Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later
Open accessAbstract
Objectives Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered.Design SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a 6-month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline.Results Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6-month follow-up (4 of 6 sites), were 67.7% lower (p<0.001) and heavy alcohol use was 38.6% lower (p<0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p<0.001), mental health (p<0.001), employment (p<0.001), housing status (p<0.001), and criminal behavior (p<0.001) were found.Conclusions SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients.
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SBIRT has been shown to reduce emergency department use.
“It has been shown to reduce health care costs by $366 per month per member,17 reduce emergency department use,18 and reduce rates of substance use by 67.7% and heavy alcohol use by 38.6% from baseline to 6 months, with significant improvements in general health and well‐being.19”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [18]
The Methods (§2.1; page unavailable) describe delivering SBIRT in emergency departments, but do not report whether subsequent emergency department use changed. The Discussion (§4.4; page unavailable) mentions reductions in re-hospitalizations, a different outcome. Searches for emergency department visits, utilization, and re-hospitalizations found no passage establishing the claimed reduction in emergency department use. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSAMHSA-funded SBIRT projects for drug use reported significant reductions in drug use and other problems from baseline to follow-up.
“published articles on SBIRT projects for drug use funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) reported significant reductions in drug use and other problems from baseline to follow-up (Gryczynski et al., 2011; InSight Project Research Group, 2009; Madras et al., 2009; Woodruff, Eisenberg, McCabe, Clapp, & Hohman, 2013)”
From A randomized study of the use of screening, brief intervention, and referral to treatment (SBIRT) for drug and alcohol use with jail inmates (2017) · cites this paper as Madras et al., 2009
Findings from brief intervention trials have been mixed, with supportive findings for unhealthy alcohol use but a lack of evidence for unhealthy drug use.
“Findings from BI trials have been mixed, with supportive findings for unhealthy alcohol use, 10 -13 but currently lack evidence for unhealthy drug use. 11,14 -16”
From Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis (2022) · cites this paper as [11]
The earlier study of the cohort 1 programs was largely positive but did not use appropriate statistical methods to assess patient improvements.
“The results of the previous study were largely positive, but it did not employ appropriate statistical methods to assess patient improvements.”
From Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice (2017) · cites this paper as [28]
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References 82 · Cited by 663
- Authors
- Madras, B. K., Compton, W. M., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W.
- Affiliations
- Harvard University (US)
- National Institutes of Health (US)
- Substance Abuse and Mental Health Services Administration (US)
- Corresponding author
- Madras, Bertha K.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 99
- Issue
- 1-3
- Pages
- 280-295
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC2760304
- OpenAlex
- W2081381051
- Cited by
- 663
- References
- 82
- Citations by year
- 2026: 17 · 2025: 14 · 2024: 18 · 2023: 16 · 2022: 16 · 2021: 28 · 2020: 33 · 2019: 44 · 2018: 34 · 2017: 65 · 2016: 36 · 2015: 69 · 2014: 65 · 2013: 58 · 2012: 76
- FWCI
- 18.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (K05DA015305)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- illicit drug use, alcohol consumption, alcohol screening, brief intervention, short-term treatment, healthcare settings, addiction prevention, follow-up outcomes
- MeSH terms
- Adult, Age Factors, Alcoholism, Community Health Centers, Crime, Data Interpretation, Statistical, Employment, Ethnicity, Female, Follow-Up Studies, Ill-Housed Persons, Hospitals, Humans, Male, Middle Aged, Outpatient Clinics, Hospital, Rural Population, Sex Factors, Illicit Drugs, Trauma Centers, Urban Population, Treatment Outcome, Substance-Related Disorders, Young Adult
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