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Screening, Brief Intervention and Referral to Treatment (SBIRT)

SBIRT as part of routine healthcare practice can reduce unhealthy alcohol and drug use.

SBIRT is a public health approach that can deliver an early intervention to anyone who uses alcohol and/or drugs in unhealthy ways.

Screening - Short, well-tested questionnaire identifies risk (such as the ASSIST, the CRAFFT, the AUDIT, the DAST, etc.)

Brief Intervention - Short, structured conversations that feature feedback and options for change

Referral - For in-depth assessment and/or diagnosis and/or treatment, if needed

Treatment - Between 1% and 10% may need some level of treatment - depending on the health care setting.

SBIRT can help health care and other professionals determine whether a patient/client uses alcohol and/or drugs in unhealthy ways. Research shows that they can engage individuals in brief, non-judgmental conversations about their substance use and help them decide whether/how to reduce their use to improve their long-term health.

Unhealthy use can lead to serious harm. Beyond injuries and illnesses like HIV, it can complicate existing chronic illnesses like diabetes, high blood pressure, cardiovascular diseases or depression. It can also cause ulcers, sleep and memory problems, and anxiety. Alcohol affects most organ systems, and many drugs affect the nervous system, and heart rates

Pyramid shape displays substance use disorders: SUD, Risky Use, No or low risk

People who use alcohol and/or drugs use them on a continuum and over a life span. SBIRT addresses the large gap between preventing early use by youth and treating people of any age who have an alcohol or drug use disorder.

The US Preventive Services Task Force (USPSTF) recommends alcohol screening and brief intervention for all adults, including pregnant women. The USPSTF also recommends unhealthy drug use screening for all adults. The American Academy of Pediatrics recommends universal substance use screening of adolescents.

To learn more about Screening in Schools go to:

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Learn More about Screening

Learn more about Screening (S)

Screening, Brief Intervention and Referral to Treatment (SBIRT) focuses on the large group of people who use alcohol and/or other drugs in unhealthy ways but who do not have a substance use disorder.

Universal screening is a non-judgmental way to learn about a patient’s health and safety risk. Validated questions ask how much individuals use, how often and how substance use impacts their lives. About 1 in 4 people screened will be positive for risky alcohol use and about 1 in 5 people screened will be positive for drug use. 

Asking about alcohol and other drug use in health care and other public health settings helps people think about alcohol or other drug use in relation to their own health. Alcohol use can lead to a variety of health and safety problems, as does drug use.    

Screening can also indicate when health care providers should recommend further assessment or treatment services.

Screening Tools

Using standardized, validated screening questions has been shown to help people be more open to talking about their substance use. Screening tools for alcohol and other drugs for different populations can be found at NIDA’s Screening and Assessment Tools Chart.  This webpage shows all tools listed below except USAUDIT.

For Adults

ASSIST -Alcohol, Smoking and Substance Involvement Screening Test

TAPS – Tobacco, Alcohol, Prescription medicine, and other Substances Tool

USAUDIT – Alcohol Use Disorders Identification Test adapted for US

For Adolescents

BSTAD – Brief Screener for Alcohol, Tobacco and Other Drugs

CRAFFT 2.0 – Car, Relax, Alone, Friends/Family, Forget, Trouble

S2BI – Screening to Brief Intervention

For further information go to MASBIRT Training and Technical Assistance

Learn About Brief Intervention (BI)

The Brief Intervention is the non-judgmental conversation that happens after the screen. It starts with a review of screening results and is meant to elicit the person’s motivation to either continue healthier choices or make changes.  

If screening shows no risk (most common in the general population), the goal of the BI is to provide reinforcement and information to encourage healthy choices.

The REACT model can be used for this conversation:

  • Reinforce: Ask why the person made the decision to use within guidelines or not to use, and then support those healthy decisions.
  • Educate: Share information about the health and safety risks of alcohol or drug use.
  • Anticipate Challenges of Tomorrow: Ask questions to explore situations that involve substance use.

When a screening shows some risk to health or safety (about 15-20% of those screened), the goal is to help the client/patient think about making a change. This conversation does not criticize the individual. It tries to help the person start to think about what motivates their choices. 

The Brief Negotiated Interview model can be used for this conversation:

  1. Build rapport
  2. Explore pros and cons
  3. Provide feedback
  4. Assess readiness
  5. Negotiate action plan

When the risk is high, the person may be referred for further assessment or care.

For further information go to MASBIRT Training and Technical Assistance.

Referral to Treatment (RT)

When the risk is high, the person may be referred for further assessment or care. This referral may help people who might never think about getting treatment on their own.  

Between 1% and 10% of those screened may need further assessment or some level of treatment.

The Massachusetts Substance Use Helpline can help people seeking information for themselves or someone else (i.e., friend/family, patient, person receiving services).

Call 800-327-5050 or visit https://helplinema.org/.  A specialist or web resources can help find appropriate services for particular situations.

To learn more about the Massachusetts Treatment system, visit https://helplinema.org/learn-more/treatment/the-treatment-system/ or call to speak with a specialist.

Skills and Resources

Learn Skills:

How can my practice/system learn to incorporate SBIRT? 

MASBIRT Training and Technical Assistance can provide free training and coaching for practices and systems in Massachusetts. 

 Resources available at the MA Clearinghouse links here

What’s happening in Massachusetts – SBIRT News

Toolkits and Resources:

FEDERAL Resources

What about reimbursement?

A typical screening takes a few minutes.  A brief intervention or referral will take time that may allow for reimbursement.

Reimbursement codes were developed in 2009 and some payers recognize them. SAMHSA has information at https://www.samhsa.gov/sbirt/coding-reimbursement 

AMA CPT codes were developed for the Brief Intervention and include screening:

  • 99408 - Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
  • 99409 - Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes

These only allow reimbursement for the time taken to do a brief intervention, not for screening alone.   

Some commercial payers reimburse for Alcohol SBI

MassHealth does not currently reimburse for screening or brief intervention.

Medicare does reimburse for alcohol SBI as part of a prevention visit.

It uses G-codes which are different from the CPT codes. 

The CMS -Medicare Fact Sheet provides instructions on billing.

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