Cited by 150Substance Abuse Treatment and OutcomesHealth Policy Implementation ScienceOpioid Use Disorder Treatment

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Facilitators and Barriers to Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care in Integrated Health Care Settings

Rahm, Alanna Kulchak, Boggs, Jennifer M., Martin, Carmen, Price, David W., Beck, Arne, Backer, Thomas E., Dearing, James W.·2015·Substance Abuse

DOI 10.1080/08897077.2014.951140

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Abstract

BACKGROUND: Substance abuse in the United States is a serious public health concern impacting morbidity and mortality. However, systematic screening and intervention has not been widely adopted into routine practice by health care organizations and routine screening and intervention is not currently in place for primary care at Kaiser Permanente Colorado. Therefore, a formative evaluation was conducted to explore and enhance implementation of the Substance Abuse and Mental Health Services Administration (SAMHSA) screening, brief intervention, and referral to treatment (SBIRT) approach in the organization. METHODS: Key clinical stakeholders, including internal and family medicine physicians, primary care nurses, mental health therapists, chemical dependency clinicians, and clinic-based psychologists provided feedback. Two focus groups were also conducted with patient stakeholders: one in English and one in Spanish. RESULTS: All clinical stakeholders promoted clinic-based psychologists to conduct brief intervention and determine referral to treatment as the optimal implementation program. Inclusion of the patient perspective also highlighted the importance of considering this perspective in implementation. Both patient groups were generally supportive of SBIRT, especially the educational value of screening questions defining healthy drinking limits; however, English-speaking patients noted privacy concerns and Spanish-speaking patients noted frequently being asked about drug or alcohol use. Organizationally, systems exist to facilitate drug and alcohol use screening, intervention, and referral to treatment. However, physician time, alignment with other priorities, and lack of consistent communication were noted potential barriers to SBIRT implementation. CONCLUSIONS: Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening, but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential.

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Self-citation
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Background
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Background
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BackgroundMethodInfluential
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Method
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Background
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Background
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Result
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“These findings are similar to reports of SBIRT programmes delivered by professional healthcare workers, such as non-specialist doctors and nurses [23, 35, 36], and adds to the body of literature endorsing the acceptability of community”
Result
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Background
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Background
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ResultInfluential
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Background
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Self-citation
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Evans, B., Kamon, J. L., & Turner, W. C. (2023) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-023-09835-6 · Cited by 10
Workflow Improvement and the Use of PDSA Cycles: An Exploration Using Screening, Brief Intervention, and Referral to Treatment (SBIRT) Integration
Moser, T., Edwards, J., Pryor, F., Manson, L., & O'Hare, C. (2020) · Quality Management in Health Care · doi:10.1097/qmh.0000000000000245 · Cited by 10
Harm Reduction: Assessing the Educational Needs of Family Medicine Residents in Care of Persons Who Inject Drugs
Sell, J. K., & Visconti, A. (2020) · Family Medicine · doi:10.22454/fammed.2020.443447 · Cited by 12
Considerations for the Development of a Substance-Related Care and Prevention Continuum Model
Perlman, D. C., & Jordan, A. E. (2017) · Frontiers in Public Health · doi:10.3389/fpubh.2017.00180 · Cited by 10
Early Insights into Implementation of Universal Screening, Brief Intervention, and Referral to Treatment for Perinatal Substance Use
Reese, S. E., Glover, A., Fitch, S., Salyer, J., Lofgren, V., & McCracken, C. (2023) · Maternal and Child Health Journal · doi:10.1007/s10995-023-03842-x · Cited by 9
“…to treatment obstetric settings in the United States, encountered challenges in implementing SBIRT (McNeely et al., 2018; Patel et al., 2021; Rahm et al., 2015), including necessary changes to workflow (Hunt et al., 2022), limited time and competing priorities during patient appointments…”
Background
Identifying available substance use disorder screening tests feasible for use in primary care: A systematic review
Pautrat, M., Barbier, E., & Lebeau, J. (2024) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2024.102610 · Cited by 9
“It is important that screening tests with proven validity in primary care are also feasible since the current addiction guidelines reiterate that primary care is an essential place for early screening (Moyer, 2013; Rahm et al., 2015).”
Background
Implementation of Screening, Brief Intervention, and Referral for Treatment in the Aging Network of Care to Prevent Alcohol, Recreational Drug, and Prescription Medication Misuse
Scott, D. M., Petras, H., Kalu, N. V., Cain, G. E., Johnson, D., Sloboda, Z., & Taylor, R. E. (2020) · Prevention Science · doi:10.1007/s11121-020-01154-y · Cited by 9
Patient Perceptions of Risky Drinking: Knowledge of Daily and Weekly Low-Risk Guidelines and Standard Drink Sizes
Sprague, D. J., & Vinson, D. C. (2015) · Substance Abuse · doi:10.1080/08897077.2015.1048922 · Cited by 9
Stakeholder perspectives on a telemedicine referral and coordination model to expand medication treatment for opioid use disorder in rural primary care clinics
Ober, A. J., Dopp, A. R., Clingan, S. E., Curtis, M. E., Lin, C., Calhoun, S., Larkins, S., Black, M., Hanano, M., Osterhage, K. P., et al. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209194 · Cited by 8
“Barriers were similar to those identified in prior studies, including workflow implications, the need to adapt practices to find the best fit for the clinic, and the need for time to implement and test alternatives (McNeely et al., 2018; Rahm et al., 2015).”
Result
Using multiple qualitative methods to inform intervention development: Improving functional status measurement for older veterans in primary care settings
Nicosia, F. M., Zamora, K. A., Rizzo, A., Spar, M. J., Silvestrini, M. C., & Brown, R. T. (2023) · PLoS ONE · doi:10.1371/journal.pone.0290741 · Cited by 9
Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol
Khazaee-Pool, M., Naghibi, S. A., Pashaei, T., & Ponnet, K. S. (2024) · Addiction Science & Clinical Practice · doi:10.1186/s13722-024-00472-8 · Cited by 8
Integration of Care in the Implementation of the Affordable Care Act: Changes in Treatment Services in a National Sample of Centers Treating Substance Use Disorders
Aletraris, L., Roman, P. M., & Pruett, J. A. (2017) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2017.1299263 · Cited by 8
“Both the adoption and appropriate implementation of processes such as SBIRT in non-SUD medical practice are challenging because of the time constraints and competing demands faced by many practitioners (Rahm et al. 2015).”
Background
Fit and Feasibility: Adapting a Standardized Curriculum to Prepare Future Health Professionals to Address Alcohol Misuse
King, D. K., Neander, L. L., Edwards, A. E., Barnett, J. D., Zöld, A. L., & Hanson, B. L. (2018) · Pedagogy in Health Promotion · doi:10.1177/2373379918785924 · Cited by 8
“…settings have identified numerous obstacles at the organizational and provider levels, including time limitations, competing priorities, lack of confidence, and threats to sustainability such as funding for staff training (Broyles, Kraemer, Kengor, & Gordon, 2013; Murphy, 2009; Rahm et al., 2015).”
Background
The Utility of the Hopkins Symptom Checklist as a Trans-Diagnostic Screening Instrument for Common Mental Disorders Among Persons Seeking HIV Testing
Bantjes, J. R., Kagee, A., & Saal, W. (2019) · AIDS and Behavior · doi:10.1007/s10461-019-02524-6 · Cited by 8
Implementation of screening, brief intervention, and referral to treatment (SBIRT) by nurses on acute care units: A qualitative descriptive study
Thoele, K., Draucker, C., & Newhouse, R. (2020) · Substance Abuse · doi:10.1080/08897077.2020.1823549 · Cited by 6
“g.(20,21) but evidence regarding implementation of SBIRT by nurses in acute care settings, such as hospitals, is limited.”
Background
Low-Burden Universal Substance Use Screening in a Primary Care Clinic to Lower Implementation Barriers
Konkle‐Parker, D. J., Williams, D. C., McAfee, N. W., Schumacher, J. A., & Parker, J. D. (2022) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-022-09814-3 · Cited by 8
Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications and CBT4CBT: protocol for a randomized clinical trial in a diverse patient population
Edelman, E. J., Perez, O. F. R., Nich, C., Corvino, J., Frankforter, T. L., Gordon, D. M., Jordan, A., Paris, M., Weimer, M. B., Yates, B. T., et al. (2023) · Addiction Science & Clinical Practice · doi:10.1186/s13722-023-00407-9 · Cited by 8
“Similarly, the BNI section of the curriculum includes 2 half-day training sessions: 3 h of instruction, beginning with guidance on the steps of the BNI and support of its use among patients presenting in medical settings [64, 83, 84]; and 3 h of skills-based practice exercises.”
Background
Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability
Levesque, D., Umanzor, C., & de Aguiar, E. (2018) · JMIR Medical Informatics · doi:10.2196/medinform.7355 · Cited by 7
“The barriers to referring patients for additional evaluation or specialty treatment include patient resistance [17,18], the stigma attached to treatment [19], and limited treatment resources [16].”
Background
Rates of and Factors Associated With Patient-reported Illicit Drug Use Screening by Health Care Professionals in the United States From 2013 to 2015
Scialli, A. C., & Terplan, M. (2019) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000537 · Cited by 7
“Other barriers to screening uptake include provider discomfort, lack of training, time, and reimbursement constraints (Moses et al., 2013; Rahm et al., 2015; Palmer et al., 2019).”
Background
Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care – a cross-sectional survey
Kokole, D., Mercken, L. A. G., Jané‐Llopis, E., Rey, G. N., Arroyo, M., Medina, P., Pérez‐Gómez, A., Mejía‐Trujillo, J., Piazza, M., Bustamante, I. V., et al. (2021) · Primary Health Care Research & Development · doi:10.1017/s1463423620000675 · Cited by 6
“A large body of literature on barriers to alcohol SBA in PHC exists, suggesting lack of time, lack of training, providers’ attitudes and lack of organisational support, as core factors affecting delivery (Johnson et al., 2011; Rahm et al., 2015; Abidi et al., 2016; Derges et al., 2017; Vendetti et al., 2017), However,…”
Background
“I Felt I Was Reaching a Point with My Health”: Understanding Reasons for Engagement and Acceptability of Treatment Services for Unhealthy Alcohol Use in Primary Care
O’Grady, M. A., Conigliaro, J. C., Levak, S., Morley, J., Kapoor, S., Ritter, M., Marini, C., & Morgenstern, J. (2021) · Journal of Primary Care & Community Health · doi:10.1177/21501327211003005 · Cited by 8
Screening, brief intervention, and referral to treatment training for family nurse practitioner students
Arends, R., Elverson, C. A., Keefner, T. P., & Mylant, M. (2020) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000423 · Cited by 7
“Overall, SBIRT improves communication and prioritization of substance use screening (Rahm et al., 2015).”
Background
Point-of-care mobile application to guide health care professionals in conducting substance use screening and intervention: A mixed-methods user experience study
O'Grady, M., Kapoor, S., Gilmer, E., Neighbors, C., Conigliaro, J., Kwon, N., & Morgenstern, J. (2019) · ACI Open · doi:10.1055/s-0039-1684002 · Cited by 6
Exploring barriers and facilitators to addressing hazardous alcohol use and AUD in mental health services: a qualitative study among Dutch professionals
Kools, N., Rozema, A. D., van den Bulck, F. A. E., Bovens, R. H. L. M., Mathijssen, J. J. P., & van de Mheen, D. (2024) · Addiction Science & Clinical Practice · doi:10.1186/s13722-024-00497-z · Cited by 6
Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: qualitative study in primary care
McCombe, G., Henihan, A. M., Klimas, J., Swan, D., Leahy, D., Anderson, R., Bury, G., Dunne, C. P., Keenan, E., Meagher, D. J., et al. (2016) · Drugs and Alcohol Today · doi:10.1108/dat-03-2016-0010 · Cited by 6
Association between alcohol screening and brief intervention during routine check-ups and alcohol consumption among adults living in California
Wells, G. K., Moonie, S. A., & Pharr, J. R. (2018) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2018.07.001 · Cited by 4
Patient survey augments detection of harmful alcohol relapse after liver transplant for alcohol-associated cirrhosis
Rice, B. A., Mehta, N. J., Grab, J. D., Dodge, J. L., & Sherman, C. B. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000126 · Cited by 5
“28] In addition, we report long-term outcomes to 10 years after LT, which enabled us to characterize clinical outcomes multiple years after relapse and is particularly important in light of our finding that AR typically presented years after LT. Prior research has also shown that poorer outcomes…”
Implementation of alcohol and drug screening, brief intervention, and referral to treatment: Nurse practitioner learner perspectives on a mobile app
Curtis, A. C., Satre, D. D., Ly, K., Wamsley, M. A., & Satterfield, J. M. (2019) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000136 · Cited by 5
A Mobile App to Promote Alcohol and Drug SBIRT Skill Translation among Multi-Disciplinary Health Care Trainees: Results of a Randomized Controlled Trial
Curtis, A. C., Satre, D. D., Sarovar, V., Wamsley, M. A., Ly, K., & Satterfield, J. M. (2019) · Substance Abuse · doi:10.1080/08897077.2019.1686723 · Cited by 5
Using a health information technology survey to explore the availability of addiction treatment data in the electronic health records: A National Drug Abuse Treatment Clinical Trials Network study
Wu, L.-T. T., Payne, E. H., Roseman, K., Case, A., Nelson, C., & Lindblad, R. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2020.01.015 · Cited by 5
“Physician time constraints and competing clinical priorities are major barriers to providing SBIRT services to patients (Pilowsky & Wu, 2013; Rahm et al., 2015).”
Background
Barriers and facilitators to implementing brief motivational interventions for cannabis use disorder in routine practice: a systematic review
Mishra, S., Mishra, S., & Rath, S. (2025) · Journal of Addictive Diseases · doi:10.1080/10550887.2025.2573362 · Cited by 4
Trajectories and strategies in implementing screening, brief intervention, and referral to treatment for substance use in primary care within public hospitals: a longitudinal qualitative study
Tieu, L., Bromley, E., Simhan, R., Bastani, R., Glenn, B. A., & Pourat, N. (2025) · Implementation Science Communications · doi:10.1186/s43058-025-00796-9 · Cited by 4
A Qualitative Study of Implementing Universal Hepatitis C Screening Among Adults at an Urban Community-Based Health Provider in Delaware
Jose, R., Kahal, D., Testa, K., & Goldstein, N. D. (2021) · Delaware Journal of Public Health · doi:10.32481/djph.2021.07.006 · Cited by 4
Using Planned and Unplanned Adaptation to Implement Universal Alcohol Screening and Brief Intervention to Prevent Alcohol-Exposed Pregnancies in Four Primary Care Health Systems
King, D. K., Ondersma, S. J., McRee, B. G., German, J. S., Loree, A. M., Harlowe, A., Alford, D. P., Sedotto, R. N. M., & Weber, M. K. (2024) · Substance Use & Addiction Journal · doi:10.1177/29767342241271404 · Cited by 5
Fetal Alcohol Spectrum Disorder Information Dissemination by Health Care Professions
Inoue, M., Entwistle, J., Wolf‐Branigin, M., & Wolf-Branigin, K. (2017) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2016.1243124 · Cited by 4
Education for Occupational Therapists to Develop the Role of Healthcare Leaders in Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Mattila, A. M., & Provident, I. (2017) · Journal of Occupational Therapy Education · doi:10.26681/jote.2017.010304 · Cited by 3
“Participants also reported a lack of interest and motivation for working with persons with SUDs, which is consistent with existing literature related to SBIRT in healthcare practice (Finnell et al., 2014; Rahm et al., 2015; Thompson, 2007).”
Result
Addressing Substance Use with the Adolescent in Primary Care
Kowalchuk, A. A., de Grubb, M. C. M., González, S., & Zoorob, R. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-66130-0.00013-2 · Cited by 4
26. Enhancing Access to Alcohol Screening, Brief Intervention, and Referral to Treatment to Better Serve Individuals and Populations
Babor, T. F., Robaina, K., & Noel, J. K. (2017) · American Public Health Association eBooks · doi:10.2105/9780875532929ch26 · Cited by 4
Missingness patterns in a comprehensive instrument identifying psychosocial and substance use risk in antenatal care
Preis, H., Djurić, P. M., Ajirak, M., Mane, V., Garry, D. J., Garretto, D. J., Herrera, K. M., Heiselman, C. J., & Lobel, M. (2021) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2021.2004302 · Cited by 4
“…to conduct assessment, may be unaware that psychosocial factors affect treatment and health, may not be skilled in screening, and may be reluctant or unable to intervene if vulnerabilities are detected (Chang et al., 2008; Petersen Williams et al., 2015; Rahm et al., 2015; Wright et al., 2016).”
Background
Stakeholders’ perceptions and experiences of factors influencing the commissioning, delivery, and uptake of general health checks: a qualitative evidence synthesis
Sommer, I., Harlfinger, J., Toromanova, A., Affengruber, L., Dobrescu, A. I., Klerings, I., Griebler, U., & Kien, C. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014796.pub2 · Cited by 5
Ethical considerations when researching with pregnant substance users and implications for practice
Hotham, E. D., Ali, R. L., White, J. M., & Robinson, J. S. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.03.007 · Cited by 3
Qualitative findings from administrators of the EMPATHY (Empowering a multimodal pathway toward healthy youth) programme using the SBIRT framework
Hamza, D. M., Greenshaw, A. J., Hamza, S. M., & Silverstone, P. H. (2019) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2019.1686121 · Cited by 3
“…research has focused on implementing SBIRT in primary care clinics, often examining barriers associated with incorporating this model of care in this setting (Agley, Gassman, Vannerson, & Crabb, 2014; Broyles & Gordon, 2010; Ogden, Vinjamuri, & Kahn, 2016; Rahm et al., 2015; Schram et al., 2015).”
BackgroundMethod
Attitudes of health professionals towards people with substance use disorders in Brazil, controlling for the effects of social desirability
Ferreira, V. L., Tostes, J. G. D. A., Knaak, S. J., da Silveira, P. S., Martins, L. F., & Ronzani, T. M. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.13749 · Cited by 3
Sustainability of Adolescent Screening and Brief Intervention Services in Primary Care After Removal of Implementation Supports
Gryczynski, J., Monico, L. B., Garrison, K., Dušek, K., Oros, M. T., Hosler, C., Brown, B. S., Schwartz, R. P., O’Grady, K. E., Kirk, A. S., et al. (2022) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.21-00324 · Cited by 3
Effectiveness of a pharmacist-delivered primary care telemedicine intervention to increase access to pharmacotherapy and specialty treatment for alcohol use problems: Protocol for the alcohol telemedicine consult cluster-randomized pragmatic trial
Metz, V. E., Leibowitz, A., Satre, D. D., Parthasarathy, S., Jackson-Morris, M., Cocohoba, J. M., & Sterling, S. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.107004 · Cited by 3
Development and Evaluation of a Relational Agent to Assist with Screening and Intervention for Unhealthy Drinking in Primary Care
Brady, J. E., Livingston, N. A., Sawdy, M., Yeksigian, K., Zhou, S., Bickmore, T., Simon, S. R., & Rubin, A. (2023) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-023-00332-3 · Cited by 3
“…physician barriers including limited availability of the physician, competing clinical demands during the primary care visit (McNeely et al., 2018; Rahm et al., 2015; Yarnall et al., 2003), the need to address other pressing medical issues, and limited overall knowledge of available follow-up…”
Background
Assessing the acceptability of implementing a Screening, Brief Intervention and Referral to Treatment for alcohol use among transgender women in Bangkok, Thailand: A mixed‐method pre‐implementation study using the Consolidated Framework for Implementation Research
Yimsaard, P., Mootz, J. J., Rungnirundorn, T., Janamnuaysook, R., Samitpol, K., Phanuphak, N., & Wainberg, M. L. (2024) · Addiction · doi:10.1111/add.16423 · Cited by 3

Authors: Rahm, A. K., Boggs, J. M., Martin, C., Price, D. W., Beck, A., Backer, T. E., & Dearing, J. W.
Affiliations: Kaiser Permanente (US)
Human Interaction Research Institute, Encino, California, USA
Corresponding author: Rahm, Alanna Kulchak
ORCID: Rahm, Alanna Kulchak
Boggs, Jennifer M.
Price, David W.
Beck, Arne
Dearing, James W.
Venue: Substance Abuse
Publisher: SAGE Publications
Published: 2015-07
Volume: 36
Issue: 3
Pages: 281-288
ISSN: 0889-7077 (ISSN-L)
1547-0164
DOI: 10.1080/08897077.2014.951140
OpenAlex: W1609891162
Cited by: 150
References: 36
Citations by year: 2026: 1 · 2025: 9 · 2024: 16 · 2023: 13 · 2022: 9 · 2021: 22 · 2020: 11 · 2019: 25 · 2018: 13 · 2017: 16 · 2016: 5 · 2015: 9
FWCI: 7.55
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Substance Abuse (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords: SBIRT, substance use screening, alcohol screening, implementation barriers and facilitators, primary care, integrated care, referral to treatment, patient perspectives, cultural differences, Spanish-speaking patients, physician time constraints, organizational leadership, Kaiser Permanente
MeSH terms: Attitude of Health Personnel, Colorado, Health Services Accessibility, Humans, Mass Screening, Patient Participation, Primary Health Care, Psychotherapy, Brief, Referral and Consultation, Substance-Related Disorders

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Facilitators and Barriers to Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care in Integrated Health Care Settings

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