How to Improve SBIRT to Address Substance Use Disorder

SBIRT (screening, brief intervention, and referral to treatment) is an evidence-based tool to help address the crisis of substance use disorder (SUD).

SBIRT programs have helped medical professionals, social workers, counselors, and community leaders:

• Identify individuals at risk of developing SUD or those with problematic use of substances
• Intervene early in cases of problematic substance use
• Refer them to proper treatment

Given recent study findings from SAMHSA (the U.S. Substance Abuse and Mental Health Services Administration) that 94% of people with a diagnosable SUD did not receive treatment in 2021, identifying and referring people to treatment is more important than ever.

SBIRT is effective against SUD

A five-year study of one million people screened for drug and alcohol found SBIRT effective in reducing alcohol misuse among the participants. The study, conducted by SAMHSA, is one of the most successful examples of how research in the field of addiction science translated to on-ground reality.

Additionally, there is a growing body of evidence that SBIRT can be helpful for risky drug use. Because of this, public health agencies and medical professionals are looking to expand programs across the country.

Leading challenges with SBIRT

SBIRT is an evidence-based way to help tackle the high rates of SUD in the country. However, there are roadblocks to expanding access to more people.

Reasons include:

• Reluctance to get screened; no option to stay anonymous.
  • In many instances, physicians do not believe that patients are honest about their substance use. There is a stigma associated with substance abuse. As a result, some individuals may resist getting screened.
  • Many people with SUD may be uncomfortable during in-person visits because there is no option to stay anonymous. Others may be intimidated in clinical settings when speaking with a physician or another medical professional.
  • Additionally, people may be more reluctant to tell the truth if there are legal or criminal consequences. For example, if they indulge in unauthorized opioid use, drive when drunk, potentially endanger a child or other such instances.
  • Marginalized communities like the LGBTQ+, recent immigrants, tribal communities, or people who are suspicious of the medical community may also be reluctant to disclose their use of substances.
• Limited resources to train more people approved to administer SBIRT. SBIRT is a staged, multi-faceted process that needs trained individuals to screen their communities. Plus, truly effective training involves repetition, constructive feedback loops, and continuous monitoring. Unfortunately, many communities have few resources to train others. Qualified individuals may be too busy with their own practice to teach others. 
• Inconsistent data collection and reporting. In this digital age, having valuable grassroots-level data for communities can help healthcare providers improve their local SBIRT initiatives. This type of analytics can help guide research, funding, on-ground effectiveness, and reporting. But if data collection is inconsistent and inefficient, it is hard to improve overall effectiveness. 
• Financial challenges. As a good start, Medicare covers SBIRT. However, SBIRT is not covered under all insurance and Medicaid programs. Expanded insurance and Medicaid coverage can help as states continue to work on tackling the rising SUD rates in their regions. More funding will go a long way toward easing the financial burden, raising awareness, and expanding the reach of SBIRT.

How can we improve SBIRT programs in the United States?

• Expand SBIRT screening tools at a grassroots level. Until now, SBIRT has been more focused on medical settings. However, better community outreach is needed. Let’s look at an example. The state of New York was recently awarded a five-year SBIRT grant from SAMHSA to implement community outreach models for marginalized populations.
• Improve access to best practices. More than 16 states have implemented formalized programs. SBIRT is research-based and has proven effectiveness against SUD. It helps the healthcare system save $3.81 to $5.60 for each $1 spent. It is also strongly supported by the Federal Government (SAMHSA) and Medicare.
• Select evidence-based screening tools. The National Institute on Drug Abuse offers a wide range of approved and validated evidence-based screening tools for SBIRT.
• Introduce digital options for self-reporting. The mode of administration for screening can make a difference. Instruments that allow people to self-report can perform well. This way, they get the option to stay anonymous and seek help. Additionally, approved assessment tools like the AUDIT-C can be more effective when administered electronically versus through a paper-based form.
• Enhance the ‘brief intervention’ stage. With more funding and awareness, the brief intervention stage can be more than telling people with SUD, “drink less” or “don’t do drugs.” Ideally, SBIRT needs more than one consultation and involves client-centric discussions without judgment or bias. Improving this part of SBIRT requires more skilled professionals, but there is a huge resource gap. Only 15 of the 180 American medical programs teach addiction.
• Remove barriers to finding appropriate treatment and refer patients accordingly. Unfortunately, it can be highly complicated for individuals to find the right treatment for their SUD. The reasons why are multifaceted, but many issues rest on a lack of substantial quantitative information about treatment capacity, resources, and effective methods. Providers and states can benefit the most when they can consistently monitor how many screenings and brief interventions lead to inpatient and outpatient treatment.

A comprehensive, integrated approach to addiction and substance use disorder screening, intervention, and treatment is the best way forward. CHESS Health can help.

CHESS Health offers an evidence-based digital platform to support better SBIRT. Learn more about how CHESS Health can help improve your SBIRT program.