SBIRT Assessment

SBIRT Assessment

This tool is designed for healthcare providers, counselors, or peer support specialists to screen for substance use, conduct a brief intervention, and provide referrals to treatment when necessary. It follows the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model (SAMHSA, 2017).

1. Screening

Purpose

Identify individuals at risk for substance use disorders using validated screening tools (Babor et al., 2001; Skinner, 1982).

Standard Drink Reference

Before screening, ensure the individual understands what constitutes a standard drink (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2020). Below are visual representations of each standard drink:

Screening Questions

Use the AUDIT-C (Alcohol Use Disorders Identification Test - Consumption) for alcohol screening and the DAST-10 (Drug Abuse Screening Test) for drug use screening.

DAST-10 (Drugs)

Ask the following yes/no questions about non-medical drug use in the past year (Skinner, 1982):

1. Have you used drugs other than those required for medical reasons?
2. Do you abuse more than one drug at a time?
3. Do you find it difficult to stop using drugs when you want to?
4. Have you had "blackouts" or "flashbacks" as a result of drug use?
5. Do you ever feel bad or guilty about your drug use?
6. Does your spouse (or parents) ever complain about your involvement with drugs?
7. Have you neglected your family because of your use of drugs?
8. Have you engaged in illegal activities in order to obtain drugs?
9. Have you ever experienced withdrawal symptoms when you stopped taking drugs?
10. Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions)?

Scoring: Count the number of "Yes" answers for all questions.

• 0: No problems reported.
• 1-2: Low level (monitor, brief intervention).
• 3-5: Moderate level (brief intervention, possible referral).
• 6-8: Substantial level (referral to treatment).
• 9-10: Severe level (urgent referral to treatment) (Skinner, 1982).

2. Brief Intervention

Purpose

Engage individuals in a short, motivational conversation to raise awareness of substance use risks and encourage behavior change (Miller & Rollnick, 2013).

Steps for Brief Intervention

Use the FRAMES model (Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy) and talking points from the SBIRT Brief Intervention Card (Miller & Sanchez, 1994).

1. Introduce Yourself and Build Rapport
   • Example: “Thanks for filling out the form. Would you mind taking a few minutes to talk with me about your use of [alcohol/drugs]? Can you tell me a little bit about a day in your life? Where does your use fit in?”
2. Explore Pros and Cons
   • Ask: “Can you help me understand the good things about using [alcohol/drugs]? What are some of the not-so-good things?”
   • Summarize: Reflect the individual’s pros and cons to show understanding.
3. Provide Feedback on Screening Scores
   • Example: “I have some information about the impacts of using [alcohol/drugs], is it okay if I share that with you? Your score suggests [low/moderate/high] risk. This means [explain risks briefly]. What do you think?”
   • Share facts, e.g., health risks of excessive alcohol (liver disease, accidents) or drug use (addiction, mental health issues) (NIAAA, 2020).
4. Assess Readiness to Change
   • Use the Readiness Ruler: Show a scale from 1 (not ready) to 10 (very ready).
   • Ask:
     • “How ready are you to make a change? Why did you choose that number and not a lower one?”
     • “How important is it to you to make a change?”
     • “How confident are you that you can make a change?”
   • Reflect their responses to encourage motivation (Miller & Rollnick, 2013).
5. Summarize and Negotiate an Action Plan
   • Example: “What are some steps you are willing to take to make a change? What and who will support you? What challenges might you face?”
   • Write down specific goals (e.g., reduce drinking to 2 drinks per week, attend a support group).
   • Provide resources and referrals (see below).
6. Express Empathy and Support
   • Example: “I can see this is important to you, and I’m here to support you in taking these steps.”

3. Referral to Treatment

Purpose

Connect individuals with moderate to severe substance use issues to appropriate treatment and support services (SAMHSA, 2017).

Referral Process

• Assess Need: Refer individuals with:
  • AUDIT-C scores ≥7 (men) or ≥6 (women) (Bush et al., 1998).
  • DAST-10 scores ≥3 (Skinner, 1982).
  • Expressed desire for help or inability to reduce use.
• Provide Warm Hand-Offs: Directly connect the individual to a counselor, treatment program, or support service.
• Document: Record the referral details and follow-up plan.

Support Resources

• National Resources:
  • SAMHSA National Helpline: 1-800-662-HELP (4357) (24/7 confidential support in English and Spanish).
  • FindTreatment.gov: Search for local treatment facilities (SAMHSA, 2017). findtreatment.gov
• State-Specific Helplines (all are free, confidential, and available 24/7 unless noted):
  • Alabama: 1-844-307-1760 (Alabama Department of Mental Health)
  • Alaska: 1-800-662-HELP (SAMHSA National Helpline)
  • Arizona: 1-800-662-HELP (SAMHSA National Helpline)
  • Arkansas: 1-800-662-HELP (SAMHSA National Helpline)
  • California: 1-800-662-HELP (SAMHSA National Helpline)
  • Colorado: 1-844-493-8255 (Colorado Crisis Services)
  • Connecticut: 1-800-563-4086 (CT DMHAS)
  • Delaware: 1-800-652-2929 (Delaware Hope Line)
  • Florida: 1-800-662-HELP (SAMHSA National Helpline)
  • Georgia: 1-800-715-4225 (Georgia Crisis and Access Line)
  • Hawaii: 1-800-753-6879 (Hawaii CARES)
  • Idaho: 1-800-662-HELP (SAMHSA National Helpline)
  • Illinois: 1-800-662-HELP (SAMHSA) or 2-1-1 (Illinois United Way)
  • Indiana: 1-800-662-HELP (SAMHSA National Helpline)
  • Iowa: 1-844-430-0376 (Your Life Iowa)
  • Kansas: 1-800-662-HELP (SAMHSA National Helpline)
  • Kentucky: 1-800-662-HELP (SAMHSA National Helpline)
  • Louisiana: 1-877-664-2248 (LA Problem Gambling and Addiction)
  • Maine: 1-800-499-0027 (Maine Crisis Line)
  • Maryland: 1-800-422-0009 (Maryland Crisis Helpline)
  • Massachusetts: 1-800-327-5050 (MA Substance Use Helpline)
  • Michigan: 1-800-662-HELP (SAMHSA National Helpline)
  • Minnesota: 1-800-657-9664 (MN Addiction Helpline)
  • Mississippi: 1-800-662-HELP (SAMHSA National Helpline)
  • Missouri: 1-800-575-7480 (MO Behavioral Health Crisis Line)
  • Montana: 1-800-662-HELP (SAMHSA National Helpline)
  • Nebraska: 1-800-662-HELP (SAMHSA National Helpline)
  • Nevada: 1-800-992-0900 (Nevada Crisis Call Center)
  • New Hampshire: 1-844-711-4357 (NH 211 for substance use)
  • New Jersey: 1-844-732-2465 (NJ Connect for Recovery)
  • New Mexico: 1-855-662-7474 (NM Crisis and Access Line)
  • New York: 1-877-846-7369 or text HOPENY (467369) (OASAS HOPEline)
  • North Carolina: 1-800-662-HELP (SAMHSA National Helpline)
  • North Dakota: 1-800-662-HELP (SAMHSA National Helpline)
  • Ohio: 1-877-275-6364 (Ohio Crisis Line)
  • Oklahoma: 1-800-522-9054 (OK Reach-Out Hotline)
  • Oregon: 1-800-923-4357 (Oregon Lines for Life)
  • Pennsylvania: 1-800-662-HELP (SAMHSA National Helpline)
  • Rhode Island: 1-401-414-5465 (RI BH Link)
  • South Carolina: 1-800-922-1518 (SC DAODAS Helpline)
  • South Dakota: 1-800-662-HELP (SAMHSA National Helpline)
  • Tennessee: 1-855-274-7471 (TN REDLINE)
  • Texas: 1-800-662-HELP (SAMHSA) or 211 (TX HHS)
  • Utah: 1-800-662-HELP (SAMHSA National Helpline)
  • Vermont: 1-800-662-HELP (SAMHSA National Helpline)
  • Virginia: 1-888-732-2247 (VA Behavioral Health Line)
  • Washington: 1-866-789-1511 (WA Recovery Help Line)
  • West Virginia: 1-844-435-7498 (WV First Call for Help)
  • Wisconsin: 1-800-662-HELP (SAMHSA National Helpline)
  • Wyoming: 1-800-662-HELP (SAMHSA National Helpline)
• Local Resources:
  • Identify local addiction treatment centers, counseling services, or peer support groups (e.g., AA, NA). Use findtreatment.gov or contact state helplines for local referrals.

Follow-Up

• Schedule a follow-up appointment to check progress on goals.
• Confirm the individual has accessed referred services.

4. Documentation

Record the following for each SBIRT session:

• Screening scores (AUDIT-C or DAST-10).
• Key points from the brief intervention (pros/cons, readiness ruler score, action plan).
• Referrals provided and follow-up plan.

Notes for Facilitators

• Training: Ensure facilitators are trained in motivational interviewing and SBIRT protocols (Miller & Rollnick, 2013).
• Cultural Sensitivity: Adapt language and approach to the individual’s cultural and personal context.
• Confidentiality: Maintain privacy and comply with HIPAA or local regulations.
• Helpline Verification: Helpline numbers are accurate as of June 10, 2025. Users should verify current contacts, as numbers may change.

References

• Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary care (2nd ed.). World Health Organization.
• Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789–1795. https://doi.org/10.1001/archinte.158.16.1789
• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
• Miller, W. R., & Sanchez, V. C. (1994). Motivating young adults for treatment and lifestyle change. In G. S. Howard & P. E. Nathan (Eds.), Alcohol use and misuse by young adults (pp. 55–81). University of Notre Dame Press.
• National Institute on Alcohol Abuse and Alcoholism. (2020). What is a standard drink? https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink
• Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7(4), 363–371. https://doi.org/10.1016/0306-4603(82)90005-3
• Substance Abuse and Mental Health Services Administration. (2017). SBIRT: Screening, Brief Intervention, and Referral to Treatment. https://www.samhsa.gov/sbirt