Indiana University Bloomington

Indiana Prevention Resource Center (IPRC)

Screening, Brief Intervention and Referral to Treatment (SBIRT)

Screening, brief intervention and referral to treatment (SBIRT) is a process designed to identify potential substance use problems and involves short questionnaires delivered electronically, orally or in written form, usually lasting anywhere from 5 to 15 minutes. The primary goal of SBIRT is to identify risky and harmful alcohol and non-medical drug use and if appropriate, to refer for further assessment and treatment if it appears there is a more serious problem.

This results in decreased risky behaviors that can lead to illness, injury and or death. Fortunately SBIRT is increasingly gaining more popularity in the allied health professions. According to an article by Join Together (Anderson, Aromaa,, Enos,  Rosenbloom, 2008). The percentage of people in primary care settings with alcohol dependence is 5%; risky drinkers comprise 20%, followed by low risk drinkers at 35% and 40% are in the abstainers’ category. Research shows that SBIRT is effective in reducing drinking in both men and women across age groups who are not alcohol dependent (Ockene, et al., 1999; Fleming, et al., 1997; Fleming, et al., 1999; World Health Organization Study Group, 1996). Furthermore, SBIRT has been demonstrated to reduce length of hospital stays, sick days and mortality (Kristenson, Ohlin, Hulten-Nosslin, Trell   Hood, 1983). For people with alcohol dependency, SBIRT is effective in facilitating follow through with referrals for evaluation and treatment (Bernstein, et al., 1997).

To understand the primary benefits of SBIRT requires a paradigm shift in the way we as a society typically think about alcohol and drug problems. The benefits yield from what is referred to as the preventive paradox (Kreitman, 1986). The preventive paradox directs our attention to the distribution of problem drinkers and points out that if alcohol and drug related problems are to be reduced at the population level then we must actually target our interventions at persons with mild to moderate alcohol problems (IOM, 1990). As a society we have traditionally targeted our resources to help those with chronic or severe alcohol or drug problems (i.e. abuse or dependency). The paradoxical part is that SB IRT focuses on the much larger population who drinks a little and has fewer related problems; comparatively more people such as this exist, consequently, focusing on a larger population with fewer problems results in preventing many more related concerns, such as unintended drug interactions, driving under the influence of maintenance medications, etc. This results in greater reductions in costs to the health care system and society.

There are barriers to the implementation of SBIRT. Anderson et al., (2008) found that many physicians are not trained in delivering SBIRT, time constraints in busy practices and doctor preferences for licensed addiction counselors to offer advice regarding alcohol and drug misuse all present roadblocks to the successful use of SBIRT in the medical field. Privacy regulations and difficulty in getting reimbursements also restrict SBIRT efforts.

On a positive note, there are several recommendations for integrating SBIRT into primary care settings. Physicians’ assistants and nurse practitioners are in key positions to deliver effective SBIRT services because of their prevention oriented approach to practice. Expanding SBIRT to the field of mental health and psychiatry, working with insurance companies to seek reimbursements and lessening restrictions on privacy regulations that may deter the provision of services, as well as mandating the inclusion of SBIRT training in medical school and residency curriculums all work towards growing SBIRT use. Other suggestions are blending SBIRT screenings with other routine prevention screenings which a patient may receive during a physician visit, gaining support for SBIRT from professional organizations, and using online self assessments (Anderson et al, 2008).

Reference

Anderson, A., Aromaa, S., Enos,G.,   Rosenbloom,D. (2008). Screening   Brief Intervention: Making a Public Health Difference. Join Together. Retrieved from http://www.jointogether.org/aboutus/ourpublications/pdf/sbi-report.pdf
Bernstein, E., Bernstein, J.,   Levenson, S. (1997). Project ASSERT: An ED-based intervention to increase access to primary care, preventative services, and the substance abuse treatment system. Annals of Emergency Medicine, 30, 181-189.
Fleming, M.F., Barry, K.L., Manwell, L. B., Johnson, K.,   London, R. (1997). Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care clinics. Journal of the American Medical Association, 227 (13), 1039-1045.
Fleming, M.F.,   Manwell, L.B. (1999) Brief intervention in primary care settings: A primary treatment method for at-risk, problem, and dependent drinkers. Alcohol Health and Research World, 23(2), 128-137.
Institute of Medicine. (1990). Broadening the Base of Treatment for Alcohol Problems. Washington, D.C: National Academy Press.
Kreitman, N. (1986). Broadening the base of treatment for alcohol problems. Institute of Medicine.
Kristenson, H.,Ohlin, H., Hulten-Nosslin. M., Trell, E.,   Hood, B. (1983). Identification and intervention of heavy drinking in middle aged men: Results and follow-up of 24-60 months of long-term study with randomized controls. Alcoholism: Clinical and Experimental Research, 7, 203-209.
Ockene, J.K., Adams, A., Hurley, T. G., Wheeler, E. V.,   Herbert, J. (1999). Brief physician-and nurse practitioner-delivered counseling for high-risk drinkers: Does it work? Archives of Internal Medicine, 159(18), 2198-2205.
World Health Organization Study Group. (1996). A cross-national trial of brief interventions with heavy drinkers. American Journal of Public Health, 86(7), 948-955.

 

By Ruth Gassman and Courtney Stewart,   4/30/2010