SBIRT: screening, brief intervention and referral to treatment
SBIRT is the public-health framework most behavioral health and primary care programs use to organize substance use screening. It has three stages — a brief validated screen for everyone, a short motivational conversation for anyone who screens positive, and a warm referral for the smaller group with likely dependence. The tools below map onto those stages, and every one of them is free to use.
Choosing a screening tool by stage
The single most common mistake is starting with a long instrument. Universal screening should take under three minutes; depth is added only for the patients whose brief screen is positive. In practice that means a prescreen (single-item or CAGE-AID), a brief severity screen (DAST-10, AUDIT-C or full ASSIST), then a comprehensive assessment (ASI-Lite) for treatment planning, followed by repeated monitoring (BAM) once someone is in care.
| Stage | Instrument | Items | Time | Scoring cut-off |
|---|---|---|---|---|
| Prescreen | CAGE-AID | 4 | 1-2 min | 1+ yes = positive; 2+ strongly suggests a disorder |
| Brief screen (drugs) | DAST-10 | 10 | 2-3 min | 1-2 low, 3-5 moderate, 6-8 substantial, 9-10 severe |
| Brief screen (alcohol) | AUDIT-C | 3 | 1 min | 4+ men, 3+ women = positive |
| Brief screen (all substances) | WHO ASSIST | 8 per substance | 5-10 min | Per substance: 0-3 low, 4-26 moderate, 27+ high risk |
| Full assessment | ASI-Lite | 111 | 30-45 min | Composite scores per life domain; no single total |
| Ongoing monitoring | BAM | 17 | 3-5 min | Use risk and protective subscale trends, not a total |
What a positive screen should trigger
- Low risk: reinforce and rescreen annually, or at any new clinical concern.
- Moderate risk: deliver a 5-15 minute brief intervention using motivational interviewing, then repeat the screen in 4-6 weeks to see whether use is moving.
- High risk or likely dependence: complete a comprehensive assessment (ASI-Lite), assess withdrawal risk, and make a same-visit warm handoff rather than handing over a phone number.
- Any positive drug screen: also screen for depression, PTSD and suicidality — over half of substance use presentations carry a co-occurring condition, and untreated co-occurrence is the strongest predictor of early return to use.
- Opioid involvement: discuss naloxone at the same visit, and document the offer.
Interpreting DAST-10 scores in practice
The DAST-10 asks about the past 12 months and deliberately excludes alcohol and tobacco, so it is normal for a patient to score 0 on the DAST-10 and still screen positive on the AUDIT-C. Score one point per 'yes', except item 3 ('Are you always able to stop using drugs when you want to?'), which is reverse scored — a 'no' earns the point. Missing that reversal is the most common scoring error we see.
A score of 3 is not a diagnosis. It means the probability of a drug use disorder is high enough that a structured assessment is warranted, and DSM-5 criteria should be reviewed directly with the patient.
| Score | Degree of problem | Suggested action |
|---|---|---|
| 0 | No problems reported | Reinforce; rescreen annually |
| 1-2 | Low level | Brief advice; rescreen in 6-12 months |
| 3-5 | Moderate | Brief intervention plus further assessment |
| 6-8 | Substantial | Intensive assessment; consider specialty referral |
| 9-10 | Severe | Intensive assessment and specialty treatment |
How often to rescreen
Screening once at intake tells you who to admit; repeated measurement tells you whether treatment is working, and it is what payers increasingly ask to see. A workable default is a brief screen at intake, a monitoring measure (BAM) every 2-4 weeks during active treatment, then monthly through the first 90 days after discharge — the window in which most returns to use occur.
Because scores only become useful as a trend line, keep the same instrument across time points. Switching from DAST-10 to ASSIST mid-episode makes the change in a patient's score uninterpretable.
The workflow end to end
1. Universal screen
Every patient at intake and annually. CAGE-AID or a single-item screen, plus AUDIT-C for alcohol.
2. Brief severity screen
Anyone positive gets DAST-10 or the full ASSIST, so intervention intensity matches risk.
3. Brief intervention
5-15 minutes of motivational interviewing, delivered in the same visit while the patient is present.
4. Referral to treatment
Warm handoff for high-risk scores, with the appointment made before the patient leaves.
5. Ongoing monitoring
BAM or a repeat brief screen at set intervals, charted as a trend for the treatment team and for payers.
Codes commonly used for screening and brief intervention
99408 / 99409
Alcohol and/or substance abuse structured screening and brief intervention, 15-30 min / over 30 min (commercial).
G0396 / G0397
Alcohol and/or substance misuse structured assessment and brief intervention, 15-30 min / over 30 min (Medicare).
H0049 / H0050
Alcohol and/or drug screening and brief intervention, per 15 minutes (many state Medicaid programs).
96160 / 96161
Administration of a patient-focused or caregiver-focused health risk assessment instrument, with scoring and documentation.
Coverage and documentation requirements vary by payer and state. Confirm with your payer before billing.
Related tools and guides
DAST-10 free download
Printable form with the reverse-scored item marked.
CAGE-AID free download
Four-item prescreen covering alcohol and drugs.
AUDIT and AUDIT-C downloads
Alcohol screening at full and short length.
ASI-Lite free download
Seven-domain structured interview for treatment planning.
Alcohol screening hub
AUDIT, AUDIT-C, CAGE and cut-offs by sex.
Relapse and return-to-use detection
How repeated scores surface early warning signs.
HEDIS measure mapping
Which substance measures feed IET, FUA and AOD reporting.
References
- Skinner HA. The Drug Abuse Screening Test. Addictive Behaviors. 1982;7(4):363-371.
- WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183-1194.
- Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse (CAGE-AID). Wisconsin Medical Journal. 1995;94(3):135-140.
- McLellan AT et al. The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment. 1992;9(3):199-213.
- Cacciola JS et al. Development and initial evaluation of the Brief Addiction Monitor (BAM). Journal of Substance Abuse Treatment. 2013;44(3):256-263.
- SAMHSA. Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment. TAP 33.
Educational information for clinicians. Screening results are not a diagnosis and do not replace clinical assessment. If you or someone you know is in crisis, call or text 988 for the Suicide & Crisis Lifeline.