What is SBIRT?

Screening, Brief Intervention, and Referral to Treatment, or SBIRT, aims to identify and assist individuals at-risk for developing a substance use disorder (SUD) as well as those with SUDs.1  

This approach fills the gap of needed services between primary prevention and more intense treatment through early intervention and treatment referral. Its primary goal is to improve health of the community by decreasing negative consequences of substance misuse.2

What Are SBIRT Characteristics?

The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines that a comprehensive SBIRT model includes the below features3:

  • Its efficacy is supported by experiential evidence or strong research.
  • It is short. Brief interventions are usually 5-10 minutes and brief treatment is typically around 5 to 12 sessions.
  • Universal screening occurs.
  • SBIRT takes place in a public health setting, not a substance abuse treatment one.
  • It targets one or multiple specific behaviors connected to risky substance use.
  • It consists of screening, brief intervention or brief treatment, and referral to treatment.

How Does It Work?

Since it can be flexibly applied, SBIRT can be done in a variety of clinical settings such as primary care centers, hospital emergency rooms, clinic-based practices and other community settings.2

The three stages of SBIRT are2,3:

  • Screening: Individuals will go through a screening process to quickly assess their substance use in order to identify if their use patterns are dangerous (thus needing intervention) and the appropriate level of treatment (if necessary). This can be administered as part of a clinician interview via an in-person questionnaire, completed through a computer program, or done over the phone via touchtone keypads.
  • Brief intervention and/or brief treatment: Brief intervention, according to SAMHSA, typically involves 1-5 sessions lasting about 5 to 60 minutes and focuses on educating individuals and raising the motivation of individuals to make behavioral changes that decrease risk. Brief treatment typically involves 5-12 sessions that last up to an hour with the goal of changing not only immediate behaviors or thoughts regarding risky actions but also of addressing long-standing problems with drug or alcohol misuse and helping those with more severe disorders to get long-term care.
  • Referral to treatment: It is recommended that those identified as meeting the diagnostic criteria for a substance use disorder or another mental illness as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) be referred to relevant treatment by a specialized provider (e.g., rehabilitation).

Is It Effective?

According to an article, implementing SBIRT was linked to improvements in equity, efficiency and economy of treatment systems.4 Furthermore,4

  • Larger decreases in substance use were related to greater intervention intensity.
  • Positive outcomes were associated with brief intervention and brief treatment.
  • Brief intervention and brief treatment did not have significant differences in how they impacted alcohol use, but brief treatment had a larger effect on decreasing the frequency of using illicit drugs than brief intervention.

SBIRT has been demonstrated to be effective for decreasing risky alcohol use.3 However, though there is some promising  research on the effectiveness of SBIRT for decreasing risky drug use, the results vary depending on the specific setting, characteristics of the provider, and the patient population targeted.3

While integrating SBIRT into the clinical setting has seen positive results, further investigation is needed to establish the best way to implement it.2

Sources:

[1]. Substance Abuse and Mental Health Services. (2017). Screening, Brief Intervention, and Referral to Treatment (SBIRT).

[2]. Agerwala, S. M., & McCance-Katz, E. F. (2012). Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. Journal of psychoactive drugs, 44(4), 307–317. doi:10.1080/02791072.2012.720169

[3]. Substance Abuse and Mental Health Services. (2011).  Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare. 

[4]. Thomas F. Babor, Frances Del Boca, Jeremy W. Bray. (2017). Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Society for the Study of Addiction.