The recent publication of Screening, Brief Intervention, and Referral to Treatment (SBIRT) studies in the Journal of the American Medical Association (JAMA) provides an excellent opportunity to focus on the benefits of SBIRT in identifying those with alcohol and other substance use disorders. Over 2 million people have been screened in the eleven years SAMHSA’s SBIRT program has been in existence. Of those, only a small percentage screened positive for any “at risk” behaviors, with about 11 percent of those screened receiving a brief intervention. Without screening the substance use disorders of many of these people would have remained invisible. SBIRT gives providers and primary care physicians an opportunity to identify potential alcohol and substance misuse or abuse and, through brief intervention, an opportunity to use that “teachable moment” to educate patients and, potentially, change behavior for the better. Additionally, SBIRT allows the person who has a substance use disorder to address that disorder immediately, if so inclined, or when they are ready.
Upon checking on patients six months after a brief intervention, providers have reported reductions in alcohol and substance abuse, as well as physical complaints, and mental and emotional difficulties. However, it’s important to remember that brief intervention does not work for everyone. For many, learning the consequences of their “at risk” behavior or abuse can provide the wake-up call they need to either stop using or seek appropriate treatment. For those individuals with more severe and complex substance use disorders, brief intervention will most likely not be sufficient to change their behaviors. For this group it is important that a treatment referral is made – and this is where the confusion surrounding the role of SBIRT surfaces. What does “referral to treatment” mean? And, is SBIRT responsible for making sure someone enters treatment, even if given a referral?
SBIRT’s value to the behavioral health and primary care providers is the ability to identify when a patient is in need. For Referral to Treatment to be effective the appropriate treatment must be available and accessible – whether it is medication-assisted treatment, residential or out-patient treatment, etc. Providers need to have a working knowledge of the treatment services and facilities in their areas so they can make an appropriate referral. It cannot be the role of SBIRT to make sure their patients enter treatment. Individuals in need of specialty treatment need to have access to that treatment, geographically, culturally, and financially. The value of SBIRT is that it makes an “invisible” clinical issue visible by providing the tools to identify and address alcohol and drug use disorders at every point in public health, from primary care to specialty care.