Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to identify, address, and manage substance use disorders (SUD) at all stages. SBIRT includes three core components:
- Screening: Healthcare providers use standardized, validated tools to assess patients for risky substance use behaviors and identify those at risk for SUD.
- Brief Intervention: Providers engage patients in focused conversations, offering feedback, raising awareness of risks of substance use, and encouraging behavior change.
- Referral to Treatment: Providers refer patients in need of specialized care to appropriate treatment programs or support services.
SBIRT is highly adaptable and effective for early identification of SUD, especially for alcohol use disorder. SBIRT can be integrated into various healthcare settings, including primary care, emergency departments, and via telehealth.
SBIRT can be especially beneficial for rural programs where SUD treatment is limited or geographically distant because it enables quick identification of individuals meeting SUD criteria and facilitates timely referrals to treatment programs. In addition, implementing SBIRT in primary care can help meet patient needs in the primary care setting and reduce the need for future SUD treatment.
Screening, Brief Intervention, and Referral to Treatment-Suicide Care (SBIRT–SC)
SBIRT-SC is an integrated model that addresses SUD with a specific focus on suicide risk. The
SBIRT-SC model combines substance use screening and suicide prevention strategies, such as safety
planning and follow-up support, to promote health and safety among individuals facing substance use
challenges.
Zero Overdose
While SBIRT is a broad approach to substance use, Zero Overdose is an implementation model for
screening and intervention that focuses specifically on overdose prevention. Zero Overdose can
complement SBIRT efforts by providing specific training and resources related to overdose prevention
including the Overdose Safety Plan. The Overdose Safety Plan is completed in a clinical setting
between clinicians and patients at risk of an overdose. That safety plan is a brief intervention in
which clinicians walk patients through seven steps to help the patient identify ways to reduce their
risk of overdose. The clinician then helps the patient identify means of support, including
professionals and agencies they can call in a crisis.
Examples of Rural Screening, Brief Intervention, and Referral to Treatment Programs
- South Carolina SBIRT Program is operated by South Carolina Department of Alcohol and Other Drug Abuse Services to expand access to SUD treatment and connect patients to community resources.
- West Virginia SBIRT Project (WVSBIRT) is a collaboration among mental health centers, primary care clinics, trauma centers, and school-based health clinics. The program delivers SBIRT training to providers and provides early intervention for individuals at risk for SUD, tailored to Appalachia's unique cultural values and needs.
Considerations for Implementation
Effective SBIRT implementation requires a structured approach, including the use of validated screening and assessment tools. Examples of validated tools include:
- Alcohol Use Disorders Identification Test (AUDIT): A 10-item tool, developed by the World Health Organization, designed to identify individuals with harmful patterns of alcohol use.
- CRAFFT 2.1+N: A 6-item screening tool for adolescents, designed to assess substance use and related behaviors. The acronym stands for the following key topics addressed in the tool: Car, Relax, Alone, Forget, Family/Friends, Trouble, and Nicotine/Tobacco.
- Drug Abuse Screening Test (DAST): A flexible instrument to assess the degree to which drug use may be causing problems in one's life. There are multiple versions, including 10-, 20-, or 28- items.
- Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): An 8-item screening tool, developed by the World Health Organization, designed for use in primary healthcare settings to identify people who are using substances.
- Screening to Brief Intervention (S2BI): An electronic screening tool that categorizes adolescent substance use into one of four risk categories.
Programs can seek reimbursement for SBIRT services through Medicare, Medicaid, or private insurance. SBIRT can be implemented by a wide range of healthcare providers, including nurses, social workers, and health educators, with minimal training requirements.
The SBIRT model has also evolved to include electronic screening and brief intervention (e-SBI), which utilizes computers and mobile devices to administer screenings and deliver interventions. This approach, recommended by the Community Preventive Services Task Force (CPSTF), has been effective in preventing excessive alcohol consumption.
By adapting SBIRT to specific populations and leveraging digital tools, rural programs can overcome geographic and resource gaps, improving access and outcomes for individuals at risk of or living with SUD.