What Is SBIRT?

• SBIRT is a health promotion approach for early assessment, brief intervention, and referral for treatment services to people with, or at risk of developing, alcohol, and drug use disorders. 
• SBIRT screening questions take less than 5 minutes and additional history, physical exam and clinical diagnosis of substance abuse disorder takes an additional 10-20 minutes. 
• Every time we ask the screening questions and offer resources, it is one time closer to when they may move from contemplation to action in substance abuse cessation. 

The Substance Abuse and Mental Health Services Administration identifies SBIRT as “Association Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.”  

Simply, the SBIRT model is the practice of having healthcare professionals from physicians, nurses, nursing assistants, medical assistants and any medical person who interacts with patients, screen for substance.   

If the patient’ screen is positive, the healthcare professional refers them to available programs and community resources.  

The SBIRT model was inspired by a recommendation from the National Academy of Medicine (formerly the Institute of Medicine) to increase community-based screening for health risk behaviors, including substance use.   

SBIRT is an early and brief intervention of screening questions and takes less than 5 minutes and additional history, physical exam and clinical diagnosis of substance abuse disorder takes an additional 10-20 minutes.  

The time for asking screening questions and offering resources is billable to Medicare/Medicaid. The screening and referral to treatment includes a patient encounter, history, physical exam, clinical diagnosis, and plan for care specific to the concern of substance abuse.   

SBIRT Components

SBIRT is a health promotion approach for early assessment, brief intervention, and referral for treatment services to people with, or at risk of developing, alcohol, and drug use disorders.  

The SBIRT benefit has three components: 

• Universal screening by a health care professional who identifies people with potential drug and alcohol use disorders. 
• Brief intervention is provided by a health care professional to a patient who shows risky substance abuse behaviors. The Brief intervention utilizes motivational interviewing techniques focused on motivating people toward positive behavioral change. 
• Referral to Treatment provides a referral to specialty care for persons deemed to be at high risk for a drug and/or alcohol use disorder. 

A key aspect of SBIRT is the integration and coordination of screening, early intervention, and treatment components into a system of care. This system in turn links patients to specialty treatment programs, community resources and social services programs in the community for long-term management of substance use disorder. 

Why Should Nurses Care About SBIRT?

Nurses are in the healing profession and care about the health of each individual and community health. Substance abuse doesn’t just impact the individual but truly impacts the community at large and greater society. Physical, emotional, interpersonal, and financial complications are caused by substance abuse disorder. Nurses can help patients identify the problem and point them towards resources and recovery.  

It is estimated that a person with a substance abuse addiction must be asked at least 10 times by a healthcare professional before they even move towards precontemplation in the behavior change process.  

You may be person #2 or #10 but it takes screening without judgement, in the spirit of help and coaching to move a person forward to begin to consider substance use. Many people in a substance abuse pattern want to stop but don’t know how or what resources are available.

SBIRT training helps healthcare professionals help patients.  

How Can Nurses Implement SBIRT?

Patients seem to want to talk about it but need the healthcare professional to bring up the questions. Simple questions to begin with include “Do you smoke?” If yes, then ask about the frequency of daily consumption and years smoked to calculate pack years.  

The next important question is simply to ask if they have a desire to stop smoking. If the answer is yes, then you can offer programs and resources. If the answer is no for them to having a desire to stop smoking, then let them know you are concerned about their health and you are available with resources when they’re ready to stop.  

Each time you have a patient encounter, simply go through the same questions and eventually the person may begin to be in the precontemplative stage of change.  

For alcohol and illicit drug use using the CAGE format is an acronym to help you remember to ask certain questions.  

Many people with a substance use disorder may feel like they are in a CAGE and just need help to get out.  

C: Have you ever felt you needed to Cut down on your drinking? … 

A: Have people Annoyed you by criticizing your drinking? … 

G: Have you ever felt Guilty about drinking? … 

E: Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? … 

Learning how to become comfortable with asking the screening questions takes practice and you can overcome any hesitation you may feel that you are prying into their personal life by practicing simple questions. 

Asking The Hard Questions

A study was done in a large Las Vegas medical care organization where the SBIRT training model was part of the required quarterly training for physicians, nurses, and medical assistants.   

During the study time frame, there were 671 participants who received the training.  Qualitative interviews from participants showed that 99% who completed the training felt much more confident in asking patients about substance use and abuse and referring them for assistance.

Mary J., RN, stated “I thought it would be scary to confront a patient, but it’s really just showing you care when you ask them about their substance use and their desire to quit.” A family practice physician in Las Vegas stated, “Being aware of asking the simple questions is easier when I make it a part of my standard routine in my patient encounter.” 

Professional Resources

Asking the questions is a strong start in the screening process but referring clients to effective resources for cessation and recovery is the next important component of SBIRT. You need to learn what resources are available in your own community such as free Alcoholics Anonymous meetings and groups, and more.

A simple Google search is a good place to start. There are also many free national resources such as the 1-800-quit-now phone lines that will offer resources to individuals seeking help.  

To learn more about Substance Abuse and Mental Health Services Administration and the U.S. Department of Health and Human Services Health Resources go to: http://www.integration.samhsa.gov/clinical-practice/sbirt.  

The Centers of Disease Control also offer many free resources and education at: https://www.cdc.gov/rxawareness/ 

Search the National Institute on Drug Abuse who offers free publications on addiction treatment and prevention for children and families.  Visit The Opioid Response Network providing free educational resources to individuals in the prevention, treatment and recovery of opioid use disorders and stimulant use at: https://nida.nih.gov/ 

The Bottom Line

SBIRT is a simple way to demonstrate holistic care, as substance abuse can impact not just the physical health but emotional, spiritual, financial, social, and even professional parts of their life.  

Every time we ask the screening questions and offer resources, it is one time closer to when they may move from contemplation to action in substance abuse cessation.  

Nurses can make a difference. Just taking a few minutes of extra time asking key questions can make a large difference in the life of an individual, which makes our whole community a little healthier.

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