Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

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

The beauty of the Screening, Brief Intervention, and Referral to Treatment model (SBIRT) is that it is simple, brief, and can be integrated into regular check-ups or interviews to initially detect and subsequently monitor changes in tobacco use. 

Finding and Intervening with Smokers

What is SBIRT?

SBIRT stands for Screening, Brief Intervention, and Referral to Treatment.1  SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for people with substance use disorders and those at-risk of developing them.  SBIRT can be used for a range of substances including tobacco, illicit substance use, abuse of prescription medications, and alcohol in addition to being used with a diverse population of patients/clients.1

            Screening: The first step is to identify who is using a particular substance and assess the severity of substance use. Screening for current smoking or past month smoking and pattern of smoking can help identify the appropriate level of intervention and treatment needed.  This step can be integrated into intake procedures at most healthcare settings and can involve the use of specific screening tools or simply asking a couple questions to learn more about the person’s current use of a substance.

            Brief Intervention: This represents a single session or multiple sessions of motivationally enhancing discussion focused on increasing insight and awareness regarding substance use and motivation toward behavioral change. Brief intervention can be tailored for variance in population or setting and can be used as a stand-alone treatment for those at-risk as well as a vehicle for engaging those in need of more extensive levels of care.

            Referral to Treatment: Referral to more specialized treatment is provided to those identified as needing more than a brief intervention, e.g., more extensive treatment than can be offered by the  provider or may take more time or need specialized intervention skills.  For smokers this can be the quitline, groups, internet programs, or individual counseling. The effectiveness of the referral process to specialty treatment is a strong measure of SBIRT success and involves a proactive and collaborative effort between SBIRT providers and any referral resources who would be providing specialty treatment to make sure the connection between client and referral are facilitated.1

Who can use this?

Primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with patients who have at-risk substance use before more severe consequences occur.  SAMHSA has recently funded states to encourage and expand the use of SBIRT within medical and community settings through state level funding.  They also funded projects for integrating SBIRT training into medical residency training programs so all doctors regardless of specialty can screen and intervene with patients with substance use.  An  very important benefit of SBIRT is the focus on identifying not only those patients who are already struggling with substance use, but also those who are beginning use or are on the verge of developing problematic use patterns.  In this sense, SBIRT is not only an intervention, but is also prevention oriented as well. 

Efficacy of SBIRT in the literature

There is a growing body of evidence supporting SBIRT’s effectiveness and cost-effectiveness in a variety of health care settings including trauma centers, emergency rooms, and primary care settings.

  • Brief interventions and follow-up for alcohol use patterns and levels in primary care settings produces small to moderate reductions in alcohol consumption that are sustained over 6-12 month periods or longer.2,3
  • Brief interventions when conducted in an emergency room setting lead to reduced hospital admissions, traumas and injuries up to 3 years post intervention. 2,3
  • The use of SBIRT was found to not only increase likelihood of making a tobacco quit attempt among patients who received a brief intervention during an Emergency Room visit, but it was also strongly and consistently associated with increased satisfaction with care provided in their visit.4
  • In a review of literature examining the use of SBIRT for tobacco cessation, studies suggest that even low-intensity SBIRT may prompt quit attempts, decreased cigarette use, and quitting, if offered routinely to ED smokers.5
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References: 
  1. SAMHSA. Screening, Brief Intervention, and Referral to Treatment (SBIRT). Retrieved March 8, 2012 from http://www.samhsa.gov/prevention/sbirt/.
  2. Gentilello, L., Rivara, F., Donovan, D., Jurkovich, G., Daranciang, E., Dunn, C., & ... Ries, R. (1999). Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Annals of Surgery, 230(4), 473-480.
  3. Solberg, L.I., Maciosek, M.V., & Edwards, N.M. (2008). Primary care intervention to reduce alcohol misuse: Ranking its health impact and cost effectiveness. American Journal of Preventive Medicine, 34(2), 143-152.
  4. Bernstein, S., & Boudreaux, E. (2010). Emergency department-based tobacco interventions improve patient satisfaction. The Journal of Emergency Medicine, 38(4), e35-e40.
  5. Cunningham, R., Bernstein, S., Walton, M., Broderick, K., Vaca, F., Woolard, R., & ... D'Onofrio, G. (2009). Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department... 10th annual Academic Emergency Medicine (AEM) consensus conference, "Public Health in the Emergency Department: Surveillance, Screening, and Intervention," May 13, 2009, New Orleans, Louisiana. Academic Emergency Medicine, 16(11), 1078-1088.