Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive public health approach to delivering early intervention and treatment to people who are at risk of developing substance use disorders and those who have already developed such conditions. SBIRT's primary purpose is to reduce the risk of injury, disease, and disability related to the misuse of potentially dangerous substances such as alcohol, drugs, and tobacco products. Thanks to its flexible nature, SBIRT has been successfully adapted for use in a wide variety of clinical settings. SBIRT is commonly implemented in hospital emergency rooms, primary care centers, doctors' offices, and other health facilities. In addition to identifying people in need of help, SBIRT intervention can provide a pathway to brief treatment for those with mild substance use disorders and formal treatment programs for those with more severe substance problems. SBIRT screening also provides public health professionals with valuable insight into the substance use risks faced by their local communities.

Background

While some of the ideas and methods tied to SBIRT date back as far as the eighteenth century, SBIRT itself did not begin to emerge until the 1980s. In large part, this was due to the changing social perceptions of alcohol dependence that were first starting to take hold at that time. In earlier times, alcohol dependence was predominantly seen as a personal shortcoming that resulted perhaps from a lack of self-control or generally low moral standards. In the 1980s, however, changing societal norms led to alcohol and even drug dependence becoming viewed as a physical, psychological, and behavioral condition that could be treated and prevented. This widespread change in thinking about dependence subsequently created a social environment in which a concept like SBIRT could become a viable public health approach to dealing with substance misuse.

As the 1980s progressed, several new alcohol and drug abuse screening tools were developed. Some of these included the Michigan Alcohol Screening Test (MAST) and the Drug Abuse Screening Test (DAST). Later in the decade, a landmark study conducted in London, England, revealed the potential benefits of the newly emerging concept of SBIRT. The study in question showed that brief physician advice helped people quit smoking. A similar Swiss study also showed that screening and brief intervention in the form of simple, but repeated, encouragement from a qualified health care provider helped to decrease alcohol consumption and lower the risks and mortality rate related to heavy drinking. As more studies were completed in the 1990s, the benefits of screening and brief intervention became even more apparent. This eventually led the World Health Organization (WHO) to start work on developing an international screening test and to further investigate the effectiveness of different brief intervention approaches for at-risk individuals. WHO's efforts ultimately led to the development of the Alcohol Use Disorders Identification Test (AUDIT) and further studies on various brief intervention techniques aimed at those most likely to have alcohol-related problems. All of this helped facilitate SBIRT's gradual integration in health care systems in the United States and other countries around the world.

Overview

At its core, SBIRT is an evidence-based method of identifying individuals who use alcohol and/or illicit drugs to a potentially dangerous extent and ultimately minimize the negative effects of such behaviors. It is important to note SBIRT is not primarily intended to identify people who are alcohol or drug dependent. Although it can certainly help such individuals, it is instead mainly aimed at identifying at-risk people, including those who do not have substance use problems, but may be at risk of developing them, and those who exhibit high-risk behaviors, but do not think they need help.

When carried out to its fullest extent, SBIRT consists of four core components: screening, brief intervention, brief therapy, and referral to treatment. The first step in the process is screening. Over the years, screening of all patients for potentially problematic drug and alcohol use has become a routine procedure in health care settings of all kinds. In most cases, screening is carried out through interviews or self-reporting using approved screening tools such as MAST, DAST, and AUDIT. On average, around 75 to 85 percent of all patients who undergo screening ultimately screen negative for risky alcohol or drug use. For patients who screen positive, further assessment is often required to determine their precise level of risk.

After screening, the rest of the SBIRT process unfolds depending on each individual's level of risk. For patients deemed to be at moderate risk, brief intervention is prescribed. Brief intervention is a direct, professional confrontation meant to make the patient aware of the risky nature and potential consequences of his or her substance use and encourage a positive change in behavior. These interventions typically take no longer than fifteen minutes to complete.

For patients deemed to be at moderate to high risk, brief therapy is often prescribed. Much like brief intervention, brief therapy involves talking to patients and attempting to empower them through ongoing assessment, education, coping mechanisms, problem-solving techniques, and the establishment of a supportive social environment. Brief therapy typically takes place over the course of four to six separate sessions during which therapists work to engage clients and encourage them to address their problems and make positive changes to improve their behavior and reduce their risk of negative consequences.

The most high-risk patients and those who are determined to already have substance use problems are immediately provided with a referral to treatment. While only a small percentage of SBIRT patients are determined to be high risk, these select few are in the greatest need of immediate help. High-risk patients who already have a substance-related medical condition are usually offered referral to formal treatment facilities, where they can get focused care that goes beyond the scope of brief intervention or therapy. Ideally, referral to treatment will help patients overcome, or at least get a better handle, on their substance use problems and start on the road to recovery.

Bibliography

Agerwala, Suneel M., and Elinore F. McCance-Katz. "Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into Clinical Practice Settings: A Brief Review." Journal of Psychoactive Drugs, vol. 44, no. 4, 2012, pp. 307–17.

Babor, Thomas F., et al. "Screening, Brief Intervention, and Referral to Treatment (SBIRT): Toward a Public Health Approach to the Management of Substance Abuse." Substance Abuse, vol. 28, no. 3, 2007, pp. 7–30.

DeFrancesco, Chris. "Substance Abuse: The Case for Early Intervention." UConn Today, 26 Jan. 2017, today.uconn.edu/2017/01/substance-abuse-the-case-for-early-intervention. Accessed 5 Dec. 2017.

"SBIRT: A Model for Addiction Prevention in Healthcare." Shatterproof, www.shatterproof.org/prevention/sbirt. Accessed 5 Dec. 2017.

"SBIRT: A Step-by-Step Guide." Massachusetts Department of Public Health, www.masbirt.org/sites/www.masbirt.org/files/documents/toolkit.pdf. Accessed 5 Dec. 2017.

Steenrod, Shelley. "What Every Social Worker Needs to Know about Screening, Brief Intervention, and Referral to Treatment (SBIRT)." The New Social Worker, www.socialworker.com/feature-articles/practice/what-every-social-worker-needs-to-know-about-sbirt/. Accessed 5 Dec. 2017.

"What Is SBIRT?" New Mexico State University, socialwork.nmsu.edu/overview/. Accessed 5 Dec. 2017.

"Why SBIRT?" SBIRT Colorado, www.integration.samhsa.gov/clinical-practice/sbirt/SBIRT‗Colorado‗WhySBIRT.pdf. Accessed 5 Dec. 2017.