also be implemented in emergency departments, and remotely through telehealth.

For more information on SBIRT, see Screening, Brief Intervention, and Referral to Treatment (SBIRT) in the Rural Prevention and Treatment of Substance Use Disorders Toolkit.

Implementation Considerations

SBIRT is a formal process rural programs can use to screen individuals who are at risk for OUD and other substance use disorders. The provider must do a structured assessment to assess whether an individual has OUD. There are several screening and assessment tools for SBIRT rural programs can use, including:

• Alcohol Use Disorders Identification Test (AUDIT) – a 10-item screening tool from the World Health Organization
• Drug Abuse Screening Test (DAST) – depending on the version, a 20-, 28-, or 10-item (DAST-10) instrument
• Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) – an 8-item screening tool from the World Health Organization

Programs implementing formal SBIRT processes should seek reimbursement coverage for screening and brief intervention services. SBIRT reimbursement is available through Medicare, Medicaid, and commercial insurers.

Program Clearinghouse Examples

• Palo Alto County Hospital

Resources to Learn More

Implementing SBIRT in Rural Clinics: A How-To Guide
Video/Multimedia
Free webinar describing SBIRT practice and how to work collaboratively to implement a cost-effective program in rural settings. Covers a series of implementation steps and discusses the opportunities and barriers for developing SBIRT in rural clinics.
Organization(s): NAADAC, the Association for Addiction Professionals
Date: 1/2019

Tap 33: Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Document
Describes the basics of implementing SBIRT programs for individuals living with or at risk for substance use disorders including organizational readiness, staffing, procedures, evaluation, and funding and reimbursement.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)
Date: 5/2013