APNA Position: Adoption of Screening, Brief Intervention, and Referral and Treatment (SBIRT)

Introduction

Over the past three decades, research has consistently demonstrated the effectiveness of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in reducing adverse health outcomes related to alcohol, tobacco, and drug use. SBIRT is a “comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders” (SAMHSA, November 2024). The American Psychiatric Nurses Association (APNA) strongly endorses the integration of this evidence-based approach into all healthcare settings.

Discussion

Preventing disease and reducing harm associated with mental health and substance use disorders is central to the practice of psychiatric-mental health nursing. Screening for high-risk behaviors such as substance use, along with appropriate assessment and referral, is a critical component of nursing care. This aligns with the Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA, APNA, ISPN, 2022).

The Centers for Disease Control and Prevention (CDC) reports that tobacco use continues to be the leading cause of preventable death, claiming more than 480,000 lives annually and costing the U.S. over $600 billion in healthcare and lost productivity (CDC, 2024). Furthermore, the economic burden of substance use disorders in the U.S. exceeds $1 trillion annually, covering healthcare costs, lost productivity, and criminal justice expenses (White House Office of National Drug Control Policy, 2022). According to the most recent National Survey on Drug Use and Health (SAMHSA, 2024):

• Approximately 48.7 million people aged 12 or older had a substance use disorder.
• Over 29.5 million had an alcohol use disorder.
• Roughly 27.2 million had a drug use disorder.
• Nearly 9 million people were living with co-occurring mental illness and substance use disorders.

These statistics highlight the urgent need for all healthcare professionals, including nurses, to be equipped with the tools necessary for screening, early intervention, and appropriate referral for treatment.

According to Finnell, et al (2014), nurse-delivered SBIRT should be embraced as part of standard nursing practice. There is extensive evidence supporting the effectiveness of SBIRT, including randomized controlled trials, systematic reviews, and field studies. Leading health agencies such as the CDC, National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommend implementing SBIRT in all clinical settings.

The National Academies of Sciences, Engineering, and Medicine (NASEM, 2021) advocates for nurses to practice to the full extent of their education and training. SBIRT represents a significant opportunity for nurses to expand their impact in public health and prevention. It also provides psychiatric-mental health nurses, whether RNs or APRNs, with the chance to lead education and implementation efforts, teaching SBIRT strategies to non-psychiatric colleagues and interdisciplinary teams. Additionally, advanced practice nurses can submit for reimbursement in eligible states, per the Centers for Medicare and Medicaid Services (CMS) (SAMHSA, April 2024). The Joint Commission (2024) has also established quality metrics supporting the use of SBIRT for performance-based reimbursement.

Position

It is the position of the American Psychiatric Nurses Association (APNA) that the widespread adoption of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in nursing practice can standardize early identification and intervention, ultimately reducing population-level risks related to alcohol, tobacco, and drug misuse. APNA strongly supports the integration of SBIRT in all healthcare settings. With a substantial body of supporting evidence, SBIRT represents an effective, nurse-led intervention that can significantly improve health outcomes. Psychiatric-mental health nurses are uniquely positioned to apply and advocate for this model across care settings, ultimately benefiting patients, families, healthcare teams, and communities.

Conclusion

There continues to be an urgent need for all healthcare professionals, including nurses, to be equipped with the tools necessary for substance use disorder screening, early intervention, and appropriate referral for treatment. SBIRT is an approach backed by decades of research and nurses are in a prime position to lead and expand its use across health care settings in order to improve health outcomes.

Approved by the APNA Board of Directors September 2012; revised June 2020, October 2025

This position was also published in the Journal of the American Psychiatric Nurses Association (JAPNA).

APNA Position: Adoption of Screening, Brief Intervention, & Referral to Treatment. Journal of the American Psychiatric Nurses Association. 2025;32(1):82-83. doi:10.1177/10783903251401867

References

American Nurses Association, American Psychiatric Nurses Association, International Society of Psychiatric-Mental Health Nurses. (2022). Psychiatric-Mental Health Nursing: Scope and Standards of Practice (3rd ed.). American Nurses Association

Centers for Disease Control and Prevention. (2024). Burden of Cigarette Use in The U.S.: Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older. https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html

Finnell, D. S., Nowzari, S., Reimann, B., Fischer, L., Pace, E., & Goplerud, E. (2014). Screening, brief intervention, and referral to treatment (SBIRT) as an integral part of nursing practice. Substance Abuse, 35(2), 114-118.

National Academies of Science, Engineering, and Medicine. (2021). The Future of Nursing 2020-2023. Charting a Path to Achieve Health Equity. The National Academies Press.

National Institute on Drug Abuse. (2024). Drug Use Trends and Statistics. https://nida.nih.gov

National Institute on Drug Abuse. (2024, August 21). Drug overdose deaths: Facts and figures. Retrieved April 11, 2025, from https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates

Substance Abuse and Mental Health Services Administration. (April 2024). Coding for Screening and Brief Intervention Reimbursement. Retrieved from https://www.samhsa.gov/substance-use/treatment/sbirt/coding

Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (PEP24-07-021). Retrieved from https://library.samhsa.gov/product/2023-nsduh-report/pep24-

Substance Abuse and Mental Health Services Administration. (November 2024). Screening, Brief Intervention, and Referral to Treatment (SBIRT). Retrieved from https://www.samhsa.gov/substance-use/treatment/sbirt

The Joint Commission. (2024). Specifications Manual for National Hospital Inpatient Quality Measures (Version 2024B). https://manual.jointcommission.org/releases/TJC2024B/

White House Office of National Drug Control Policy. (2022). National Drug Control Strategy. https://www.whitehouse.gov/ondcp