Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice designed to identify risky alcohol and drug use, provide brief motivational intervention to change and, if necessary, refer for additional intervention through treatment. Used primarily with adults, SBIRT has been more recently applied to identify and prevent risky substance use among adolescents. Decades of research has indicated that SBIRT and other screening and brief interventions are effective in reducing substance abuse.
One screening and brief intervention model designed specifically for providing integrated prevention AND wellness involves Screening, Feedback, Goal-setting, and Follow-up (SFGF). SFGF includes screening current health habits of individuals, providing feedback and positive image communication, setting multiple behavior goals for improvement, and offering follow-up strategies and support. SFGF was developed to provide universal substance use prevention with health promotion, and has more recently been applied for youth and adults in substance abuse recovery.
Both SBIRT and SFGF are similar in their use of screening and provision of brief intervention. However, these two evidence-based practices models also have key differences. We compare the two approaches and discuss their similarities and differences below, as well as provide recommendations for future use.
SBIRT: Screening in SBIRT is conducted for the purpose of identifying at-risk or high-risk substance users. Typically screening is conducted on a single risk behavior, primarily alcohol or tobacco use. The aim of SBIRT is to identify, reduce and prevent problematic use, abuse and dependence on alcohol or drugs.
SFGF: Screening in SFGF is done for the purposes of assessing a range of current health behaviors, as well as to provide data for customizing positive behavior and image feedback and goal setting for participants. Screening is conducted on both health risk (i.e., substance use) and health enhancing behaviors, such as alcohol, tobacco and marijuana use, physical activity, healthy eating, sleep and stress management. The aim of SFGF is to prevent and reduce substance use while at the same time increase health enhancing behaviors and positive self-images of participants.
SBIRT: Brief intervention in SBIRT is designed to change participant behavior by increasing insight and awareness regarding substance use. It can last a few minutes to several sessions depending upon the risk level of the participant, and is usually unstructured. Feedback emphasizing substance abuse risks is provided based on a participant’s risk score, followed by advice to reduce or avoid use. Behavior change skills may be taught to limit negative consequences of use. Those identified as “high-risk” are provided with a referral for further care.
SFGF: In SFGF personalized feedback is provided to participants to influence multiple risk behaviors through positive image awareness. It typically consists of a single session lasting 30-50 minutes, and uses a scripted protocol to enhance ease and fidelity. Based on screening responses, participants are provided with positive feedback for engaging in each healthy behavior and avoiding each substance use behavior. Feedback for non-healthy habits is neutral (i.e., non-negative) and encouraging.
In addition to feedback, SFGF provides participants with positive image and behavior messages. Positive images are triggered using vivid, gain-framed content modeling peers and future selves experiencing positive image outcomes from participating in each health enhancing behavior. Then, loss-framed messages illustrate how each substance use behavior interferes with individual healthy behaviors and produces opposing negative behavior and image effects. Together, this content highlights how each of the substance use behaviors is associated with and influences each of the healthy behaviors.
SBIRT: Part of the brief intervention in SBIRT may involve encouraging participants to set goals to reduce substance use. This typically involves helping participants identify specific steps in achieving those goals.
SFGF: Goal setting in SFGF is designed to develop self-regulation skills to set and monitor concrete goals to improve both health enhancing and risk behaviors to achieve desired positive images in the future. In addition, participants make a public commitment to their goals, strengthening their resolve to revise and achieve multiple goals over time.
Referral to Treatment/Follow-up:
SBIRT: Those identified at “high-risk” using SBIRT are referred for an advanced treatment option. This care is typically provided by specialized addiction treatment programs. Participants are helped to select and access a treatment program, and navigate any barriers such as cost or transportation which would prevent them from receiving treatment in a specialized setting.
SFGF: Following up with participants in SFGF is designed to reinforce image awareness and image-behavior linkages, and support motivation and action to continue to set and monitor multiple health behavior improvement goals in the future. Follow-up strategies vary, including providing participants with additional sessions targeting other critical health behaviors or presenting more in-depth information about targeted health habits, repeating booster interventions, offering participants opportunities to review and revise goal plans, or using new communication channels such as providing print materials or web-based resources.
Both SBIRT and SFGF are evidence-based practices models that can be used to prevent substance abuse among youth and adults. Both models emphasize screening and brief intervention for participants.
Key differences exist between these two practices due in part to their underpinning conceptual models. SBIRT is based on the Transtheoretical Model of Change and Motivational Interviewing, while SFGF is founded on the Behavior-Image Model.
Because of these theoretical differences, SBIRT typically focuses on influencing a single substance use behavior, and employs primarily risk-based communication. SBFG, on the other hand, emphasizes connecting and influencing both substance use risk habits and healthy behaviors simultaneously to enhance overall well-being through positive image awareness and multiple behavior goal setting.
Structural differences in these two practices include the open-ended approach of SBIRT which emphasizes screening for the purpose of mitigating substance abuse among “at-risk” youth and adults. SFGF, however, uses a structured strategy designed to provide a universal, holistic prevention with wellness intervention for all youth and adults, but has also been used with high risk individuals including youth and adults in recovery and treatment.
Lastly, SBIRT is designed to screen and refer “high-risk” individuals into treatment services. SFGF, however, focuses on reinforcing brief intervention with follow-up booster content and experiences aimed at supporting and extending initial intervention effects.
Health and substance abuse providers and parents have two evidence-based practices models emphasizing screening and brief intervention for preventing substance use and promoting health. One of these practices may be selected over another based upon specific organizational or individual goals, setting and population needs. However, both approaches can also be used together to enhance prevention and health outcomes for participants.
We recommend experimenting with applying both SBIRT and SFGF concurrently. Below are few possibilities:
1) SFGF can be used as a universal prevention and health practice for all adolescents and young adults, followed by SBIRT for those higher-risk youth groups which may need more in depth substance abuse intervention and even referral to treatment.
2) SFGF could be implemented to a target population of youth or adults, and SBIRT could be implemented as a follow-up strategy for all participants to strengthen the substance abuse prevention effects.
3) SBIRT can be implemented to identify “at-risk” youth or adults, who can then receive SFGF to improve health enhancing behaviors and overall well-being.
4) SBIRT and SFGF could be integrated into a single practice model. This approach would involve adding each element of both models into a somewhat longer, more comprehensive strategy involving enhanced screening of health behaviors; brief intervention entailing feedback and content including risks and positive image awareness; multiple behavior goal setting; and follow-up sessions along with referral to substance abuse treatment as needed.
Only future experimentation with SBIRT and SFGF in varied settings and with differing populations will determine how these two similar evidence-based practices models might best be implemented together to improve substance use prevention and wellness promotion. We believe that the use of both practices can enhance the effectiveness of future efforts aimed at preventing substance abuse and promoting the whole health of youth and adults.