FNPs and Substance Abuse Screening

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As primary caregivers, family nurse practitioners (FNPs) stand on the front lines in the fight against substance abuse. In their daily jobs, FNPs identify and address substance abuse problems in their patients, utilizing evidence-based practices that focus on universal screenings, early interventions and effective services.

Many FNPs, using the Screening, Brief Intervention and Referral to Treatment (SBIRT) practice, have been able to recognize, reduce and thwart problematic use of alcohol and drugs. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) said prevention and early intervention services are the keys to reducing the impact of substance abuse (and mental health) disorders across the United States.

“Prevention approaches focus on helping people develop the knowledge, attitudes and skills they need to make good choices or change harmful behaviors,” the organization said.

Research shows only one in 10 people affected by substance-abuse disorders receives the necessary treatment. One of the most common reasons patients don’t get treatment is because they don’t know where to go for it, a SAMHSA study found.

FNPs working as substance abuse nurse practitioners can use their skills and knowledge to help people struggling with addictions. The SBIRT model is the most widely used evidence-based practice for suspected substance abuse in the United States. Providers have found it to be safe and effective.

The SBIRT Model at Work

SBIRT is not intended to treat people who have identified problems. Instead, it is aimed at helping people who may not be seeking treatment but know their drinking or drug use is problematic. The program’s primary goal is to identify people who could benefit from intervention before alcohol and drug use becomes a problem.

In the past, substance-use concerns have been addressed as moral, social, individual and criminal justice problems, so the solutions were not easily identified. SBIRT differs from previous approaches because it instead addresses substance overuse as a public health problem.

“SBIRT mirrors what the healthcare system has always done by seeking to identify potential problems via screening for them before they are acute or chronic (and become more difficult and more expensive to treat). This allows us to intervene earlier,” the Institute for Research, Education and Training in Addictions (IRETA) said in “National Screening, Brief Intervention and Referral to Treatment (SBIRT) Training of Trainers Manual.”

The SBIRT model has three core components:


Two types of screening tools are used to provide context for beginning discussions about substance abuse and identifying patients who need a referral for additional assessments:

  • Simple universal screenings (consisting of four to five questions) rule out adult patients who are at low or no risk for substance abuse, shifting the focus to those who are at risk.
  • Targeted screenings are provided to specific patients based on positive blood-alcohol results or suspected alcohol-related health problems.


Three types of interventions are used based on the screening results:

  • Feedback only – Individuals whose screening results show little to no risk for substance abuse are encouraged to continue with their current path.
  • Brief intervention – Those whose screening results show a slight risk for substance abuse engage in a 5- to 15-minute discussion with the provider about recognizing and reducing risks.
  • Extended brief intervention (also called brief treatment) – Those with higher risk factors are encouraged to engage with providers for longer periods.

Referral to treatment

Individuals who show high to very high risk factors for substance abuse are encouraged to accept a referral for further assessments. The treatments include:

  • Outpatient counseling – Individual or group treatment sessions
  • Acute treatment (detox) – In-patient services that last four to seven days to manage withdrawal from alcohol or drugs
  • Clinical stabilization services – Intense residential counseling that lasts seven to 10 days following detox to plan next steps
  • Group counseling – Peer-based support rooted in the 12-step system, including Alcoholics Anonymous (AA) or Narcotics Anonymous (NA)

Overall, SBIRT is based on motivational interview strategies, a counseling method that helps individuals change behaviors by exploring feelings and impulses. For FNPs, learning the SBIRT model, along with other nursing terminology, is crucial to assisting at-risk patients.


As a proven method to identify patients who are at risk for substance abuse, SBIRT has become the go-to assessment approach. FNPs who work in primary care must become skilled in working with patients to properly screen, identify and intervene for possible substance-abuse problems. At least one study shows that FNPs who administer SBIRT assessments and counseling not only improve patient health but also reduce healthcare costs overall.

“The cost of healthcare in the U.S. has been steadily growing and providers, policymakers and consumers are eager to identify high-quality, cost-effective strategies to coordinate the care of individuals and manage chronic illnesses,” SAMHSA said in “SBIRT: Screening, Brief Intervention, and Referral to Treatment: Opportunities for Implementation and Points for Consideration. “SBIRT is an evidence-based practice that has been clinically shown to identify, reduce and prevent substance misuse and the disease of addiction and ultimately reduce healthcare costs.”

For FNPs, learning how to implement SBIRT into real-world situations is crucial to proper patient care. At Duquesne University, online master’s in nursing students who are studying to become FNPs learn about the positive impact SBIRT has on patients.

About Duquesne University’s Online MSN-FNP and FNP Post-Master’s Certificate Programs

As a leader in online nursing education, Duquesne University has helped RNs and APRNs learn skills, strategies and evidence-based practices to become FNPs. The coursework is presented entirely online, so students can maintain their careers and personal lives while pursuing their education goals. Graduates are prepared to successfully complete the American Academy of Nurse Practitioners Certification Board (AANPCP) and American Nurses Credentialing Center (ANCC) Family Nurse Practitioner certification examinations.

For more information, contact Duquesne University today.



Early Intervention, Treatment, and Management of Substance-Use Disorders: NCBI

Reasons for Not Seeking Treatment: NCBI

In Focus: Expanding Access to Addiction Treatment Through Primary Care: The Commonwealth Fund

SBIRT: Screening, Brief Intervention, and Referral to Treatment

Opportunities for Implementation and Points for Consideration: SAMHSA

National Screening, Brief Intervention and Referral to Treatment (SBIRT) Training Of Trainers Manual: IRETA

SBIRT: A Step-By-Step Guide: Massachusetts Department of Public Health