Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based approach to identify individuals who use alcohol and other drugs (substances) at risky levels. SBIRT has been shown to be valid and reliable in identifying and improving outcomes for people who use substances. The goal of SBIRT is to prevent or reduce use of substances to prevent related health consequences, disease, accidents and injuries through an early intervention approach.
SBIRT can be utilized by many types of staff in a variety of settings. SBIRT uses a universal screening approach and intends to screen all people in a particular group (clinic, school, community center, etc). SBIRT incorporates screening for all types of substance use with brief interventions designed to guide participants in a conversation to identify goals and values, increase motivation to address problematic substance use, and set goals for improving health. Individuals who need a higher level of care can be identified and referred to specialty supports and services as needed.
Why use SBIRT?
- Identify risky or potentially risky patterns of substance use in a population
- Provide evidence-based interventions for people who may otherwise not access care.
- Connect people to resources, services, and supports
- Prevent disease, accidents, and injuries.
- Improve the health of individuals, families, and communities
- Reduce costly healthcare utilization.
- SBIRT is a billable service
Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment. The following approved screening tools include tools developed for the general population as well as tools that have been developed and validated for specific populations: adolescents, older adults, and pregnant persons.
- Pre-screening Tools
- Full 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 the pre-screen is positive.
Common 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 | AUDIT-C in Spanish | Full 10-question Audit in Spanish
- DAST 1: The DAST-1 refers to the first question of the DAST-10. It asks: "In the last 12 months, have you used drugs other than those required for medical reasons?" Positive responses should be followed up with the full DAST-10 also available in Spanish.
- NIAAA Single Alcohol Screening Question (SASQ): “How many times in the past year have you had (4 for women, or 5 for men) or more drinks in a day?” Responses of one or more should be followed by full screen.
- NIDA Single Question Screening Test for Drug Use: “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons (for example, because of the experience or feeling it caused)?” Responses of one or more should be followed up by full screen.
- Substance Use Brief Screen (SUBS): “How many times in the past year have you used a recreational drug or used a prescription medication for non-medical reasons?” Responses of one or more should be followed by full screen.
- Older Adult Brief Screen: This one-page brief screen pre-screens adults over 60 for alcohol and other substance use.
Full screening tools are administered after an individual has screened positive on a pre-screen or may be administered alone. Full screening tools 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.
Included are tools developed for the general adult population as well as tools that have been developed and validated for specific populations: adolescents, older adults, and pregnant persons.
Adult Screening Tools
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.
Alcohol, Smoking, and Substance Abuse Involvement Screen Test (ASSIST)
ASSIST description: Developed by the World Health Organization (WHO) and an international team of substance use researchers, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) screens for all levels of problem or risky substance use in adults. The ASSIST consists of eight questions covering tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants (including ecstasy) inhalants, sedatives, hallucinogens, opioids and 'other drugs'.
A simplified version of the ASSIST that screens for 6 commonly used substances including alcohol, tobacco, cannabis, stimulants, opiates, and sedatives.
|TAPS – Tobacco, Alcohol, Prescription Medication, and Other Substance Use Tool
|Adapted from ASSIST-LITE, this tool combines screening and brief assessment for a two-stage screen for commonly used substances.
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.
An 8-item measure used to screen for cannabis use disorders (CUD).
Adolescent Screening Tools
Car, Relax, Alone, Forget, Family or Friends, Trouble (CRAFFT)
The CRAFFT screens youth under 21 for alcohol and other drug use and is recommended by the American Academy of Pediatrics.Version 2.1 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.
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.
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.
Older Adult Screening Tools
|Short Michigan Alcohol Screening Test – Geriatric (SMAST-G)
|The SMAST-G is a screening tool used to detect alcohol use or misuse in older adults. The questions address the physical signs of excessive drinking, the connection between drinking and emotional states, problems controlling the amount of alcohol consumed, and the reactions of others to the older person’s drinking.
Pregnant Person Screening Tools
The 5 P’s Integrated Screening Tool is a quick, non-threatening, and effective screening tool for pregnant persons that asks about use of alcohol and drugs as well as depression, violence, and tobacco. It provides clear guidelines for use and follow up recommendations.
Tolerance, Annoyance, Cut Down, Eye Opener (T-ACE)
|A four-item questionnaire developed to assess alcohol use in pregnant persons. 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.
Tolerance, Worried, Eye Opener, Amnesia, K/Cut Down (TWEAK)
A five-item scale which was developed originally to screen for risky drinking during pregnancy.
- 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.
- 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