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.
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.
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
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:
- Build rapport
- Explore pros and cons
- Provide feedback
- Assess readiness
- 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
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:
- AAFP - American Academy of Family Physicians
Addressing Alcohol Use Practice Manual
- CDC - Centers for Disease Control and Prevention
Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use
Communication between Health Professionals and Their Patients About Alcohol Use
- ACS-COT - American College of Surgeons – Committee on Trauma
COT Quick Guide – Alcohol SBI for Trauma Patients (PDF)
- NIH – NIAAA - National Institute for Alcohol Abuse and Alcoholism
Helping Patients Who Drink Too Much: A Clinician's Guide
Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide
- NIH – NIDA - National Institute on Drug Abuse
NIDAMED for Medical and Healthcare Professionals
TAPS - Tobacco, alcohol, prescription drug and other substance tool
- VA – Department of Veterans Affairs
Teaching Guide: Reducing Alcohol Use with Brief Intervention
- WHO - World Health Organization
ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) Manuals
- CDC - Centers for Disease Control and Prevention
- Alcohol Screening and Brief Intervention For People Who Consume Alcohol and Use Opioids
- CDC’s Alcohol Screening and Brief Intervention Efforts
- Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use (cdc.gov)
- Vital Signs
- NIAAA - National Institute of Alcohol Abuse and Alcoholism
- Rethinking Drinking
- NIDA – National Institute on Drug Abuse
- SAMHSA - Substance Abuse and Mental Health Services Administration
- SAMHSA SBIRT
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.