Ten years of implementing screening, brief intervention, and referral to treatment (SBIRT): Lessons learned

The US Surgeon General recently issued a comprehensive report indicating that substance use is a major public health concern that must be addressed using a number of strategies. Screening, brief intervention, and referral to treatment (SBIRT) is one such strategy. SBIRT Colorado, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), has implemented a statewide initiative for the past 10 years that has provided ample opportunities to identify key components for successful implementation. Successful implementation requires (1) strong clinical and management advocates; (2) full integration of services into practices' workflow utilizing technology whenever possible; (3) interprofessional team approaches; (4) appropriate options for the small proportion of patients screening positive for a possible substance use disorder; (5) cannabis screening that accounts for legalization, and interventions that acknowledge differences between alcohol and cannabis use; (6) incorporating SBIRT into standard health care professionals' training; and (7) addressing the significant issues regarding reimbursement through private and public payers for SBIRT services. Implementing and sustaining SBI as a standard of integrated care is essential to reduce the burden of substance use. Interdisciplinary approaches, technology, and training to increase practitioner confidence and skill are fundamental.