How to Screen for Substance Use Disorder  and Connect People to Care

Screening for substance use disorder means using a short, validated set of questions to identify people who may have a problem, then acting on the result the same day. The most widely used approach is SBIRT: screening, brief intervention, and referral to treatment. A staff member asks a few standardized questions, gives brief feedback and counseling to anyone at risk, and connects people who screen positive to treatment through a warm handoff rather than a slip of paper. Done well, screening turns a routine visit into an entry point for care.

The reason screening matters is the size of the gap between need and treatment. Among adults who needed opioid use disorder treatment in 2022, only 25.1% received medication for it, according to the CDC's Morbidity and Mortality Weekly Report. Most people who could benefit are never identified or never linked. Screening is the step that finds them. This post covers the tools, why the gap makes screening urgent, and how mobile programs extend screening to people fixed clinics rarely see. For the operating model behind this work, see our Behavioral Health Satellite Clinic Network.

What is SBIRT (screening, brief intervention, referral to treatment)

SBIRT is a three-part public health approach for catching and addressing substance use early. Screening identifies risk with a validated questionnaire. Brief intervention is a short, motivational conversation with anyone whose score suggests risky use. Referral to treatment links people who need specialty care to a provider who can deliver it.

The strength of SBIRT is that it fits into existing visits. A person coming in for wound care, a wellness check, or a naloxone refill can be screened in a few minutes, and staff can respond in the same encounter. That design makes it well suited to settings where people show up once and may not return, which is exactly the situation many mobile and outreach programs face. Building SBIRT into the visit flow is a core part of how our health center and satellite clinic operators reach people who fall outside routine care.

What screening tools are used

Screening tools are short validated questionnaires matched to the substance and the setting. Common instruments include the AUDIT and AUDIT-C for alcohol, the DAST for other drugs, the single-item screeners for quick triage, and combined tools that cover tobacco, alcohol, and drugs in one pass. The choice depends on time, staff training, and the population.

A practical setup uses a very short first-stage screen for everyone, then a longer assessment only for people who screen positive. This keeps the encounter fast while still catching risk. Whatever tool you choose, use it consistently and train every staff member to score and respond to it the same way. Standardizing the tool and the response is part of what our planning and staffing advisory helps programs put in place before launch.

The treatment gap and why screening matters

Screening matters because you cannot treat what you never identify, and the untreated population is enormous. Alcohol use disorder shows the gap starkly: an estimated 28.9 million Americans age 12 and older had alcohol use disorder in 2023, while only about 4.5 million received any alcohol treatment in the past year, according to the 2023 National Survey on Drug Use and Health.

That gap persists even though effective medications exist. FDA-approved medications for alcohol use disorder, including naltrexone, acamprosate, and disulfiram, are effective and underused, per the National Institute on Alcohol Abuse and Alcoholism. Screening is the bridge between people who could benefit from these treatments and the treatments themselves. A program that screens routinely turns the gap into a list of people it can actually help.How do mobile programs make screening reach people

Mobile programs make screening reach people by going to where people already are instead of waiting for them to arrive. A unit parked outside a shelter, a food pantry, or a syringe services site screens people who would never schedule a clinic appointment, and it screens them in a low-stress setting they already trust.

This reach matters most for people who avoid formal care because of stigma, cost, transportation, or past bad experiences. Meeting them on familiar ground lowers the bar to answering honestly, which is the whole point of a screen. A mobile program can also fold screening into another reason for the visit, so a person coming for wound care or naloxone leaves having been screened and, if appropriate, offered treatment. Programs that want to design this outreach around real community need can draw on our research and grant services to ground the plan in local data.

How to connect a person with a positive screening to treatment (warm handoff)

Connect a person with a positive screen to treatment with a warm handoff: a direct, person-to-person connection made during the same visit, not a phone number handed over at the door. A warm handoff means the screening staff member introduces the person to a prescriber, counselor, or peer specialist then and there, or schedules and confirms the next step before the person leaves.

The most durable version starts treatment on the spot. When a mobile program can begin buprenorphine at the same visit as the positive screen, the handoff and the treatment become one moment. When same-visit treatment is not possible, the next best step is a confirmed appointment with a named contact and a peer specialist who follows up. Referral works when it is a relationship between programs, which is why signed agreements and shared contacts should be in place before you screen your first person.

Why screen for co-occurring mental health conditions

Screen for mental health conditions alongside substance use because the two so often travel together and are so rarely treated together. Only about 6% of adults with co-occurring disorders receive both mental health and substance use treatment, according to SAMHSA. Screening for one without the other misses most of what a person is carrying.

The overlap is large. Among people with a substance use disorder, 43% have a mental illness, and among people with serious mental illness, 45% have a substance use disorder, per SAMHSA. A short mental health screen added to the substance use screen catches this overlap early, so the referral can point toward integrated care rather than two disconnected services. That is the difference between a handoff that holds and one that drops someone between systems.

Frequently asked questions

What is the difference between screening and assessment?

Screening is a brief, standardized check that flags whether someone may have a problem, and it is meant for everyone in a given setting. Assessment is a longer, in-depth evaluation done only for people who screen positive, and it guides the treatment plan. Screening finds risk; assessment defines it.

How long does substance use screening take?

A first-stage screen can take under two minutes using a short validated tool, and a single-item screener is faster still. A positive screen then leads to a longer assessment, but most people screen negative and move on quickly. This design keeps screening fast enough to fit into any visit.

What is a warm handoff and why does it work?

A warm handoff is a direct, person-to-person connection to treatment made during the same visit, rather than handing someone a phone number to call later. It works because it removes the drop-off points, the missed call, the lost paper, the lost nerve, that cause most referrals to fail. The strongest version starts treatment on the spot.

Should mobile programs screen for mental health too?

Yes. Substance use and mental health conditions frequently co-occur, and only about 6% of adults with co-occurring disorders receive both treatments, per SAMHSA. Adding a brief mental health screen helps route people toward integrated care instead of a single service that misses half the picture.

Who can perform substance use screening?

Screening does not require a prescriber. Trained nurses, medical assistants, counselors, and peer support specialists can all administer and score validated screens, which is what makes screening scalable in mobile and outreach settings. The key is consistent training so every staff member scores and responds the same way.

If you want to build routine, non-stigmatizing screening into a program that reaches people where they are, our team can help you design the tools, workflow, and referral network. Learn more about our Behavioral Health Satellite Clinic Network.