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Cited by 258Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentMental Health Treatment and Access

Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review

Open access
Agerwala, Suneel M., McCance-Katz, Elinore F.·2012·Journal of Psychoactive Drugs
DOI 10.1080/02791072.2012.720169PMC PMC3801194
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Abstract

Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to determine how best to implement SBIRT.

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Crossref · 10.1080/02791072.2012.720169

Cites

Statistics

Nothing to recompute.

Claims the paper makes

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  • Premisecitation

    Reliable screening tools for alcohol and drug abuse, such as MAST, CAGE, and DAST, were developed in the 1980s.

    “It was during this time period that reliable screening tools for alcohol and drug abuse, such as the Michigan Alcohol Screening Test, the CAGE, and the Drug Abuse Screening Test, were developed (Babor & Kadden 2005).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Babor & Kadden 2005

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  • Premisecitation

    In that RCT, the counseling visits reduced episodes of binge drinking at 12 months.

    “A randomized, controlled clinical trial conducted in 1997 found that for problem drinkers (men consuming more than 14 drinks per week and women consuming more than 11 drinks per week), two 10- to 15-minute counseling visits led to reductions in seven-day alcohol use, episodes of binge drinking, and frequency of excessive drinking at a 12-month follow-up (Fleming et al. 1997).”
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    • cites Fleming et al. 1997

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  • Premisecitation

    In the Malmo study, SBI lowered the incidence of negative medico-social consequences.

    “The study showed that SBI, in the form of repeated encouragement from a health care provider, was helpful in decreasing overall alcohol consumption, lowered the incidence of negative medico-social consequences, and decreased mortality associated with heavy drinking (Kristenson et al. 1983).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kristenson et al. 1983

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  • Premisecitation

    In the Malmo study, SBI decreased mortality associated with heavy drinking.

    “The study showed that SBI, in the form of repeated encouragement from a health care provider, was helpful in decreasing overall alcohol consumption, lowered the incidence of negative medico-social consequences, and decreased mortality associated with heavy drinking (Kristenson et al. 1983).”
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    • cites Kristenson et al. 1983

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  • Premisecitation

    The current SBIRT model is based on the Institute of Medicine 1990 report.

    “The current model of SBIRT is based on the Institute of Medicine (IOM 1990) report, Broadening the Base of Treatment for Alcohol Problems.”
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    • cites IOM 1990

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  • May combine two claims. 20
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    Premisecitation

    Referral to treatment may be more useful for excessive drinkers because brief intervention has little effect on this population.

    “Referral to treatment may be more useful for excessive drinkers, as brief intervention has been shown to have little effect on this population (Beich et al. 2007; Beich, Thorsen & Rollnick 2003; Beich, Gannic & Malterud 2002).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Beich et al. 2007

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    • cites Beich, Thorsen & Rollnick 2003

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    • cites Beich, Gannic & Malterud 2002

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  • Classified as probably not a substantial claim.

    Premisecitation

    The IOM recommended integrated service systems linking community-based screening and brief intervention to assessment and referral.

    “The IOM recommended the development of integrated service systems that link community-based screening and brief intervention to assessment and referral activities.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites IOM 1990

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    Premisecitation

    SBIRT's main goal is to improve community health by reducing adverse consequences of substance misuse, including SUDs, through early intervention and referral when needed.

    “The main goal for SBIRT is to improve community health by reducing the prevalence of adverse consequences of substance misuse, including SUDs, through early intervention and, when needed, referral to treatment (IOM 1990).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites IOM 1990

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other large SBIRT programs are located in Brazil, South Africa, and the European Union.

    “Other large programs of note are located in Brazil, South Africa, and the European Union (Babor et al. 2007).”
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    • cites Babor et al. 2007

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    Premisecitation

    Up to 75% of patients screened in EDs will not be at risk for SUDs, and the yield is expected to be 25% or less.

    “Up to 75% of patients screened will not be at risk for SUDs, and the time spent to screen all patients in the ED when the yield is expected to be 25% or less (Madras et al. 2009) may discourage the use of SBIRT among ED staff.”
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    • cites Madras et al. 2009

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    • Rests on an assumption: Screening plus BNI lasts approximately ten minutes.

  • May combine two claims.

    Premisecitation

    ED health promotion advocates improved patient flow and community relations, reduced need for security involvement, and succeeded in finding detoxification placements.

    “Important contributions of ED HPAs have included improving patient flow and community relations, as well as reducing the need for security involvement and success in finding detoxification placements (Bernstein et al. 2009c).”
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    • cites Bernstein et al. 2009c

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    Premisecitation

    At 12 months after training, health practitioners had increased confidence in performing SBIRT and a greater sense of responsibility to screen.

    “At 12 months after the training, health practitioners had increased confidence in their ability to perform SBIRT and a greater sense of responsibility to screen.”
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    • cites Academic ED SBIRT Research Collaborative 2007a

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    Premisecitation

    Patients receiving brief intervention in an ED were more likely to enter substance abuse treatment in the following year, especially those with no treatment in the past two years.

    “In a recent study, those patients receiving a brief intervention (BI) were more likely to enter into substance abuse treatment in the year following BI. This was particularly true of patients who had no substance abuse treatment in the past two years (Krupski et al. 2010).”
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    • cites Krupski et al. 2010

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    Premisecitation

    SAMHSA's SBIRT initiative has demonstration sites in 11 states.

    “This program has demonstration sites operating in 11 states (Babor et al. 2007).”
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    • cites Babor et al. 2007

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    Premisecitation

    Identified barriers to ED SBIRT included lack of belief in effectiveness, lack of role models, concern about angry patient responses, lack of reimbursement, and lack of referral sources.

    “Identified barriers included a lack of belief in the effectiveness of SBIRT, a lack of role models among faculty, a concern for angry responses from patients, lack of reimbursement, and lack of referral sources.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Academic ED SBIRT Research Collaborative 2007a

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    • Rests on an assumption: A general lack of referral sources exists.
    • Rests on an assumption: Reimbursement issues include a low reimbursement rate, a minimum 15-minute length of service requirement for billing, and reimbursement only for licensed healthcare providers.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    As of 2006, the American College of Surgeons Committee on Trauma recommended that all Level I and II trauma centers be equipped to use SBIRT screening tools and that Level I centers offer brief intervention when necessary.

    “As of 2006, the Committee on Trauma of the American College of Surgeons has recommended that all Level I and II trauma centers be equipped to use SBIRT screening tools and that Level I centers offer a brief intervention when necessary (Soderstrom et al. 2007).”
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    • cites Soderstrom et al. 2007

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    Premisecitation

    At three months post-training, 72% reported delivering at least one SBIRT intervention, and trainees were more likely to use SBIRT.

    “Seventy-two percent reported delivering at least one SBIRT intervention in their clinical practice, and trainees were more likely to use SBIRT.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Academic ED SBIRT Research Collaborative 2007a

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    Premisecitation

    Clinics using dedicated SBIRT specialists have been shown to implement a higher percentage of completed interventions, although differences between sites exist.

    “Clinics using specialists have been shown to implement a higher percentage of completed interventions, although clear differences between sites have emerged.”
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    • cites Babor et al. 2005

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    Premisecitation

    The ASSIST instrument was developed, validated, and adopted as the screening tool in a randomized controlled trial of brief intervention for illicit drugs.

    “Recently, however, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) has been developed, validated, and used as the screen for a randomized controlled trial of a brief intervention for illicit drugs.”
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    • cites Humeniuk et al. 2012

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    Premisecitation

    In a pediatric emergency department study of screening and brief intervention to reduce marijuana use among teens and young adults, those in the intervention group had greater likelihood of 30-day abstinence and fewer substance-use days at 12-month follow-up.

    “a study attempting to reduce marijuana use among teens and young adults in a pediatric ED setting using SBI found that intervention participants were more likely to be abstinent for the past 30 days and showed a reduction in days of substance use at 12-month follow-up (Bernstein et al. 2009b).”
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    • cites Bernstein et al. 2009b

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    Premisecitation

    The USPSTF's B recommendation means there is fair evidence that the benefits of SBIRT in primary care outweigh the harms.

    “This means that there is fair evidence that the benefits outweigh the harms.”
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    • cites United States Preventive Services Task Force (2004)

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    Premisecitation

    The overall rate of alcohol disorders in that employee assistance program sample was about 8%, close to the rate in the general United States population.

    “An overall rate of approximately 8% for alcohol disorders approached that of the general population in the United States.”
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    • cites McPherson et al. 2010

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    Interpretationcitation

    The employee assistance program study indicates that screening and brief intervention can be useful and widely applicable outside health care systems.

    “This study shows the potential usefulness of screening and brief intervention in settings outside of health care systems and the wide applicability of this intervention.”
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    • cites McPherson et al. 2010

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    Premisecitation

    In a survey of 242 hospitals, 18% reported screening all adolescents in the ED, and 26% screened adolescents admitted to trauma service.

    “Of 242 hospitals that responded to the survey, 18% reported screening all adolescents in the ED, and 26% screened adolescents admitted to trauma service.”
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    • cites Schweer 2009

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    Premisecitation

    Among those employees contacting the employee assistance program, the most common reasons were stress, anxiety or panic (38%), depression (19%), alcohol use (6%), and other drug issues (1%).

    “Common reasons for contacting the EAP were stress/anxiety/panic (38%), depression (19%), alcohol use (6%), and other drug issues (1%).”
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    • cites McPherson et al. 2010

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    Interpretationcitation

    The employee assistance program approach has limitations, including limited participation by employees and concerns about confidentiality.

    “Limitations of this approach include limited participation rates by employees and patient concerns about confidentiality.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites McPherson et al. 2010

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    Premisecitation

    Two brief interventions, personalized motivational intervention and brief information and advice, resulted in decreases in alcohol consumption and fewer negative consequences from drinking in trauma center patients at six- and 12-month follow-ups.

    “Another study showed that two brief interventions, personalized motivational intervention and brief information and advice results in decreases in alcohol consumption and fewer negative consequences from drinking in trauma center patients receiving SBIRT at six- and 12-month follow-ups (Sorderstrom et al. 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Sorderstrom et al. 2007

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    Premisecitation

    Brief motivational interviewing has shown a reduction in incidence of alcohol-related injury, traffic violations, and driving after drinking among 18- and 19-year-olds.

    “This intervention has also shown a reduction in the incidence of alcohol-related injury, traffic violations, and driving after drinking among 18- and 19-year-olds, although this particular study showed no significant differences in reduction of alcohol consumption between brief intervention and standard care (Monti et al. 1999).”
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    • cites Monti et al. 1999

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    Premisecitation

    A meta-analysis found that effective programs tend to focus specifically on alcohol and to include multiple components.

    “One meta-analysis did find, however, that promising programs are those that have a specific focus on alcohol and those that are multi-component (Anderson et al. 2004).”
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    • cites Anderson et al. 2004

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    Premisecitation

    Those individuals also reported better general and mental health, employment, and housing, and less criminal activity.

    “Those same individuals reported improvements in general health, mental health, employment, and housing, as well as decreased criminal activity (Madras et al. 2009).”
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    • cites Madras et al. 2009

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    SBIRT can also be a chance to educate medical staff about substance use disorders and their treatment, including primary care pharmacotherapies.

    “SBIRT can also be used as an opportunity to teach medical staff about substance use disorders and their treatment, including pharmacotherapies that can be implemented in primary care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Training individuals with bachelor's degrees to deliver SBIRT services could yield further cost savings.

    “Further cost savings could be realized by training individuals with bachelor’s degrees to dispense SBIRT services (Brown 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown 2011

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  • The paper relies on this without support.

    SBIRT can be flexibly applied and delivered in many clinical care settings.

    “SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings.”

  • The paper relies on this without support.

    Screening large numbers of individuals presents an opportunity to engage those in need of treatment.

    “Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment.”

  • The paper relies on this without support.

    There is no strong research evidence for SBIRT effectiveness for illicit and prescription drug use.

    “although for these latter categories there is no strong research evidence for its effectiveness as yet.”

  • The paper relies on this without support.

    A general lack of referral sources exists.

    “There is also a general lack of referral sources, which points to a larger systemic problem.”

  • The paper relies on this without support.

    Reimbursement issues include a low reimbursement rate, a minimum 15-minute length of service requirement for billing, and reimbursement only for licensed healthcare providers.

    “Ongoing challenges include a low reimbursement rate, a minimum 15-minute length of service requirement for billing, and the availability of reimbursement only for licensed healthcare providers delivering the intervention.”

  • The paper relies on this without support.

    Screening plus BNI lasts approximately ten minutes.

    “Screening plus BNI lasts approximately ten minutes, which in ED settings is a lengthy period that some clinicians may not find to be the best use of ED time.”

  • The paper relies on this without support.

    Few data exist on which screening tools work and whether SBIRT helps illicit drug users.

    “There is little data on effective screening tools and usefulness of SBIRT interventions in illicit drug users.”

  • The paper relies on this without support.

    The SBIRT literature has largely examined effects only up to one year after intervention.

    “most SBIRT studies have focused on short-term effects (up to one year after the initial intervention).”

  • The paper relies on this without support.

    Some studies of alcohol and drug use decrease at six months after service delivery lack control groups.

    “some of these studies lack control groups.”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Follow-up duration differs from the cited study title

    Minor

    The text describes the Malmo study's follow-up as extending to six years, while the cited study's title gives a maximum of 60 months, or five years.

  • Tobacco is both within SBIRT's original scope and proposed as an expansion

    Minor

    The paper says SBIRT was developed for tobacco use disorders, but later presents tobacco misuse as something to add to its scope. It does not explain how the proposed addition differs from its stated original scope.

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The citation lists haven’t been fetched yet

References 85 · Cited by 258

Research works printed but not linked: 5

  1. Barry K.L., 1990, Journal of the American Board of Family Practice, 3, 93
  2. D'Onofrio G., 1996, Emergency Medicine and the Health of the Public, 51
  3. Seale J.P., 2010, BMC Medical Education, 10, 1
  4. Whitlock E.P., 2004, Behavioral Counseling Interventions in Primary Care to Reduce Risky/Harmful Alcohol Use [Internet]
  5. Williams R.H., 2001, Journal of Family Practice, 50, 307

Authors
Agerwala, S. M., & McCance-Katz, E. F.
Affiliations
  • University of California, San Francisco (US)
  • c Professor in Residence, University of California , San Francisco
Venue
Journal of Psychoactive Drugs
Publisher
Informa UK Limited
Published
2012-09-01
Volume
44
Issue
4
Pages
307-317
ISSN
  • 0279-1072 (ISSN-L)
  • 2159-9777
DOI
10.1080/02791072.2012.720169
PMC
PMC3801194
OpenAlex
W1983224143
Semantic Scholar
bcc790c186435ecf219409b9eb054f37b70e7c9e
Cited by
258
References
85
Citations by year
2026: 12 · 2025: 13 · 2024: 18 · 2023: 22 · 2022: 20 · 2021: 30 · 2020: 25 · 2019: 27 · 2018: 10 · 2017: 29 · 2016: 23 · 2015: 15 · 2014: 9 · 2013: 5
FWCI
6.94
Type
journal article
Language
en
Open access
Locations
  • Journal of Psychoactive Drugs (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (K24DA023359)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
SBIRT, substance use disorders, early intervention, clinical implementation, primary care, emergency department, short-term treatment, public health approach
MeSH terms
Adolescent, Adult, Child, Child Health Services, Emergency Service, Hospital, Health Services Accessibility, Humans, Mass Screening, Occupational Health Services, Organizational Objectives, Predictive Value of Tests, Primary Health Care, Public Health Administration, Referral and Consultation, Adolescent Health Services, Program Development, Delivery of Health Care, Integrated, Substance-Related Disorders, Early Diagnosis, Young Adult, Early Medical Intervention

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