SBIRT for Referral to Treatment

Do you or a loved one struggle with addiction? Have you ever heard of SBIRT? Learn about its uses in referral to addiction treatment.

Screening, briefing and referral to treatment (SBIRT) is a screening tool for determining if individuals would likely benefit from substance use treatment. SBIRT was preceded by the Alcohol Use Disorders Identification Test (AUDIT), created in 1982 by the World Health Organization. Though AUDIT has been extremely effective at identifying individuals struggling with alcohol addiction, the Substance Abuse and Mental Health Services Administration (SAMHSA) developed SBIRT in 2003 to evaluate the misuse of other substances.

What Is SBIRT?

What is SBIRT and how does it work? Importantly, how is SBIRT different from previously enacted government programs? First, SBIRT stands for Screening, Brief Intervention and Referral to Treatment. As a precursor of SBIRT, AUDIT has proven to be accurate regardless of ethnicity or sex. The goal of programs like AUDIT or SBIRT is to identify individuals with substance use problems and encourage them to receive treatment.

Components of SBIRT

There are three main components of SBIRT: screening, brief intervention and referral to treatment. Each component is unique and collectively helps institutions that have funding through SBIRT determine how to best help individuals with substance use disorders.

1. Screening

The initial SBIRT screening involves pre-screening candidates and asking them about their risky behaviors. Typically, there are four different screening tests individuals can be given. These include:

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

Depending on the screening test, the SBIRT questions will differ slightly but will still be similar in nature. Screening tests are given a positive or negative score. If given a positive score, individuals are divided by their risk of substance abuse, measured as low risk, moderate risk or high risk. Moderate and high-risk individuals are recommended for a brief intervention. Examples of SBIRT questions include:

• In the past twelve months, have you drank:
  • Five or more drinks in one day (if you are a man)?
  • Four or more drinks in one day (if you are a woman)?
  • Four or more drinks in one day (if you are aged 65 and older)?
• In the past twelve months, how many times have you:
  • Used illegal substances?
  • Used prescribed medications improperly?
  • Used another person’s prescribed medications?

2. Brief Intervention

After the initial screening process, the next step is an SBIRT brief intervention. The goal of an intervention is to discuss risky substance use behaviors with individuals. During this time, an individual may be given informational or educational material that encourages them to undergo treatment or modify their behaviors.

If a person is amenable to discussing treatment options for a substance use disorder or acknowledges that they would like to change their risky behaviors, a brief treatment period may be initiated. In the brief treatment stage, a patient educator or other health professional will meet with a person for several sessions. During these sessions, they’ll discuss risky behaviors, health problems and substance use with the client.

3. Referral to Treatment

The last step of an SBIRT program involves referral to treatment. Many individuals that score in the moderate to high-risk groups are already in treatment or highly considering treatment. For those individuals not yet participating in a treatment program, the goal of this stage is to continue to encourage individuals to seek treatment. In some cases, individuals will enter the brief treatment stage again.

Benefits of SBIRT in Health Care

What are the benefits of SBIRT? Currently, SBIRT has shown many benefits, including its efficacy and cost-effectiveness and the agencies that endorse it. As far as cost-effectiveness, there was an 89% cost savings per patient screened under the SBIRT program, with a savings of $330 per patient intervention. Estimated potential savings from SBIRT funded programs could reach 1.5 billion dollars per year.

The SBIRT program is endorsed by the WHO, the United States Preventive Services Task Force, the Committee on Trauma of the American College of Surgeons and SAMHSA.

Who Can Practice SBIRT?

Depending on the SBIRT-funded program, a variety of medical providers can practice SBIRT. It is important to note that there may be different criteria for Medicaid versus Medicare-covered SBIRT. Nevertheless, eligible providers include:

• Physicians
• Physician’s Assistants
• Nurse Practitioners
• Clinical Nurse Specialists
• Clinical Psychologists
• Clinical Social Workers
• Certified Nurse Midwives

SBIRT Training and Certification

Individuals may obtain training and certification for providing SBIRT services through several agencies. There may also be specific agencies in every state that provide SBIRT training. Some helpful resources and agencies for training include:

• Institute for Research, Education & Training in Addictions (IRETA)
• The Addiction Technology Transfer Center (ATTC)
• National Council for Behavioral Health
• Rethinking Drinking
• Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide
• Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices.
• The BIG (Brief Intervention Group) Initiative SBIRT Education
• SBIRT for Dental Practitioners Online Course offered by Arizona State University
• The World of SBIRT

Is SBIRT Effective?

SBIRT’s efficacy has been proven. Heavy drinkers that received an SBIRT intervention were twice as likely to enter treatment relative to those with no intervention. In the past ten years, rates of alcohol and other drug use have been reduced by 39% and 68% six-months post SBIRT, respectively. Thus, data shows that SBIRT is an effective way to reduce risky behaviors and substance abuse in the United States.

How the Recovery Village Uses SBIRT

Representatives at The Recovery Village use SBIRT to assess an individual’s risk of addiction and connect them to treatment that heals. This process begins with administering a drug and alcohol addiction screening test. Once it’s determined that an individual is at a high risk of addiction, a representative can begin the process of enrolling the individual in a treatment program specializing in the treatment of addiction and co-occurring disorders, The Recovery Village offers something for everyone.