Screening, Brief Intervention, Referral, and
Treatment
(SBIRT)
Division of Services Improvement
Organization and Financing Branch
Juli Harkins
June 26, 2005
Consider these facts…

20 million Americans (8%) of the population aged 12 or older were
current users of illicit drugs.

3 million 1st time marijuana users (each day an average of 7K, mostly
<age 18)

2 million current cocaine users

1 million current hallucinogen users

119,000 current heroin users

6 million current users of psychotherapeutic drugs taken non-medically
Source: 2003 NSDUH
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Drinker Distribution
Probable
Alcohol
Dependence
5%
High-Risk
Drinkers
20%
Abstainers
40%
Low-Risk
Drinkers
35%
Source: Brief Intervention for Hazardous and Harmful Drinking, World Health Organization, 2001
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Most People Who Needed Treatment
for an Illicit Drug Problem Did Not
Feel a Need for Treatment
4%
5%
17%
20%
Female
75%
Male
79%
Felt No Need for TX
Felt Need for TX
Received TX
2002 NSDUH
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Most People Who Needed Treatment
for Alcohol Problems Did Not Feel a
Need for Treatment
8%
Female
5%
9%
Male
87%
4%
87%
Felt No Need for TX
Felt Need for TX
Received TX
2002 NSDUH
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Why SBIRT?
The research suggests…
 Substance use and abuse have significant medical,
social, and financial consequence to our society.
 Effective treatments exist but fewer than half of those
who need treatment for substance use disorders receive
the appropriate treatment.
 Early and brief intervention is more effective clinically and
much more cost efficient than the traditional more
intensive treatment necessary if the use progresses to
addiction.
 Excessive drinking and illicit drug use are often
undiagnosed by medical professionals and go untreated,
leading to a more chronic, severe condition.
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SBIRT Encourages Moving from
Research to Practice and from Science to
Service in Medical Care Settings.




Emergency services, chest pain, urgent care
Trauma inpatient
Primary care
Dental services, pre-natal, breast exam clinics,
adolescent clinics
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Integrated Spectrum of Users and Services
Prevention
Generalist
System
Intervention
Specialist
System
Treatment
Non-Users and
Low Risk
Users
At-Risk
Users
Abuse
Disorder
Dependence
Disorder
Assessment, Treatment, Support
Brief Intervention and Boosters
Education, Information (Brief Advice) and Boosters
Linkages by uniform decision rules; permeable boundaries
SBIRT Goals as a
Conceptual Model and Planning Tool
 Increase access to clinically appropriate care for nondependent as
well as dependent persons
 Link generalist and specialist treatment systems
 Combine prevention, intervention, and treatment toward a consistent
continuum of care.
 Diminish barriers to access to care
 Increase the numbers of screenings and BI’s.
 Reduce Prevalence of Alcohol, Drug, and Medications Related
Disorders
 Building coalition between health care services and alcohol and drug
treatment services
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SBIRT: Core Clinical Components
 Screening: Very brief screening provides identification of
substance related problems.
 Brief Intervention: Raises awareness of risks and
motivation of client toward acknowledgement.
 Brief Treatment: Cognitive behavioral work with clients
who acknowledge risks and are seeking help.
 Referral: Referral of those with more serious addictions.
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FFY 2003 Cooperative Agreement
Awards made to 6 States and 1
Tribal Organization
California
Cook Inlet Tribal Council
Illinois
New Mexico
Pennsylvania
Texas
Washington
$3.485m
$1.672m
$3.500m
$3.500m
$2.970m
$3.500m
$2.970m
Awards are renewable for up to five years,
depending on performance and availability of funding.
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Recommended S-BIRT Awards
FY 2003
WA
PA
IL
CA
NM
AK
AI/AN
TX
SBIRT GPRA Summary (6/22/05)
Area
Target to Date
Actual to Date
Percentage
Intake
162,657
198,806
122.2%
Screening
125,137
162,257
129.7%
Brief Intervention
28,134
28,424
101.0%
Brief Treatment
5,110
3,863
75.6%
Referral & Treat
4,273
4,262
99.7%
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SBIRT Grants:
 Expanding the State’s continuum of care to include screening,brief
intervention, brief treatment, and referral services in medical and
other community settings;
 Supporting clinically appropriate treatment services for
nondependent substance users;
 Developing collaborative linkages between providers of SBIRT
services and the more traditional substance abuse treatment
providers to build resilience and facilitate recovery; and
 Identifying opportunities for system and policy change to improve
access to care and ensure a life in the community for everyone.
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SBIRT Evaluation:
 CSAT has funded Cross-site evaluation team:
contractors Johnson, Bassin & Shaw (JBS), RTI
International, and the University of Connecticut Health
Center (UCHC)
 Purpose: to understand how SBIRT will work best in
various settings and under different approaches and
examine which SBIRT models offer the greatest potential
to improve the U.S. healthcare system
 Evaluation Plan is under development
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SBIRT ACTIVITIES
Current Involvement:
Uniform Accident and Sickness Policy and Provision Law Studies
CMS Coding
National Highway Transportation and Safety Administration
Office of National Drug Control Policy
American Society of Addiction Medicine
Around the Corner:
College University Grants
New Fall Grants
Worldwide Collaboration
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