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What is Screening, Brief Intervention & Referral to Treatment (SBIRT)?

Screening, Brief Intervention & Referral to Treatment is otherwise known as SBIRT. It is an approach to delivering early intervention and treatment to individuals with substance use disorders and people at risk for developing them.

SBIRT was introduced after the Alcohol Use Disorders Identification Test (AUDIT), created in 1982 by the World Health Organization. It is essentially a screening tool for determining if people would likely benefit from substance use treatment.

AUDIT has been proven to be effective at identifying people struggling with alcohol addiction. Still, the Substance Abuse and Mental Health Services Administration (SAMHSA) created SBIRT in 2003 to assess the misuse of other drugs.

Depending on the program, various medical providers can perform SBIRT. It is essential to note that there may be different criteria for Medicaid versus Medicare-covered SBIRT.

Qualified providers include:

  • Physicians
  • Physician’s assistants
  • Nurse practitioners 
  • Clinical nurse specialists
  • Clinical psychologists 
  • Clinical social workers 
  • Certified nurse-midwives

How Does SBIRT Work?

There are three primary components of SBIRT. These include screening, brief intervention, and referral to treatment.

Each part of SBIRT is unique and collectively helps determine how to help people who require substance abuse treatment services.

Screening

The initial SBIRT screening includes pre-screening individuals and asking them about their risky behaviors and habits. Usually, there are different screening tests candidates can receive.

These tests include:

  • AUDIT Drug Abuse Screening Test (DAST)
  • Alcohol, Smoking, Substance Involvement, Screening Test (ASSIST) 
  • Cut Down, Annoyed, Guilty, Eye-Opener (CAGE)

Depending on the type of screening test, the following questions differ slightly but will still be similar. Screens receive a positive or negative score.

If the result is a positive score, candidates are divided by their risk of substance use. The risks are divided by low risk, moderate risk, and high risk. Moderate and high-risk candidates are recommended for a brief intervention. 

Examples of SBIRT questions include:

  • In the past year, have you drunk: Five or more alcoholic drinks in one day (if you are male)? Four or more alcoholic beverages in one day (if you are female)? Four or more alcoholic drinks in one day (if you are 65 or older)? 
  • In the past year, how many times have you: Used illegal substances? Used prescribed medications improperly? Used another person’s prescribed medications? 

Brief Intervention

After the screening process, the next step is a brief intervention. The goal of brief interventions is to discuss risky substance use behaviors and problems with candidates.

The individual may receive informational or educational material that helps them undergo treatment or change their behaviors. A brief treatment period may be introduced if a person is open to discussing treatment services or changing their behaviors.

During the brief treatment stage, a patient educator or other healthcare professional meets an individual for several sessions. During these sessions, they will discuss risky behavioral problems, health problems, and substance use with the client.

Referral to Treatment

The final step of the program involves referral to treatment services. Many people scoring in the moderate to high-risk groups are already in treatment or considering it. For those not yet involved in a treatment program, this stage encourages them to seek treatment.

In some circumstances, individuals will enter the brief treatment stage again.

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What are the 4 P's for Substance Use Screening?

The purpose of the 4 P’s for substance use screening is to identify pregnant women and parents at risk for alcohol, tobacco, and drug use.10 The 4 P’s works as a short screening tool to quickly and efficiently identify expectant mothers requiring an assessment or follow-up monitoring.

Screening patients for substance abuse with the 4 P’s may also lead to further questions concerning depression and domestic violence risk.

The 4 P’s stand for:

  • Parent substance use — the mother is asked about her parent’s drug and alcohol use to learn more about the patient’s experiences with parenting.
  • Partner substance use — the mother is asked about her partner’s use of drugs and alcohol. This provides information of the contact and company the mother surrounds herself with. This question is also crucial in learning about whether the mother suffers from domestic violence.
  • Past use of substances — the mother is asked about her personal use of beer, wine, liquor, cigarettes, and other drugs taken at any time in her life. It is essential to specify ‘beer, wine, or liquor’ instead of ‘alcohol’ as some families do not consider beer or wine as alcohol.
  • Pregnancy — the mother is asked about her substance use in the month before discovering she was pregnant. It is essential to ask about the month before she knew she was pregnant instead of the month before she was pregnant. This reduces defensive responding and normalizes the questions.
  • Current substance use — the mother is asked how frequently she is currently using alcohol, cigarettes, and other drugs.

Is SBIRT Effective?

The efficiency of SBIRT has been proven with evidence. 

Heavy drinkers who received an intervention were twice as likely to receive treatment than those without intervention.3 

Likewise, in the past ten years, alcohol and other drug use rates have reduced by 39 percent and 68 percent.3  Finally, evidence shows that SBIRT is an effective way to lessen risky behaviors and substance abuse in the United States.

Who is Eligible for SBIRT?

SBIRT can be performed throughout the continuum of healthcare and for a variety of patient populations. It is recommended particularly for those who may have an alcohol use disorder (AUD).

Benefits of Using SBIRT

SBIRT has proven many benefits. This includes its efficacy and cost-effectiveness. 

Research shows that there was an 89 percent cost savings per patient screened under the program. There were savings of $330 per patient intervention. Estimated potential savings from funded programs may reach 1.5 billion dollars annually.3  

Additionally, the program does not require comprehensive education or training. Implementation can occur from various healthcare providers, including social workers, nurses, and health educators.

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Resources

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  1. Screening, Brief Intervention, and Referral to Treatment (SBIRT), Substance Abuse and Mental Health Services Administration (SAMHSA), September 2017
  2. Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare, Substance Abuse and Mental Health Services Administration (SAMHSA), April 2011
  3. Benefits of SBIRT, Prevention Insights, Indiana University School of Public Health
  4. Yonkers, Kimberly A et al. “Screening for prenatal substance use: development of the Substance Use Risk Profile-Pregnancy scale.” Obstetrics and gynecology vol. 116,4 (2010): 827-833
  5. Hargraves, Daniel et al. “Implementing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care: lessons learned from a multi-practice evaluation portfolio.” Public health reviews vol. 38 31. 29 Dec. 2017
  6. Agerwala, Suneel M, and Elinore F McCance-Katz. “Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review.” Journal of psychoactive drugs vol. 44,4 (2012): 307-17
  7. Barata, Isabel A et al. “Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department: A Systematic Review.” The western journal of emergency medicine vol. 18,6 (2017): 1143-1152. doi:10.5811/westjem.2017.7.34373
  8. Dwinnells, Ronald. “SBIRT as a Vital Sign for Behavioral Health Identification, Diagnosis, and Referral in Community Health Care.” Annals of family medicine vol. 13,3 (2015): 261-3
  9. Aldridge, Arnie et al. “Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT).” Addiction (Abingdon, England) vol. 112 Suppl 2 (2017): 43-53
  10. Chasnoff, I J et al. “Validation of the 4P's Plus screen for substance use in pregnancy validation of the 4P's Plus.” Journal of perinatology : official journal of the California Perinatal Association vol. 27,12 (2007): 744-8. doi:10.1038/sj.jp.7211823
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