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Research Summary

Emergency-Department Screening, Brief Intervention, and Referral to Treatment Is Associated with Reduced Health-Care Costs

Screening and brief intervention has been shown to reduce alcohol and illicit drug use, but less is known about its effect on health-care costs. This study analyzed health-care costs of Medicaid patients who participated in a screening, brief intervention, and referral to treatment (SBIRT) program in 9 hospital emergency departments (EDs). Patients age 18–64 who screened positive for a drug or alcohol problem based on AUDIT* and DAST-10† scores (n=1557) were compared with equal number of propensity-matched controls. Interventions were delivered by trained substance abuse counselors. Fifty-seven percent of intervention patients received brief intervention only; the remaining 43% were referred for further treatment.

  • The SBIRT program was associated with a $366 per-member, per-month reduction in health-care costs as well as a significant reduction in hospital inpatient days in the year after the intervention.
  • Cost decreases were greater for those who received brief intervention only and had no chemical dependence treatment in the year prior to or following the ED visit as well as for those treated for injury during the ED visit.

*AUDIT=Alcohol Use Disorders Identification Test.
†Dast-10=Drug Abuse Screening Test.


This study suggests that SBIRT in emergency-care settings can reduce health-care costs. It remains to be seen whether the effect is sustained beyond a year. While it appears that having substance abuse counselors in the ED saves money for the health-care system as a whole, incentives will be needed to encourage hospitals to invest in their services or to have existing staff deliver the intervention. Darius A. Rastegar, MD


Estee S, Wickizer T, He L, et al. Evaluation of the Washington state screening, brief intervention, and referral to treatment project: cost outcomes for Medicaid patients screened in hospital emergency departments. Med Care. 2010;48(1):18–24.