Screening and Brief Intervention (SBI) is a proven method to identify, and intervene with, individuals who are at risk for substance use-related problems or injuries. The goal of SBI is to use systems such as trauma centers/emergency rooms, community clinics, and school clinics to screen patients for at-risk substance use and, if necessary, provide them with a brief intervention or referral to appropriate treatment. By screening people in these settings, it is possible to identify those who have a substance use-related illness or injury that could provide motivation for behavior change.  

Although SBI has been with us for more than ten years, adoption of the practice has been slow. Federal SBIRT grants and new accreditation standards by the American College of Surgeons – Committee on Trauma have added some momentum to SBI adoption in trauma centers and emergency rooms, but primary care and community clinics have lagged behind – despite the fact that hazardous alcohol and substance use play a significant role in disease, injury, and mental illness.  

The need for SBI is clear. The economic cost of hazardous use amounts to more than $375 billion every year and the emotional toll on families and communities is devastating.   The foundation for increased SBI adoption was laid last January when the federal Centers for Medicare and Medicaid Services (CMS) implemented a new policy to reimburse physicians for services to identify and treat Medicaid patients’ problems with alcohol and other drugs. CMS added two new codes to the HCPCS Level II coding system that Medicaid and other insurers use to process medical insurance claims.  

But the biggest development in 2007 was the American Medical Association’s approval of new CPT codes for SBI. CPT codes are the keys to reimbursement from most private insurers and their availability in 2008 will lead to greater adoption by primary care and community clinic practitioners. In addition, the federal Centers for Medicare and Medicaid Services (CMS) instructed its fiscal intermediaries to pay on two new HCPCS G codes, which replicate the CPT codes. Because CMS does not pay for screening unless mandated by law, the new G codes will allow CMS to pay for alcohol and drug assessment and brief intervention.  

Less than 10 percent of adults with alcohol or drug disorders are identified and treated. In comparison, more than 40 percent of people with depression are diagnosed and treated – most by primary care doctors. By adding new codes, the AMA and CMS are helping to make screening and brief intervention a routine part of primary and emergency medical care.

The new screening and brief intervention codes will help expand the treatment of substance use disorders to primary medical providers. Making the identification and treatment of substance use disorders the business of family doctors will help to increase the number of people getting treatment.  

Historically, substance use-related intervention has emphasized either universal prevention strategies aimed at those who have never used substances or specialist treatment for those who are dependent. Little attention has been paid to the large group of individuals who use alcohol and other drugs, are not dependent, and could successfully reduce their use through early intervention. Incorporating SBI into a wide range of health-related practice will lead to a substantial reduction in the problems caused by hazardous substance use.