Overview
Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based approach to identifying patients who use alcohol and other drugs at risky levels. The goal of SBIRT is to reduce and prevent related health consequences, disease, accidents and injuries. Risky substance use is a health issue that often goes undetected, by incorporating this evidence-based tool that are demonstrated to be valid and reliable in identifying individuals with problem use or at risk for a substance use disorder (SUD) must be used.
SBIRT can be performed in a variety of settings. Screening does not have to be performed by a physician. SBIRT incorporates screening for all types of substance use with brief, tailored feedback and advice. Simple feedback on risky behavior can be one of the most important influences on changing patient behavior.
Why use SBIRT?
- SBIRT is an effective tool for identifying risk behaviors and providing appropriate intervention.
- Prevent disease, accidents and injuries related to substance use, resulting in better patient outcomes.
- By screening for high risk behavior, healthcare providers can use evidence-based brief interventions focusing on health and other consequences, preventing future problems.
- SBIRT reduces costly healthcare utilization.
- SBIRT is reimbursable, billing codes are available in New York State. Many payers reimburse for SBIRT services.
Introduction to SBIRT
Pre-Screening Tools
A pre-screen, also known as a brief screen, is defined by SAMHSA as "a rapid, proactive procedure to identify individuals who may have a condition or be at risk for a condition before obvious manifestations occur." It involves short questions relating to alcohol and drug use and can be administered prior to beginning a full screening. Many SBIRT providers ask individuals the pre-screening questions first and then ask the full screening questions if follow up is indicated.
Commonly used Pre-screening tools:
| AUDIT-C - consists of three questions related to drinking frequency and quantity. The higher the score, the more likely alcohol is affecting the individual’s health and safety. Audit-C questions are a subset of the full 10-question Audit. |
| NIDA Quick Screen – pre-screen that assesses use of alcohol, tobacco, and prescription drugs for non-medical reasons, and use of illegal drugs during the last year. |
| Four Ps- pre-screen for prenatal substance use. |
| DAST 1: A one item screening tool for past year use of substances not including alcohol. |
Full Screening Tools
Full screening tools are administered after an individual has screened positive on a pre-screen. Full screens ask a validated series of questions that assess the severity of an individual's substance use. Depending on the tool being used, full screens can be administered as written self-reports, or as part of a verbal interview.
Adult Screening
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Alcohol Use Disorder Identification Test (AUDIT) |
Developed by the World Health Organization (WHO), the 10 question AUDIT has been found to provide an accurate measure of risky alcohol use across gender, age, and cultures. The Audit is available in multiple languages. |
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Alcohol, Smoking, and Substance Abuse Involvement Screen Test (ASSIST) |
Developed by the World Health Organization (WHO) and an international team of substance use researchers, the ASSIST screens for hazardous, harmful and dependent use of alcohol, tobacco and other substances.
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Drug Abuse Screening Test (DAST-10) |
The DAST-10 is a 10 item self-report instrument that asks about use of drugs, not including alcoholic beverages, during the past 12 months. "Drug use" refers to the use of prescribed or over the counter drugs in excess of what’s directed and any non-medical and/or illegal use of drugs. |
Adolescent Screening
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Car, Relax, Alone, Forget, Family or Friends, Trouble (CRAFFT)
CRAFFT Manual
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The CRAFFT screens those under 21 for alcohol and other drug use and is recommended by the American Academy of Pediatrics. 2.1 version has three questions which screen for alcohol and other drug use. The 2.1+N version has four questions including a screening question for tobacco use and vaping. There are self-administered and clinician interview versions of the CRAFFT. It is available in English and Spanish. |
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Screening to Brief Intervention (S2BI) |
S2BI is a seven-item tool used to assess the frequency of alcohol and substance use (e.g., tobacco, marijuana, prescription drugs, illegal drugs, inhalants, herbs or synthetic drugs) among adolescents from 12 to 17 years of age. |
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NIAAA Alcohol Screening for Youth |
NIAA Alcohol Screening for Youth uses a two-item scale to assess alcohol use among youth and adolescents between 9 and 18 years of age. The first question determines the frequency of friends' drinking, and the second question assesses personal drinking frequency |
Pregnant Women Screening
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Tolerance, Annoyance, Cut Down, Eye Opener (T-ACE) |
A four-item questionnaire developed to assess alcohol use in pregnant women. It provides obstetricians and gynecologists with a brief and useful way to identify patients at risk for drinking amounts which may be dangerous to the fetus. |
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Tolerance, Worried, Eye Opener, Amnesia, K/Cut Down (TWEAK) |
A five-item scale which was developed originally to screen for risky drinking during pregnancy. |
Training
In classroom:
- SBIRT Training Providers can be found using the Training Catalog.
- Those seeking an in-person 4-hour or 12-hour training should contact the trainer nearest them to set up training sessions.
Online:
- SBIRT Training Program offered by University of Missouri Kansas City
- 3.5 hours SBIRT for Healthcare Professionals (self-paced course)
- 0.5 hours SBIRT Putting it All Together (self-paced course)
- Meets 4 hour SBIRT training requirement for SBIRT Medicaid billing (https://www.health.ny.gov/health_care/medicaid/program/update/2016/2016-04.htm#sbirt)
- Available free of charge with course registration
- Approved for OASAS credentialing hours
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