A recent study of over one million people who were screened for drug and alcohol use disorders over a five-year period reviewed the effectiveness of SBIRT (Screening, Brief Intervention and Referral to Treatment) in a variety of medical and community settings.

SBIRT is a tool that allows primary care providers to identify patients with drug and alcohol abuse disorders and connect them with treatment services.  SBIRT enables health care professionals to talk to patients about substance use during routine medical visits and has been shown to be especially effective in the early stages of problem drinking and drug use. Doctors can use standardized screening tools to identify those at risk, engage in brief interventions and, when necessary, refer patients to additional treatment options.

The study, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and published in the journal Addiction, found the following:

• SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services.
• Greater intervention intensity was associated with larger decreases in substance use.
• Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances.
• Brief Intervention (BI) was shown to be primarily effective with alcohol abusers, and Brief Treatment (BT), which provides a more intensive level of care than BI, had a greater impact in reducing the frequency of illicit drug use.
• Regarding economic efficiency, BI was more cost-effective than BT.
• Flexibility is key: The authors attribute the large reach of the SBIRT programs in part to the variety of implementations available and the adaptability of program design.

The authors also discuss insurance reimbursement, the sustainability of SBIRT and affordability of services. They note differences in cost effectiveness in high patient flow versus low patient flow facilities, indicating that high volume venues are most cost effective and are sites where most patients are likely to receive care in the future. Additionally, high volume settings allow practitioners to reach patients with a wide variety of co-occurring physical and mental health issues.

The authors conclude, “Treatment services for substance use problems are typically fragmented, with both personal and societal costs and consequences. Ideally, services should be integrated with continuity of care from one type of specialized service to another, so that patients are assigned to the least intensive level of care that suits their needs. SBIRT attempted to maximize efficiency and effectiveness, and to minimize cost, by providing a wide range of services, including less intensive services, to meet the needs of individuals at each point along the substance use risk continuum.”