SBIRT (screening, brief intervention and referral)

Domain VI · Brief, integrative, trauma, hypnosis & coaching

What it is

SBIRT is a public-health service model, not a single therapy: a standard way of finding people whose alcohol or drug use puts them at risk (screening), responding in proportion to that risk (no action, brief advice, brief intervention, brief treatment), and connecting the small high-risk group to…

Format

• Format: decide who administers (self-report on paper or tablet, or interview), where results are recorded, which tools you use, your referral list and who does follow-up.
• For a psychotherapist: build a prescreen into every intake form and re-screen at least annually and when presentation changes; keep a current, checked list of local specialist services, withdrawal management, mutual-help groups and harm-reduction services.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• drop-out after the first appointment; see 5.7.
• abstinent people in recovery: congratulate and keep vigilance in view.
• accept every answer without arguing; do not "correct" the good things.
• under-reporting when drink sizes are vague; show a standard-drink chart.
• a plan that is really your plan; set realistic expectations and a review date.

Problems the guide addresses

• Client declines screening or the conversation
• Minimising, under-reporting or denial
• Resistance and negative reactions to feedback
• Stuck: low readiness across several contacts
• Non-adherence: goal not met
• Cannot moderate
• Declines referral or drops out of treatment
• Overwhelm, shame or distress during the BI
• Possible physical dependence and withdrawal
• Client attends intoxicated

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.