July 2012

SBIRT at a Glance

Screen Patients

Screening quickly assesses the 

severity of substance use and 

identifies the appropriate level of 

treatment. Screenings take place in 

trauma centers, emergency rooms, 

community clinics, health centers, 

dental clinics, and school clinics.

Screening can be done through one 

to five pre-screen questions based 

on evidence from NIDA and NIAAA.

Conduct Brief Intervention

and Brief Therapy

Brief Intervention and Brief 

Therapy use motivational 

interviewing techniques to 

increase a person’s awareness of 

substance use and encourage 

changes in behavior.

Refer to Treatment

Referral to treatment offers access 

to specialty care for individuals who 

are in need of treatment for 

substance abuse.

Screening, Brief Intervention, and

Referral to Treatment (SBIRT)

A Comprehensive Public Health Approach

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive

public health approach for delivering early intervention and treatment services to 

people with, or at risk of developing, substance use disorders. Healthcare providers 

using SBIRT ask patients about substance use during routine medical and dental 

visits, provide brief advice, and then, if appropriate, refer patients who are at risk of 

substance use problems 

to treatment. Release of 

the Institute of Medicine 

report Broadening the 

Base of Treatment for 

Alcohol Problems1

provided recognition that 

alcohol and drug abuse 

occur along a continuum 

of both level of 

consumption and 

consequences. This recognition is illustrated by a treatment pyramid (shown above) 

that has been developed to depict the role of SBIRT in addressing needs across the 

continuum of use.

Studies show the need for a tool such as SBIRT:

Results of the most recent National Survey on Drug Use and Health (NSDUH) 

show that an estimated 22.1 million people aged 12 or older have a 

diagnosable alcohol or illicit drug use disorder.2

In 2010, according to NSDUH, 8.1 percent of the population aged 12 or older –

about 20.5 million people – needed but did not receive substance use 

treatment at a specialty facility in the past year.

3

In 2006, excessive drinking cost the United States $223 billion.4Factoring in 

public health, public safety, and lost productivity, illicit drug use cost the 

Nation an estimated $193 billion in 2007.

5

Elements of SBIRT

Healthcare practitioners have the important responsibility of looking after their 

patients’ general health and welfare. In this role, they must be vigilant in identifying 

a host of potential health problems. It is critical, therefore, to focus resources and 

efforts on expanding the continuum of care health practitioners provide for their patients.

http://www.samhsa.gov

FACT SHEET

Office of National Drug Control Policy (ONDCP)

Substance Abuse and Mental Health 

Services Administration (SAMHSA)

Step 1

Steps

2 and 3

Step 4
July 2012

With SBIRT, substance abuse screening is incorporated into mainstream healthcare settings, such as college health 

clinics, hospitals, trauma centers, and dental clinics, as well as into tribal and military healthcare settings. Practitioners 

screen patients to assess substance use, then, based on the screening results, provide the appropriate intervention.

SBIRT is a four-part process:

Universal screening assesses substance use and identifies people with substance use problems.

Brief intervention is provided when a screening indicates moderate risk. Brief intervention utilizes motivational 

interviewing techniques focused on raising patients’ awareness of substance use and its consequences and 

motivating them toward positive behavioral change.

Brief therapy continues motivational discussion for persons needing more than a brief intervention. Brief 

therapy is more comprehensive and includes further assessment, education, problem solving, coping 

mechanisms, and building a supportive social environment.

Referral to treatment provides a referral to specialty care for persons deemed to be at high risk.

A key aspect of SBIRT is the integration and coordination of screening, early intervention, and treatment components 

into a system of care. This system links community health care and social service programs with specialty treatment 

programs. In each of the SBIRT grantee programs, healthcare professionals and clinical support staff conduct universal 

screening that targets risky to harmful use, thereby helping to reduce the number of people who move from substance 

use to addiction.

History of the Federal SBIRT Program

In 2003, the Federal Government established the SBIRT grantee program within the Substance Abuse and Mental Health 

Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment to implement SBIRT services in primary 

care and community health settings 

for adults with substance use 

disorders6(see grantee map at

right). To date, SAMHSA has fully or 

partially funded four portfolios for 

SBIRT grantees: (1) SBIRT 

Cooperative Agreements to Single 

State Authorities (SSAs) for 

Substance Abuse Services; (2) SBIRT 

implementation on college 

campuses; (3) a pilot project for 

SBIRT implementation within 

Federally Qualified Health Centers 

(FQHCs); and (4) SBIRT 

implementation within medical 

residency programs. These realworld implementations build on 

findings of more than 100 research 

studies conducted over the past 30 

years that have supported 

development of reliable screening 

tools, empirically proven brief 

interventions, and implementation and technology transfer research.

Effectiveness of SBIRT

Research on SBIRT’s effectiveness for alcohol and drug problems indicates the approach clearly leads to short-term 

health improvements and, though not fully demonstrated, may also yield substantial long-term benefits.7,8 One study 

found that, in some instances, a brief motivational intervention appears to facilitate abstinence from heroin and cocaine 

use at a 6-month follow-up interview, even in the absence of specialty addiction treatment.9
July 2012

Data from SAMHSA grant programs10 help demonstrate the impact of SBIRT on patient health through documented:

Reduction in alcohol and drug use 6 months after receiving intervention (41 percent of respondents reported 

abstinence from drugs and/or alcohol at follow-up, compared to just 16 percent at baseline);

Improvement in quality-of-life measures, including employment/education status, housing stability, and 30-day 

past arrest rates (95 percent of respondents reported no arrests in the past 30 days at follow-up, compared to 

88 percent at baseline); and

Reduction in risky behaviors, including fewer unprotected sexual encounters (injection drug use decreased from 

3.2 percent at baseline to 1.5 percent at follow-up).

SBIRT also reduces the time and resources needed to treat conditions caused or worsened by substance use, making our 

health systems more cost-effective.

11 For example, participants in the Washington State Screening, Brief Intervention, 

and Referral to Treatment (WASBIRT) program who received a brief intervention experienced a reduction in total 

Medicaid costs ranging from $185-$192 per month. Participants admitted as hospital inpatients after emergency 

department visits saw reductions in associated costs ranging from $238-$269 per month.12

Seeking Local Solutions

State and local level actions:

Healthcare professionals can learn screening techniques to identify patients with, or at risk for, substance use 

problems and talk to them about consequences and behavioral change. To learn more about SBIRT, visit 

www.integration.samhsa.gov/clinical-practice/sbirt.

More training can be made available to primary healthcare providers and staff to ensure fidelity to evidencebased practices such as SBIRT. Training and webinars on SBIRT are available at 

www.integration.samhsa.gov/clinical-practice/sbirt.

Parents can talk to their children about the consequences of alcohol and illicit drug use. Advice and information 

about teen drug use is available online at http://www.theantidrug.com.

Community anti-drug coalitions can apply for Federal grants through ONDCP’s Drug Free Communities Support 

Program (http://www.whitehouse.gov/ondcp/drug-free-communities-support-program). 

Codes for Reimbursable SBIRT Services

The chart below lists codes approved by the American Medical Association (CPT Codes) and the Centers for Medicare 

and Medicaid Services (G and H Codes) to be used by healthcare practitioners for reimbursable SBIRT services.13

Payer Code Description

Commercial

Insurance

CPT 99408 Alcohol and/or substance abuse structured screening and brief 

intervention services; 15 to 30 minutes

CPT 99409 Alcohol and/or substance abuse structured screening and brief 

intervention services; greater than 30 minutes

Medicare

G0396 Alcohol and/or substance abuse structured screening and brief 

intervention services; 15 to 30 minutes

G0397 Alcohol and/or substance abuse structured screening and brief 

intervention services; greater than 30 minutes

Medicaid

H0049 Alcohol and/or drug screening

H0050 Alcohol and/or drug service, brief intervention, per 15 minutes
July 2012

Resources for Codes for Reimbursable SBIRT Services

Private Insurance

More information about Current Procedural Terminology (CPT) codes for private insurance is available from 

SAMHSA at http://www.samhsa.gov/prevention/SBIRT/index.aspx

Medicare and Medicaid

More information about Medicare and Medicaid G and H codes is available from SAMHSA at

http://www.samhsa.gov/prevention/SBIRT/index.aspx and from the Centers for Medicare & Medicaid Services 

at http://www.cms.gov/.

More information on Codes for Reimbursable SBIRT Services is available from the Medicare Learning Network at 

http://www.cms.gov/MLNgeninfo/.

Physicians

AMA Healthier Life StepsTM: Coding for Routine Adult Lifestyle Screening, Early Intervention, and Motivational 

Interviewing, published in cpt Assistant: Your practical guide to current coding (2009), is available online from 

the American Medical Association at http://www.ama-assn.org/ama1/pub/upload/mm/433/cpt-assistant.pdf.

Other SBIRT Resources

To learn more about substance use and SBIRT, visit the websites for SAMHSA (www.samhsa.gov) and 

the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at www.niaaa.nih.gov.

Screening for Drug Use in General Medical Settings: Quick Reference Guide, National Institute on Drug 

Abuse, 2009. Available online at http://m.drugabuse.gov/sites/default/files/files/screening_qr.pdf

Screening for Drug Use in General Medical Settings: A Resource Guide for Providers, National Institute on Drug 

Abuse. Available online at www.nida.nih.gov/nidamed/resguide/resourceguide.pdf

The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), developed by the World Health 

Organization (WHO), is designed to help healthcare providers detect and manage substance use and related 

problems in primary and general medical care settings. More information about this screening tool is available 

on WHO’s website at http://www.who.int/substance_abuse/activities/assist/en/

Wisconsin created a coding, billing, and reimbursement guide 

(http://www.wiphl.com/uploads/media/SBIRT_Manual.pdf)

Notes

 

1

Institute of Medicine. 1990. Broadening the Base of Treatment for Alcohol Problems: Report of a Study by

a Committee of the Institute of Medicine, Division of Mental Health and Behavioral Medicine.

Washington, DC: National Academy Press.

2

Substance Abuse and Mental Health Services Administration, 2011. Results from the 2010 National Survey on Drug Use and Health: Volume 1. Summary of National

Findings. DHHS Publication No. SMA 10-4856.

3

Substance Abuse and Mental Health Services Administration, 2011. Results from the 2010 National Survey on Drug Use and Health: Volume 1. Summary of National 

Findings. DHHS Publication No. SMA 10-4856.

4

Bouchery, E., Harwood, H., Sacks, J., Simon, C., Brewer, R. (2011). Economic Costs of Excessive Alcohol Consumption in the U.S., 2006. American Journal of 

Preventive Medicine, 41(5), 516-524.

5

National Drug Intelligence Center (2011). The Economic Impact of Illicit Drug Use on American Society. United States Department of Justice. Retrieved from 

http://www.justice.gov/ndic/

6

SAMSHA FY 2011 Request for Applications (RFA), Cooperative Agreements for Screening, Brief Intervention and Referral to 

Treatment (Short Title: SBIRT), Initial Announcement, Request for Applications (RFA) No. TI-11-005.

Posting on Grants.gov: March 30, 2011, http://www.samhsa.gov/grants/2011/ti_11_005.aspx

7

Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT): Toward a public health approach 

to the management of substance abuse. Substance Abuse,2007. 28(3): 7-30.

8 Madras B., Compton W., Avula D., Stegbauer T., Stein J., & Clark H.W. (2009). Screening, brief intervention, referral to treatment (SBIRT) for illicit drug and alcohol 

use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence, 99 (1-3), 280-295. doi: 10.1016/j.drugalcdep.2008.08.003.

9

Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, & S., Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin 

use. Drug and Alcohol Dependence, 77, 49-59.

10 Unpublished data from SAMHSA's Services Accountability Improvement System, July 2012.

11 Estee, S., He, L., Mancuso, D., & Felver, B.(2006).Medicaid cost outcomes.Department of Social and Health Services, Research and Data Analysis Division: Olympia, 

Washington.

12 Estee, S., Wickizer, T., He, L., Shah, M.F., Mancuso, D. (2010). Evaluation of the Washington State screening, brief intervention, and referral to treatment project: 

cost outcomes for Medicaid patients screened in hospital emergency departments. Medical Care, 48(1), 18-24.

13 Substance Abuse and Mental Health Services Administration, 2011. Retrieved from http://www.samhsa.gov/prevention/SBIRT/coding.aspx
July 2012

Office of National

Drug Control Policy

www.WhiteHouse.gov/ONDCP