The DOI matches its Crossref record; 34 of the 36 references it cites were found in a registry or an index.
Facilitators and Barriers to Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Primary Care in Integrated Health Care Settings
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
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?
In the citing paper
“Alcohol use disorder, substance abuse, and depression are illnesses that deteriorate the quality of life (QOL) of patients with chronic liver disease (CLD).”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [11]
In the citing paper
“Depression remains under diagnosed and untreated in CLD10 and is associated with worse clinical outcomes and higher mortality.11”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [11]
Citations
Cites
The Coding Manual for Qualitative Researchers
Saldaña, J. (2025) · SAGE Publications Ltd eBooks · doi:10.4135/9781036235611 · Cited by 19,193
SAUNDERS, J. B., AASLAND, O. G., BABOR, T. F., DE LA FUENTE, J. R., & GRANT, M. (1993) · Addiction · doi:10.1111/j.1360-0443.1993.tb02093.x · Cited by 13,597 · cited 1×
“The screening, brief intervention, and referral to treatment (SBIRT) approach was developed in response to recommendations of the Institute of Medicine(15) and the World Health Organization (WHO) to screen for unhealthy drinking.(16,17) The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that…”
MethodDetecting Alcoholism: The CAGE Questionnaire
Ewing, J. A. (1984) · JAMA · doi:10.1001/jama.1984.03350140051025 · Cited by 3,005
Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007) · Substance Abuse · doi:10.1300/j465v28n03_03 · Cited by 1,100
Broadening the base of treatment for alcohol problems
Hertzman, M. (1991) · Journal of Substance Abuse Treatment · doi:10.1016/0740-5472(91)90057-h · Cited by 832
Whitlock, E. P., Polen, M. R., Green, C. A., Orleans, T., & Klein, J. D. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-7-200404060-00017 · Cited by 728
SAUNDERS, J. B., AASLAND, O. G., AMUNDSEN, A., & GRANT, M. (1993) · Addiction · doi:10.1111/j.1360-0443.1993.tb00822.x · Cited by 480
Qualitative and Mixed Methods in Public Health
Padgett, D. (2012) · doi:10.4135/9781483384511 · Cited by 458
Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients
Blair, I. V., Steiner, J. F., Fairclough, D. L., Hanratty, R., Price, D. W., Hirsh, H. K., Wright, L. A., Bronsert, M., Karimkhani, E., Magid, D. J., et al. (2013) · The Annals of Family Medicine · doi:10.1370/afm.1442 · Cited by 409 · cited 3×
“Blair et al.(37)also found that although Latino patients rated the patient-centeredness of their care lower than white patients, these ratings did not correlate with the implicit biases of their physician.”
BackgroundSelf-citationU.S. Preventive Services Task Force* (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-7-200404060-00016 · Cited by 387
Research works printed but not linked: 4
- Fleming MF, 1999, J Fam Pract, 48, 378
- Substance Abuse and Mental Health Association (SAMHSA), 2012, Screening, Brief Intervention, and Referral to Treatment in Behavioral Healthcare
- Morgan DL., 1997, Planning Focus Groups
- Substance Abuse and Mental Health Services Administration, 2013, Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment
Cited by
Sorted by citations
Items 101–149 of 149
Shrier, L. A., O’Connell, M., Torres, A., Shone, L. P., Fiks, A. G., Plumb, J. A., Maturo, J. L., McCaskill, N. H., Harris, D. L., Burke, P. J., et al. (2024) · JMIR Research Protocols · doi:10.2196/55039 · Cited by 3
“Pediatric primary care clinicians also face barriers to brief intervention based on screen responses, including insufficient time during the appointment, a lack of familiarity with validated screening tools, and a lack of experience with managing care for patients who screen positive [16-18].”
BackgroundCheck, D. K., Li, Z., Shibeika, S., Sloan, C. E., Sitlinger, A. P., Zullig, L. L., Graf, S. A., & Blalock, D. V. (2025) · JCO Oncology Practice · doi:10.1200/op-24-01030 · Cited by 3
Bokhari, S. F. H., Waseem, A. B., Raza, H., Javaid, S., Idrees, B., Saad, K. A. D., Iqbal, A., Bakht, D., & Dost, W. (2025) · World Journal of Surgical Procedures · doi:10.5412/wjsp.v15.i1.104178 · Cited by 3
Johnson, K., Quanbeck, A., Maus, A., Gustafson, D. H., & Dearing, J. W. (2015) · Translational Behavioral Medicine · doi:10.1007/s13142-015-0327-y · Cited by 3
Self-citationAlcohol and Substance Use Disorders in Medical Rehabilitation
Skidmore, W. C., & Budd, M. A. (2016) · Springer eBooks · doi:10.1007/978-3-319-34034-0_28 · Cited by 3
Reznik, S. J., Lucksted, A. A., Myers, N., Jones, N., Savill, M., Pagdon, S., Ereshefsky, S., George, P., Goldman, H. H., Hayes, S. L., et al. (2025) · Community Mental Health Journal · doi:10.1007/s10597-024-01427-8 · Cited by 2
“For example, pre-planned qualitative work could identify potential facilitators and barriers in advance, avoiding costs associated with implementation failure (i.e. Rahm et al., 2015).”
Hagle, H., Kameg, B., Lindsay, D. L., Matthews, E., & Mitchell, A. M. (2023) · Journal of the American Association of Nurse Practitioners · doi:10.1097/jxx.0000000000000855 · Cited by 2
“This concern is in line with previous research among practicing clinicians (Muench et al., 2015; Rahm et al., 2015; Thoele et al., 2021).”
ResultVendetti, J. A., Bangham, C., Riba, M. L., Whitmore, C. B., Gallucci, K. S., Hanson, B. L., & Greece, J. A. (2024) · Substance Use & Addiction Journal · doi:10.1177/29767342241267074 · Cited by 2
“Consistent with the literature, 14,28,33-35 readiness for implementation, leadership support, and the ability to use available resources (especially IT and EHR platforms) were common factors that supported the implementation and evaluation of SBI in primary care practices.”
A Shared Decision-Making Tool to Prevent Substance Abuse: Protocol for a Randomized Controlled Trial
Long, J., Yuan, J. M., & Johnson, R. K. (2018) · JMIR Research Protocols · doi:10.2196/resprot.7650 · Cited by 2
Promoting SBIRT Training for Social Work Students Across Field Settings
Tajima, E. A., McCowan, K. J., Lindhorst, T. P., Haggerty, K. P., Rivara, J. B., Schack, S., Ramey, A., & Jackson, T. R. (2019) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2019.1592993 · Cited by 2
“Although SBIRT services might be effective in reaching people at risk for harm from alcohol use in primary care (Pilowsky & Wu, 2012; Rahm et al., 2015) the widespread implementation of SBIRT is dependent on access to professionals who are skilled in its use in a range of health and social service settings (Agerwala &…”
BackgroundLópez‐Pelayo, H., Caballería, E., Díaz, E., Sánchez, A., Segura, L., Colom, J., Wallace, P., & Gual, A. (2019) · Health Informatics Journal · doi:10.1177/1460458219855177 · Cited by 2
Stevens, M., Ivers, R. G., Telenta, J., & Ali, R. L. (2023) · Australian Journal of Primary Health · doi:10.1071/py23148 · Cited by 2
“More work is needed to ensure a consistent approach to implementation, including buy-in from organisation leadership (Rahm et al .”
BackgroundJacquet, J.-M., Donnadieu‐Rigole, H., Peries, M., Makinson, A., Nagot, N., Reynes, J., Peyrière, H., & the MesConsos study group name (2019) · HIV Medicine · doi:10.1111/hiv.12709 · Cited by 2
Pérula-Jiménez, C., Rodríguez, E. M. R., Fernández-Solana, J., Fernández-García, J. Á., Rejano, J. M. P., de Torres, L. Á. P., la Rubia, A. G.-D., González‐Santos, J., & Collaborative Group ALCO-AP20 Study (2024) · Healthcare · doi:10.3390/healthcare12020262 · Cited by 1
“However, several obstacles hinder healthcare professionals’ interventions in alcohol-related issues [50].”
BackgroundCampbell, R. L., & Bridges, A. J. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13185629 · Cited by 1
Correlates of three-year outpatient medical care use among rural stimulant users
Cucciare, M. A., Han, X., Timko, C., Zaller, N. D., Kennedy, K. M., & Booth, B. M. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.02.017 · Cited by 1
Implementing a Substance Use Screening Protocol in Rural Federally Qualified Health Centers
Reddick, B., Foli, K. J., Coddington, J. A., & Hountz, D. (2020) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390320975493 · Cited by 1
SIGNIFICADOS CIENTÍFICOS DEL CUERPO DE MUJER PRESENTACIÓN
Pairet, M. C. I., & Gómez, T. O. (2008) · Asclepio · Cited by 1
Why Substance Use Screening Frequency Matters in Adult Primary Care
Drnach-Bonaventura, G. M., Moore, D. W., Scott, G. L., Cloutier, R. M., & Pringle, J. L. (2023) · Substance Use & Addiction Journal · doi:10.1177/29767342231210112 · Cited by 1
“16,40,41 However, some patients may refuse the offered screening, or worry about confidentiality, particularly if they do not have a positive relationship with their provider.”
BackgroundFeasibility of Primary Care Family-Centered Mental Health Treatment Engagement Intervention
Weissinger, G., Mensinger, J. L., & Arun, R. (2024) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2023.104890 · Cited by 1
Fornili, K. S. (2016) · Journal of Addictions Nursing · doi:10.1097/jan.0000000000000118 · Cited by 1
“Despite these endorsements and more than 40 years of research evidence, SBIRTremains underimplemented in many primary care settings (Saitz, 2007) for a variety of reasons (Rahm et al., 2015).”
BackgroundNytteverdien av kartleggingsverktøyetBrukerPlan – en spørreundersøkelse til aktuelle kommuner
Lønning, T., Håland, M. E., Lie, T., Nesvåg, S. M., & Stevenson, B. (2018) · Tidsskrift for psykisk helsearbeid · doi:10.18261/issn.1504-3010-2018-04-08 · Cited by 1
Screening, Assessment, and Brief Interventions for Substance Use
Mancini, M. A. (2020) · Springer eBooks · doi:10.1007/978-3-030-59659-0_10 · Cited by 1
Savino, R. F., Bowen, E. A., Irish, A., & Johnson, A. K. (2021) · Advances in Social Work · doi:10.18060/24293 · Cited by 1
Psychological Assessment in Medical and Healthcare Settings
Marek, R. J., Knight, C. F., Nghiem, D. M., & Markey, C. H. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00116-3 · Cited by 1
Hall, K. S. (2021) · Journal of Women s Health · doi:10.1089/jwh.2020.9005 · Cited by 1
“19,23,24 23–26 Patient-level factors include reluctance to disclose symptoms; lack of awareness or acceptance of risky behavior; limited knowledge/misbeliefs about health consequences and treatment options; disinterest in/opposition to referral; stigma; and payment issues.”
SBIRT Implementation Training for Undergraduate Nursing Students
VanRuler, D. M., Mennenga, H. A., Mylant, M., & Elverson, C. A. (2017) · 44th Biennial Convention (28 October - 01 November 2017)
Developing an SBIRT Curriculum in Advanced Practice
Feigeles, J. B. (2018) · Springer eBooks · doi:10.1007/978-3-319-72778-3_18
Adoption and Implementation of Screening, Brief Intervention, and Referral to Treatment
Thoele, K. (2020) · IUScholarWorks (Indiana University) · doi:10.7912/c2/1314
Sebastian, S., Thomas, D., Brimblecombe, J. K., Arley, B., & Cunningham, F. C. (2021) · Health Promotion Journal of Australia · doi:10.1002/hpja.542
Role of Early Brief Psychological Interventions in Substance Use Disorders
Kakar, M. S., Rauf, S., Iqbal, M. W., Qureshi, A., & Nabeel, S. (2021) · Journal of Bahria University Medical and Dental College · doi:10.51985/jbumdc2021029
Prevention Strategies for Unhealthy Alcohol Use
Hunley, B. T., Willis, B., & Zepeda, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-83469-2_13
Kirton, C. A. (2017) · doi:10.1093/med/9780199392742.003.0040
Kowalchuk, A. A., Ostovar-Kermani, T. G., Schaper, K., Grigoryan, L., Hirth, J. M., de Grubb, M. C. M., Spooner, K. K., & Zoorob, R. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02427-z
“Clinicians acknowledge that there are barriers to offering these services, such as competing priorities and better leadership in organizing to promote efforts to effectively intervene and provide treatment to their patients [28].”
BackgroundBangham, C., Alford, D. P., German, J. S., Kranz, M., Liu, X., Codner, A., O’Hagan, B., Harlowe, A., & Greece, J. A. (2024) · Pedagogy in Health Promotion · doi:10.1177/23733799241298257
“…pediatric, prenatal, primary care), adoption of these practices has been limited (del Boca et al., 2017) given lack of time and competing demands (Rahm et al., 2015), insufficient systems-level supports and education (Rosário et al., 2021), and low self-efficacy when discussing alcohol use with…”
Burnout Among Social Workers in Integrated Care
McGee, K. (2025) · doi:10.70013/r9vm2bcy
Cannabis Use and Psychiatric Symptoms in Adolescence
Costello, M. A., Schuster, R. M., Gilman, J. M., & Evins, A. E. (2025) · Springer eBooks · doi:10.1007/978-3-031-87990-6_16
Lindenfeld, Z., Franz, B. A., Fenstemaker, C., Lai, A. Y., Pagán, J. A., Cronin, C. E., & Chang, J. E. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-09785-z
“[16,,20] However, there remains a gap in knowledge regarding which implementation strategies are needed to support SBIRT implementation and sustainment for OUD within safety-net hospitals.”
Kowalchuk, A. A., Ostovar-Kermani, T. G., Schaper, K., Grigoryan, L., Hirth, J. M., Mejia, M. C., Spooner, K. K., & Zoorob, R. (2024) · Figshare · doi:10.6084/m9.figshare.25918878
Additional file 4 of Alignment in implementation of evidence-based interventions: a scoping review
Lundmark, R., Hasson, H., Richter, A., Khachatryan, E., Åkesson, A., & Eriksson, L. (2021) · Figshare · doi:10.6084/m9.figshare.16900786
Additional file 5 of Alignment in implementation of evidence-based interventions: a scoping review
Lundmark, R., Hasson, H., Richter, A., Khachatryan, E., Åkesson, A., & Eriksson, L. (2021) · Figshare · doi:10.6084/m9.figshare.16900789
Additional file 2 of Alignment in implementation of evidence-based interventions: a scoping review
Lundmark, R., Hasson, H., Richter, A., Khachatryan, E., Åkesson, A., & Eriksson, L. (2021) · Figshare · doi:10.6084/m9.figshare.16900780
Kowalchuk, A. A., Ostovar-Kermani, T. G., Schaper, K., Grigoryan, L., Hirth, J. M., Mejia, M. C., Spooner, K. K., & Zoorob, R. (2024) · Figshare · doi:10.6084/m9.figshare.25919077
Additional file 3 of Alignment in implementation of evidence-based interventions: a scoping review
Lundmark, R., Hasson, H., Richter, A., Khachatryan, E., Åkesson, A., & Eriksson, L. (2021) · Figshare · doi:10.6084/m9.figshare.16900783
Woodward, D. W., Wilens, T. E., Glantz, M. D., Rao, V., Burke, C. W., & Yule, A. M. (2024) · Figshare · doi:10.6084/m9.figshare.26577869
Additional file 6 of Alignment in implementation of evidence-based interventions: a scoping review
Lundmark, R., Hasson, H., Richter, A., Khachatryan, E., Åkesson, A., & Eriksson, L. (2021) · Figshare · doi:10.6084/m9.figshare.16900792
Additional file 1 of Alignment in implementation of evidence-based interventions: a scoping review
Lundmark, R., Hasson, H., Richter, A., Khachatryan, E., Åkesson, A., & Eriksson, L. (2021) · Figshare · doi:10.6084/m9.figshare.16900774
Etudes menées autour de repérage des troubles addictifs en soins premiers
Pautrat, M. (2023) · theses.fr (ABES) · doi:10.70675/4fd8a5d3z5b1cz4b49z98caz9b8772848a74
Shrier, L. A., O’Connell, M., Palmer, A., Parker, S., Kossowsky, J., Katz‐Wise, S. L., Burke, P. J., Milliren, C. E., & Harris, S. K. (2026) · JMIR Research Protocols · doi:10.2196/105908 · Cited by 1
“Using trained interventionists to deliver treatment has facilitated sustained SBIRT in primary care [42,43].”
Metadata
- 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
- Venue
- Substance Abuse
- Publisher
- SAGE Publications
- Published
- 2015-07
- Volume
- 36
- Issue
- 3
- Pages
- 281-288
- ISSN
- 0889-7077 (ISSN-L)
- 1547-0164
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
