Screening, Brief Intervention, and Referral to Treatment: Evaluation of a National Implementation

Evidence has been lacking to support routine screening, brief intervention, and referral to treat-ment (SBIRT) for illicit drug use in medical practice. The authors of this study sought to evaluate the impact of the Center for Substance Abuse Treatment’s 2003 implementation of large-scale SBIRT initiatives in 6 states. Settings were diverse and included trauma centers, emergency departments, primary and specialty care sites, and hospitals. All patients (N=459,599) were screened for substance use, 23% of whom screened positive for risky or problematic alcohol or drug use in the prior 30 days. Of these, 52% reported using alcohol, and 55% reported using illicit drugs (categories were not mutually exclusive). Based on the severity of their disorder, 70% of patients who screened positive were recommended for brief intervention (BI), 14% were recommended for brief treatment (BT), and 16% received a referral to specialty treatment (RT). Protocols for each treatment varied across sites. Ten percent of patients who screened positive were randomly selected for reassessment 6 months later.

• Self-reported rates of heavy alcohol use and illicit drug use had decreased by 39% and 68%, respectively.

• Self-reported rates of overall and mental health, employment, housing status, and criminality among persons receiving BT or RT improved significantly.

Comments:

These data provide clear evidence of the feasibility of implementing federally funded SBIRT programs across diverse settings and patient populations. Although the decreases observed across all substances are striking, it is unclear to what extent self-reported improvements reflected true changes in patterns of use rather than participants’ desire to give the perceived correct answer at follow-up. It is also unclear whether the improvements can be attributed to the SBIRT process itself. Because only those participants who screened positive were selected for follow-up, possible increases in drug use among persons not using at baseline were not detec-ted. These findings suggest randomized controlled trials of SBIRT for illicit drug use are needed to further test the efficacy of this promising intervention.

Marc N. Gourevitch, MD, MPH

Reference:

Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99(1–3):280–295.