Using SBIRT to address opioid and substance use disorders
As a result of the COVID-19 pandemic, there has been a 20% increase in substance use nationwide, and nearly 100,000 opioid overdose related deaths between 2020 and 2021.1 Black Americans have been disproportionately affected by this increase in overdoses.2 Increasing screening, brief intervention, and referral to treatment (SBIRT) may help provide an opportunity to engage those with emerging and existing substance use disorders through proactive identification and connection to professional services when indicated.
SBIRT resources for providers
A provider toolkit for SBIRT is available on the Empire BlueCross BlueShield HealthPlus provider portal. This toolkit includes SBIRT collateral materials for your use, which outline recommended screening tools, a guided SBIRT process, and resources to help identify appropriate referrals.
More about the SBIRT approach
SBIRT is a “comprehensive, integrated public health approach to the delivery of early intervention and treatment services for persons with substance use disorders (SUD), as well as those who are at risk of developing these disorders,” according to the Substance Abuse and Mental Health Service Administration (SAMHSA). The goal of SBIRT is to reduce the potential consequences of SUDs.3
SBIRT encounters include a brief screening and intervention that identifies:
- One or more behaviors related to risky alcohol or drug use
- Right type and amount of treatment
The screening is a brief set of questions that identify the patient’s risk of SUD-related problems. The brief intervention is a short (15 to 30 minutes) counseling session to raise awareness of the risks. By leveraging motivation enhancement techniques, this seeks to work with the patient where they are at and with what they are ready and willing to do to address identified substance misuse. Referral to treatment helps the patient access specialized treatment when indicated.
The purpose of the encounter is to facilitate change with the patient’s immediate behavior or thoughts about a risky behavior. In addition, SBIRT results help those with higher levels of need to obtain long-term care, including referrals to specialty providers. This evidence-based program (EBP) has been shown to result in a $2 to 4 healthcare savings for every $1 spent.4
Healthcare providers who encounter an at-risk member have an opportunity for early intervention and referral to appropriate treatment. The core goal is to reduce and prevent problematic use, abuse, and dependence on alcohol, opioids, and other substances. SBIRT has been proven effective regardless of age, gender, race, and culture in children, adolescents, and adults.
Encounters with patients in need of SBIRT may occur in public health, non-substance use treatment settings including primary care centers, hospital emergency rooms, trauma centers, and community health settings. Primary care providers (MD/DOs, PAs, ARNPs), behavioral health providers (therapists, counselors, psychiatrists, clinical social workers), and nurses may provide SBIRT.
Recommended screening tools include:
- Alcohol use disorder identification test (AUDIT)5 for adults with alcohol risk
- Drug abuse screening test (DAST-10)6 for adults with drug risk
- Car, relax, alone, forget, family or friends, trouble (CRAFFT)7 for children and adolescents
- Tolerance, worried, eye opener, amnesia, k/cut down (TWEAK)8 for pregnant people
Below is the SBIRT process flow.
August 2022 Newsletter