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SBIRT: Screening, Brief Intervention & Referral to Treatment

A clinicians' tool for identifying risky behaviors and providing appropriate intervention.
SBIRT: Screening, Brief Intervention & Referral to Treatment

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.

    Screening Tools

    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-Screen

    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 Screen

    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)

    AUDIT Manual 

    Questionnaire
    English or Spanish

    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 Manual

    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.

    ASSIST-LITE

    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. 

    Drug Abuse Screening Test or DAST-10

    DAST-10 in Spanish
    Questionnaire

    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.

    The Cannabis Use Disorders Identification Test - Revised (CUDIT-R)

     An 8-item measure used to screen for cannabis use disorders (CUD). 

     

    Adolescent Screening Tools

    Car, Relax, Alone, Forget, Family or Friends, Trouble (CRAFFT)

    CRAFFT Manual
    CRAFFT 2.1 Questionnaire 
    CRAFFT 2.1+N Questionnaire

    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.  

    Screening to Brief Intervention (S2BI)
    S2BI Online Tool
    S2BI Manual 
    Quick Guide
    Questionnaire

    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.

    NIAAA Alcohol Screening for Youth
    Manual
    Quick Guide
    NIAA Youth Pocket Card

    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

    Five P’s Integrated Screening Tool for Pregnant Women

    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) 

    Questionnaire

    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)

    Questionnaire

    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:

     

    Print Materials