SBIRT in Primary Care: A Practical Guide to Screening for Substance Use

Your Patient With Uncontrolled Blood Pressure May Be Drinking a Bottle of Wine a Night

Most people with a substance use disorder never walk into a treatment center on their own. They do, however, show up in primary care, urgent care, and emergency departments, often for conditions that substance use is quietly driving: hypertension, insomnia, GI complaints, falls, depression. Fewer than one in four people with a substance use disorder receive treatment in a given year. Providers who screen consistently are the single most important bridge across that gap.

What SBIRT Is

SBIRT stands for Screening, Brief Intervention, and Referral to Treatment. It is an evidence-based, public health approach endorsed by the Substance Abuse and Mental Health Services Administration for identifying and addressing risky substance use in general medical settings. The framework is deliberately brief so it can fit into a standard visit.

• Screening uses a validated tool to identify risk level.
• Brief intervention is a short, motivational conversation for patients at moderate risk.
• Referral to treatment connects patients at high risk or with a likely disorder to specialty care.

The Recommendation Behind It

The U.S. Preventive Services Task Force gives a Grade B recommendation to screening adults for unhealthy alcohol use and providing brief counseling, and a Grade B recommendation to screening adults for unhealthy drug use when appropriate services can be offered or referred. In practical terms, universal screening is now standard of care.

Tools That Take Under Two Minutes

• AUDIT-C: three questions on alcohol frequency, quantity, and binge episodes. A score of 4 or more in men or 3 or more in women suggests risky use.
• Single-item drug screen: "How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?" Any answer above zero is a positive screen.
• DAST-10: a ten-item follow-up for positive drug screens that helps gauge severity.

Build the questions into intake paperwork or the rooming workflow so they are asked every time, not just when suspicion is high. Suspicion misses most cases.

The Brief Intervention in Practice

A brief intervention is not a lecture. It follows a motivational interviewing rhythm: ask permission to discuss the results, share the score and what it means, ask what the patient makes of it, explore their own reasons for change, and agree on a next step. Three to five minutes is enough for many patients. For those in the moderate range, it can be repeated at follow-up visits.

When to Refer to Residential Treatment

Refer promptly when a patient:

• Screens in the high-risk range or meets criteria for a moderate to severe substance use disorder
• Uses alcohol or benzodiazepines heavily enough that unsupervised withdrawal poses seizure or delirium risk
• Has failed outpatient attempts or has an unstable home environment
• Has a co-occurring psychiatric condition that complicates outpatient management
• Presents with overdose, injection use, or fentanyl exposure

A warm handoff, where your staff contacts the treatment center while the patient is still in the room, dramatically increases the odds that the referral is completed.

Billing Notes

SBIRT services are billable. Commercial payers commonly recognize CPT codes 99408 and 99409 for alcohol and substance use screening and brief intervention, and Medicaid programs often use HCPCS codes H0049 and H0050. Confirm specifics with your billing team and payers.

A Referral Partner in the Wichita Metro

LifeSpring Recovery of Andover provides medical detox and residential treatment with rapid admissions for referring providers. We accept select KanCare plans, and our admissions team can complete a warm handoff while your patient is still in clinic. Call (316) 348-5571, visit our provider referral page, or review our admission criteria. The screening question you ask today may be the reason a patient gets help this month.