Implementing Universal SBIRT in Primary Care: Tools and Resources for Your Practice

SBIRT: Proven and Recommended

SBIRT can easily be used in primary care settings to enable health-care professionals to systematically screen and assist people who may not be seeking help for a substance use problem, but whose alcohol or substance use may cause or complicate their ability to successfully handle health, work or family issues.

SAMHSA-HRSA Center for Integrated Health Solutions

Texas Medicaid covers SBIRT as a payable benefit that can be provided in primary care offices, outpatient hospitals and other locations with patients 10 years and older who have a substance use disorder or are at risk for developing such a disorder. SBIRT provides an opportunity for primary care providers—including obstetricians/gynecologists—to identify substance use and misuse and intervene as part of routine clinical care. Primary care providers are not the only ones who may be reimbursed by Texas Medicaid for delivering SBIRT services. Social workers, counselors, psychologists, hospitals and others may be reimbursed. Find a full list later in this tutorial.

Early intervention and treatment are especially critical for specific sub-populations such as adolescents, pregnant and postpartum women, and patients with a mental health condition.

  • Adolescents

    2018 youth substance use in the U.S. by the numbers:

    Alcohol:

    • Ages 12-17
      • 9 percent use alcohol currently
      • 4.7 percent engaged in binge drinking in preceding month
      • 1.6 percent have alcohol use disorder
    • Ages 18-25
      • 55.1 percent use alcohol currently
      • 34.9 percent engaged in binge drinking in preceding month
      • 10.1 percent have alcohol use disorder

    Illicit substances:

    • Ages 12-17
      • 16.7 percent used illicit substances in past year
      • 2.7 percent have substance use disorder
    • Ages 18-25
      • 38.7 percent used illicit substances in past year
      • 7.6 percent have substance use disorder

    Marijuana use:

    • Ages 12-17: 12.5 percent
    • Ages 18-25: 34.8 percent

    Prescription pain reliever use:

    • Ages 12-17: 2.8 percent
    • Ages 18-25: 5.5 percent

    Opioid use:

    • Ages 12-17: 2.8 percent
    • Ages 18-25: 5.6 percent

    Source: 2018 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019).

    Youth health consequences of substance use:

    • Youth with substance use disorder (SUD) have higher rates of:
      • Physical and mental illnesses: cancer, heart disease, anxiety disorders and major depression (National Institute on Drug Abuse [NIDA], 2020)
      • Diminished overall health and well-being
      • Potential progression to addiction (CDC, 2019)
      • Most adults with a substance use disorder started using substances as teens or young adults (Ibid.)
      • Substance use is associated with risky sexual behavior, experiencing violence, mental health disorders and increased risk of suicide (Ibid.)
  • Pregnant and Postpartum Women

    Perinatal substance use, by the numbers:

    • About 5 percent of pregnant women in the U.S. use one or more addictive substances (National Institute on Drug Abuse ([NIDA], 2020)
    • Overdose was the leading cause of maternal death within 365 days postpartum from 2012-2015 in Texas (Texas Department of State Health Services [DSHS], 2018)
    • Overdose accounted for 17 percent of all maternal deaths in Texas and almost 80 percent of these deaths occurred more than 60 days postpartum (Texas Maternal Mortality and Morbidity Task Force, 2018)

    Consequences of perinatal substance use:

    Identification, intervention and treatment for SUD are critical in the preconception and perinatal periods.

    • Women who use tobacco or marijuana, take prescription pain relievers or use illegal substances during pregnancy can double or triple their risk for stillbirth (NIDA, 2020)
    • Regular use of some substances can cause neonatal abstinence syndrome (NAS), in which the baby experiences physical symptoms of withdrawal due to abrupt discontinuation of substance exposure. While NAS is commonly associated with opioids, other substances such as alcohol, barbiturates, benzodiazepines and caffeine also may lead to NAS (Ibid.)
    • Maternal use of alcohol and tobacco after the first trimester of pregnancy is associated with a twelvefold increased risk for sudden infant death syndrome (SIDS) compared with those unexposed or only exposed to alcohol and smoking in the first trimester of pregnancy (Ibid.)
  • Patients with a Mental Health Condition

    Patients with both SUD and a mental health diagnosis have co-occurring disorders — also called comorbid disorders or dual diagnosis. It is important to note that symptoms of substance use and mental health diagnoses may overlap, which can make it difficult to determine the primary cause until substance use has been discontinued.

    According to the Child Mind Institute, the Center on Addiction in collaboration with Partnership for Drug-Free Teens (2019):

    If untreated, mental health disorders can pose serious risks for problematic substance use. Similarly, substance use poses a serious risk for developing a mental health disorder in the future. Helping to identify risk factors and protective strategies early on can help prevent these problems.

    Youth with mental health diagnoses often self-medicate with substances. Untreated, co-occurring disorders increase risk for self-harm (Ibid.).

    Co-occurring disorders by the numbers for U.S. youth:

    • 65 percent or more of youth with SUD also have a mental health disorder.
    • 30–45 percent of youth with mental health disorders have a co-occurring SUD.
    • One in five adolescents has a mental health disorder. The most common are anxiety disorders, depression and attention-deficit hyperactivity disorder (ADHD).

    Source: Child Mind Institute and Center on Addiction in collaboration with Partnership for Drug-Free Teens (2019)

SBIRT can reduce health-care costs and promote timely treatment

Untreated SUDs are associated with health complications and substantial costs related to illness, injury, hospitalization and premature death. According to SAMHSA (n.d.), SBIRT can:

  • Reduce health-care costs:
    • Every dollar spent on SBIRT reduces health-care costs by $3.81 to $5.60.
    • Those who receive screening and brief intervention in an emergency department, hospital or primary care office have:
      • 20 percent fewer emergency department visits
      • 33 percent fewer nonfatal injuries
      • 37 percent fewer hospitalizations
      • 46 percent fewer arrests
      • 50 percent fewer motor vehicle crashes
  • Reduce severity of alcohol and other substance use:
    • Screening and intervention help people recognize and change unhealthy patterns of use.
    • Screening and intervention was the most effective treatment method of the more than 40 treatment approaches studied, particularly among groups of people not actively seeking treatment.
  • Reduce risk for trauma and percentage of at-risk patients with no substance use treatment:
    • Reductions in alcohol consumption
    • Successful referral to and participation in alcohol treatment programs
    • Reduction in repeat injuries and injury hospitalizations

Need to Know

SBIRT is endorsed for use in primary care by leading medical associations and health-care organizations, including:

  • U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)
  • American Academy of Pediatrics (AAP)
  • American College of Obstetricians and Gynecologists (ACOG)
  • American Society of Addiction Medicine (ASAM)
  • U.S. Preventive Services Task Force (USPTF)