SBIRT (Screening, Brief Intervention, Referral to Treatment) is a public health approach to delivering early intervention to anyone who uses alcohol and/or drugs in unhealthy ways. Proper SBIRT training is key to successful intervention.
SBIRT has proven to be an effective way to identify and curtail potential substance abuse problems. Substance abuse has a major impact on public health.
A report from The National Center on Addiction and Substance Abuse at Columbia University (CASA) states that excessive use of alcohol and other drugs contributes to more than 70 diseases and leads to expensive, long-term health problems.
Substance abuse also has many societal economic costs. According to UCLA, of 350,000 adults on probation in California, 41% had been arrested on drug-related offenses.
Screening programs have shown to be cost-effective by interrupting drug-use patterns before severe addiction develops. The return on investment can be more than 3x.
While SBIRT’s focus is on person-to-person interactions, there are various ways that technology can assist with training and administration.
Screening can occur in many different places, ranging from criminal justice settings to primary care settings to emergency rooms/trauma centers to drinking driver programs.
This step consists of a brief set of questions that identifies risk of substance-related problems.
According to David Geffen School of Medicine at UCLA, the following are the characteristics of a good screening tool.
- Brief (10 or fewer questions)
- Easy to administer, easy for the patient
- Addresses both alcohol and other drugs
- Indicates whether there’s a need for further assessment or intervention
Questions are around the frequency and volume of drug and alcohol consumption. They also focus on potential negative effects of substances on the interviewee and those around them.
Questionnaire types include:
- DAST (Drug Abuse Screening Test)
- ASSIST (Alcohol, Smoking and Substance Involvement Screening Test)
- AUDIT (Alcohol Use Disorders Identification Test)
- CRAFFT (For adolescents)
Technology has a role in SBIRT screening training. It can facilitate the administration of questions and the collection of responses.
For example, there is a free SBIRT screening tool iPad app in the Apple App Store. The app provides three levels of questions:
There are instructions at the beginning of each questionnaire. Here is the introduction page for DAST:
The app provides a series of questions with Yes/No answers. It also has frequency questions such as this one.
This app does not store the responses beyond the current session, but it does give a visual result as to whether the patient is low risk, medium risk, high risk or “assessment recommended.”
This step is brief counseling that raises awareness of risks and motivates a client toward acknowledgement of a problem.
For the best outcomes, experts recommend that questions are asked in a non-confrontational and non-judgmental way.
The SBIRT Institute produced several free SBIRT training videos. One of them demonstrates an ideal SBIRT Brief Negotiated Interview (BNI) between an emergency department (ED) doctor and a patient.
A related video demonstrates an ineffective, confrontational approach in the same situation.
Reimbursement for screening and brief intervention (SBI) is available through commercial insurance, Medicare and Medicaid. Technology plays a role in tracking and reporting SBI.
This step is the set of procedures to help patients access specialized care.
A hand-off to treatment can be facilitated by:
- Calling to make appointment for a patient
- Providing directions and clinic hours to patient/student
- Coordinating transportation when needed
Having access to a current database of treatment centers can help a provider direct a patient to the right specialized care facility.
There are many different options for drug rehab and for detox. These range from state-funded rehab to faith-based rehab, some of which are free.
Treatment centers are increasingly relying on technologies such as CRM to streamline their intake and patient management processes.
SBIRT Training Resources
Here are some of the available SBIRT training resources.
Clinical Tools, Inc.
Clinical Tools develops online learning sites for buprenorphine, opioid addiction, obesity, substance abuse, and genetics.
The SBIRT core training is available from SBIRTtraining.com. The training costs $50 and takes about 4 hours to complete.
There is a supplemental training called Motivational Interviewing For Primary Care. It costs $20 and takes about an hour to complete.
UCLA Integrated Substance Abuse Programs
UCLA and the Pacific Southwest Addiction Technology Transfer Center offer a customized, paid for SBIRT training.
The Substance Abuse and Mental Health Services Administration offers a free downloadable publication called Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT).
In 2016, the legislature in our home state of Massachusetts enacted requirements for public schools to engage in substance use screening and education. MASBIRT offers a periodic six hour SBIRT training workshop. There are also options for on-site trainings in the region.