SBIRT works. The SBIRT model is one of the most effective secondary prevention strategies available to health care providers. Our work in Virginia shows that after receiving an SBIRT intervention, 50% of people are drinking at significantly lower levels 6 months later, and 1 in 3 people using drugs are abstinent 6 months later. These striking outcomes are echoed in other programs across the country.
Clinical research also shows that SBIRT can lead to decreases in substance use as well as negative consequences often linked to use, such as accidents, injuries, and legal consequences.
For these reasons, the U.S. Preventive Services Task Force has recommended alcohol and drug screening and behavioral counseling interventions in primary care.
The Virginia SBIRT Project
In 2016, Virginia’s Department of Behavioral Health and Developmental Services was awarded a five-year grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to support the integration of SBIRT into health care settings throughout the Commonwealth. Through a partnership with George Mason University, a Virginia SBIRT Team was assembled to oversee and implement this program.
Our goal: Screen 100,000 Virginians for substance and depression risk and offer interventions for identified risk.
Our partner health care sites to-date have included primary care settings, emergency departments, and health department sexually transmitted infection clinics.
How We Support Integration
With the right training, any health care professional can be trained to have a role in the SBIRT process.
Here in Virginia, our SBIRT team supports SBIRT integration into health care and other settings. We do this through hands-on consultation and training to support the implementation of this new evidence-based practice into an existing system. We hope that we can be a source of support in your SBIRT journey.
Learn More About the SBIRT Steps
Screening is the first step in the SBIRT model. Where possible, this includes universal screening of all people in a given setting. Substance use screening can include alcohol, drugs, and/or tobacco and nicotine. Given the high co-occurrence between substance use and mental health symptoms, screening for mental health often includes depression, anxiety, posttrauma reactions, and/or suicide.
- Universal screening includes a few questions to assess potential risk. About 80% of people screened In general community settings will screen negative for substance risk. The remaining 20% who score positive on a universal screen will complete a secondary screen. This secondary screening tool stratifies a person’s level of substance use risk into mild, moderate, or severe risk categories, which helps clinicians identify the appropriate level of intervention.
- In general, the vast majority of people who score positive and complete a secondary screen will fall in the mild risk category. This is where people are using substances and often just beginning to experience negative problems linked to their use. Intervening when someone is at this low risk range, to help individuals take action before patterns of use worsen and problems worsen is the core of what the SBIRT model strives to do. A smaller number of people will fall into the moderate or severe risk categories. Those who screen at a severe risk level are likely to meet diagnostic criteria for a Substance Use Disorder.
In the second step, Brief Interventions are offered to people identified in the mild, moderate, or severe risk categories.
- For those at mild and moderate risk levels, the Brief Intervention is typically a 5-10 minute conversation that aims to increase awareness of substance misuse and any associated consequences, provide feedback and education, explore and enhance readiness to change, and develop a plan to lower one's risk. The Brief Intervention is heavily informed by a Motivational Interviewing approach in which the provider skillfully dialogues with the at-risk individual in a way that is likely to activate that individual toward making a change.
- When people screen at severe risk levels, the goals of the brief intervention remain the same although the emphasis is on working to help the at-risk individual to be open to accepting a referral for further assessment and treatment.
Referral to Treatment is an active and collaborative approach. This may include planning around the facilitators and barriers to accepting the referral, developing relationships with common referral sites to streamline the transition, and instituting follow-up as a standard of care.
- SBIRT sites with the capacity to offer ongoing counseling or therapy are encouraged to offer on-site Brief Treatment services. People who fall in the moderate risk range would often benefit from a higher level intervention than a single brief intervention yet their severity may not make them appropriate for specialty SUD treatment. These individuals are often better suited to an in-between level of care: 6-12 sessions of outpatient weekly or biweekly counseling. SAMHSA has created a treatment manual to support the delivery of Brief Treatment, called Integrated Change Therapy.