Screening, brief intervention and referral to treatment

SBIRT stands for Screening, Brief Intervention, and Referral to Treatment. The model encourages mental health and substance abuse screenings as a routine preventive service in healthcare.

Background: What is SBIRT?

Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based, public health approach aimed at delivering early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. Unhealthy and unsafe alcohol and drug use are major preventable public health problems resulting in 3 million deaths every year, worldwide, as reported by WHO.

Research shows SBIRT to be most effective with patients with unhealthy alcohol or drug use who do not have a substance use disorder, therefore, the primary goal of SBIRT is intended to reduce the harms and societal costs associated with the risky use of such substances before the problem elevates to a disorder. SBIRT model was developed by the Institute of Medicine as a result of a recommendation that encouraged community-based screening for health risk behaviours, including substance use. As explained by SAMHSA (Substance Abuse and Mental Health Services Administration), SBIRT consists of three major components:

• Screening: a healthcare professional assesses a patient for risky substance use behaviours using standardized screening tools. Screening can occur in any healthcare and school-based healthcare setting.

• Brief Intervention: a healthcare professional engages a patient showing risky substance use behaviours in a short conversation, providing feedback and advice.

• Referral to Treatment: a healthcare professional provides a referral to brief therapy or additional treatment to patients who screen in need of additional services

Three Major Components of SBIRT

Screening

Screening quickly assesses the severity of substance use by and usually accompanies tailored feedback and advice. Simple feedback on risky behavior can be one of the most important influences on patient behavior and change. Screening large numbers of individuals present an opportunity to engage those who are in need of treatment and refer them to correct resources. Universal, annual Screening identifies unhealthy use of alcohol and drugs, and it s reported that 75-85% of patients will screen negative. For those who screen positive, further assessment is needed to determine the level of risk associated with their use.

Brief Intervention

The brief intervention aims at providing detailed feedback, which focuses on increasing insight and awareness regarding substance use and instills motivation towards behavioural change. Intervention usually includes giving feedback on the risks and negative consequences of substance use, advising on modifying alcohol and drug use and suggestions options to choose from to modify risky behavior, hence encouraging the individual to exercise decision making.

Referral to Treatment

In cases where brief intervention has shown to have a little effect, the individuals are referred to treatment. A referral is usually indicated for only about 5% of people screened.

Applications of SBIRT

The applications of SBIRT are very flexible so it can be delivered in various settings, including, primary care centres, school-based health centers, clinics, and other community settings provide excellent opportunities for early intervention with at-risk substance users and for intervention for persons with substance use disorders.