SBIRT: Screening, Brief Intervention & Referral to Treatment

Published: February 2026 | Last Updated: February 2026 | Reading Time: 6 min

What Is SBIRT?

SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an evidence-based, comprehensive public health approach to identifying and addressing substance misuse in healthcare settings. Rather than waiting for patients to develop severe substance use disorders, SBIRT takes a proactive approach — screening all patients, providing brief motivational conversations for those at risk, and referring individuals with more severe problems to specialized treatment.

The SBIRT framework was developed from decades of research demonstrating that early identification and brief intervention can significantly reduce risky substance use before it progresses to addiction. SAMHSA has invested over $1.5 billion in SBIRT implementation across all 50 states since 2003.

The Three Components

Screening

The first component involves administering a brief, validated screening tool to all patients during routine healthcare visits. Common screening tools used in SBIRT include the AUDIT or AUDIT-C (for alcohol), the DAST-10 (for drugs), the NIDA Quick Screen, and the ASSIST (for all substances). Screening takes 2-5 minutes and categorizes patients into risk levels: no risk/low risk (no further action needed), moderate risk (proceed to brief intervention), and high risk (proceed to brief intervention plus referral).

Brief Intervention

For patients who screen at moderate risk, a brief intervention is conducted. This is a short (5-15 minute), structured conversation using motivational interviewing techniques. The brief intervention typically includes providing feedback about the screening results and associated health risks, assessing the patient's readiness to change, exploring the patient's own reasons for change, negotiating a goal or plan for reducing use, and providing educational materials and follow-up.

The FRAMES model summarizes the key elements of effective brief interventions: Feedback (personalized information about risk), Responsibility (emphasizing personal choice), Advice (clear recommendation to reduce or stop), Menu (offering a range of strategies), Empathy (nonjudgmental, supportive tone), and Self-efficacy (building confidence in ability to change).

Referral to Treatment

Patients who screen at high risk — suggesting a possible substance use disorder — receive a brief intervention plus a direct referral to specialized treatment. Effective referral involves more than simply handing a patient a phone number. It includes explaining the need for further evaluation, identifying appropriate treatment options, addressing barriers to treatment access (transportation, insurance, childcare), providing a warm handoff when possible (calling the treatment provider together with the patient), and scheduling follow-up to ensure the referral was completed.

Evidence Base

Effectiveness

The evidence supporting SBIRT is substantial. Research demonstrates that brief interventions for alcohol reduce weekly consumption by an average of 3-4 drinks, brief interventions reduce heavy drinking episodes by 10-30%, SBIRT in emergency departments reduces alcohol-related injuries and return visits, brief interventions for drug use show smaller but meaningful reductions, and early identification prevents progression to more severe disorders.

Cost-Effectiveness

Economic analyses consistently demonstrate that SBIRT programs are cost-effective. A large-scale SAMHSA study found a return of $3.81 for every $1 invested, driven by reduced emergency department visits, decreased hospitalizations, reduced criminal justice involvement, and increased productivity.

Implementation

Who Can Deliver SBIRT?

SBIRT can be delivered by a range of healthcare professionals including physicians, nurses and nurse practitioners, physician assistants, social workers, health educators, and trained peer specialists. Training typically requires 4-8 hours and includes screening tool administration, motivational interviewing basics, referral processes, and documentation.

Settings

While originally designed for primary care, SBIRT has been successfully implemented in emergency departments, community health centers, college health services, prenatal care settings, criminal justice settings, and military healthcare facilities.

Frequently Asked Questions

Is SBIRT effective for drug use, not just alcohol?

The evidence for SBIRT with drug use is growing but not as robust as for alcohol. Brief interventions for drug use show smaller effect sizes compared to alcohol, but screening and referral components are valuable for connecting individuals with appropriate treatment. Research in this area continues to evolve.

Does insurance cover SBIRT services?

Yes. Medicare, Medicaid, and most commercial insurers cover SBIRT services. Specific CPT and HCPCS codes exist for billing SBIRT screening (99408, 99409, H0049, H0050) and brief intervention services.

How is SBIRT different from traditional substance abuse treatment?

SBIRT is not treatment — it is a preventive approach. Traditional treatment addresses diagnosed substance use disorders. SBIRT identifies people at risk before they develop disorders and provides early intervention to prevent escalation. Think of it as the substance use equivalent of cholesterol screening and lifestyle counseling to prevent heart disease.

References

1. Babor, T.F., et al. (2007). Screening, Brief Intervention, and Referral to Treatment (SBIRT). Substance Abuse.
2. Substance Abuse and Mental Health Services Administration. (2023). SBIRT: Screening, Brief Intervention, and Referral to Treatment.
3. Madras, B.K., et al. (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use. Drug and Alcohol Dependence.
4. Agerwala, S.M. & McCance-Katz, E.F. (2012). Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings. Frontiers in Psychiatry.
5. Aldridge, A., et al. (2017). The cost-effectiveness of SBIRT. Drug and Alcohol Dependence.

This article was reviewed by the Valley Spring Recovery Center Editorial Team. For a confidential substance use assessment, call (201) 781-8812 or visit our admissions page.

Valley Spring Recovery Center — Evidence-based addiction treatment in Norwood, New Jersey.