Detection of Populations At-Risk or Addicted: Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Clinical Settings

Alcohol and drug misuse are two of the leading causes of morbidity and mortality in the United States. However, their detection is currently not a routine aspect of medical care in doctor's offices, hospitals, and emergency departments. It has been a longstanding public health goal to ensure that all patients with a substance use problem, or a medical or psychiatric condition related to substance use, have access to clinicians with the knowledge and skills to diagnose and treat their problem, and to refer them for appropriate treatment when necessary.Over 80% of adults have contact with a physician each year, which provides an opportunity to detect these problems, and to intervene. However, clinical training in addressing alcohol and drug misuse is generally not provided in most medical school and residency curricula, even though most physicians regardless of specialty will treat patients with these problems on a daily basis.The purpose of this chapter is to review concepts, knowledge, and skills that clinicians should be familiar with in order to detect substance misuse, and to appropriately intervene and refer patients, regardless of their type of practice or role in health care.