(Screening, Brief Intervention, Referral, and Treatment)
How many people with patterns of unhealthy drug or alcohol use could be prevented from falling into real substance-abuse disorders if their current behaviors raised a red flag, and their primary-care providers (PCPs) intervened?
That question is at the core of the Screening, Brief Intervention, Referral, and Treatment (SBIRT) process, which uses clinical screening to systematically identify, treat, and refer for care those patients currently at risk of developing alcohol, tobacco, or other drug-use problems, but who do not yet have an actual substance-use disorder (i.e., abuse, or dependence).
SBIRT approaches substance-use disorders on a continuum that range from no use to dependence, and strives for the earliest possible intervention where use becomes unhealthy, which is why its focus is on at-risk patients.
Primary-care centers, hospital emergency rooms, trauma centers, mental health facilities, and other community settings provide opportunities for early intervention with at-risk substance users before more severe health-outcomes may occur. Research has shown that at-risk users can, and often do, successfully change their drug- and alcohol-use patterns based upon such early interventions.
SBIRT can help decrease a patient’s frequency and severity of drug and alcohol use and reduce the risk of associated traumas, in addition to increasing the number of patients who enter specialized treatment.
The health advantages for successful early detection and intervention are clear – not to mention that cost-benefit analyses and cost-effectiveness analyses of SBIRT integration both show significant net savings in overall patient-care costs.
- (S) Screening. The screening process for unhealthy-use patterns is very brief, with the majority of patients screening negative. For those who screen positive, however, further assessment is then needed to determine the level of risk to their health.
- (BI) Brief Intervention. The provider gives feedback to the patient about unhealthy substance use, which can focus on education and increasing patient awareness of the risks related to the behavior, though feedback can also take the form of encouragement in support of healthy behavioral changes. Providers are encouraged to employ doctor-patient communication based upon motivational interviewing techniques, to spur changes in patient behavior.
- (RT) Referral to Treatment. A referral for addiction assessment and possible treatment is typically indicated only for about 5 percent of people who are screened. Research has shown SBIRT to be most effective with patients with unhealthy alcohol or drug use who do have yet to develop a substance-use disorder.
To see the SBIRT process used in a clinical situation, view this video from SBIRT NC, a statewide resource for SBIRT information, resources, and coordination, as well as for downloadable toolkits for integrating this beneficial clinical approach into your own practice.
SBIRT NC is a collaborative effort between our state partners at Community Care of North Carolina (CCNC); the Governor’s Institute; the state Division of Mental Health, Development Disabilities, and Substance Abuse Services; the federal Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT); and the NC Center of Excellence for Integrated Care.