Screening and Brief Intervention (SBI) is a specific set of techniques with proven effectiveness in reducing risky drinking and harmful drug use, and preventing or reducing subsequent health consequences when delivered by trained providers who apply the techniques with fidelity.

The effectiveness of BI has been extensively demonstrated. Comparisons between BI and routine medical advice, or non-specific alcohol or drug counseling provided by medical practitioners, consistently find significantly greater clinical effect for SBI across a broad range of clinical populations and providers. Indeed, a combined analysis of 361 clinical trials of different types of alcohol counseling methods found BI to be the most effective of the 40 different methods studied. Non-specific, generalized counseling without use of BI techniques ranked 39th out of the 40 treatments studied (Miller & Hester, 2003). The effectiveness of BI has been extensively demonstrated. More than 30 controlled clinical trials, including over a dozen randomized, controlled clinical trials, have conclusively demonstrated the clinical efficacy and effectiveness of BI techniques as delivered by physicians and other health professionals across a wide range of settings and patient populations. For example, a prospective, randomized controlled trial of SBI in patients admitted to a large urban trauma center found a 47% reduction in re-injuries requiring an emergency department visit, and a 48% reduction in injuries requiring another admission to a hospital, with three years follow-up (Gentilello, 1999).

Controlled clinical trials also demonstrate that SBI produces substantial health care cost savings. Studies of health care utilization and costs after SBI delivered in primary care (Fleming et al 2000, 2002), emergency departments and trauma centers (Gentilello et al, 2005; D’Onofrio & Degutis, 2002), internal medicine (Storer, 2003) and behavioral health settings (UKATT, 2005; Parthasarathy et al, 2001) have all found cost savings exceeding $3 for every $1 invested in SBI.

Because of the large number of published prospective trials, the Cochrane Collaboration disseminated a systematic review of brief interventions in patients with hazardous or harmful alcohol consumption that reported an overall 22.7% difference in alcohol consumption between intervention and control groups (Cochrane Colloquia, accessed 2006). Given such evidence, the US Preventive Services Task Force (Whitlock et al, 2004) now recommends routine use of SBI for all adults in the primary care setting, and the American College of Surgeons requires it for all patients admitted to Level 1 Trauma Centers.

With respect to screening, instruments with documented reliability and appropriate sensitivity and specificity also exist. BI is guided by the use of standardized, evidence-based screening instruments. For example, the Alcohol Use Identification Test (AUDIT) has been extensively validated in a variety of clinical samples including primary care, emergency departments, trauma centers, and in geriatric patients, college students, in a variety of socioeconomic strata, in multiple languages, and is equally sensitive in both male and female patients (World Health Organization, 2001).