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Brief Screening, Intervention, and Referral for Alcohol and Opiate Disorders An Effective Three-Step Process Brief Screening AUDIT-C FOR ALCOHOL 1. How often do you have a drink containing alcohol? 2. How many drinks containing alcohol do you have on a typical day of drinking? 3. How often do you have five or more drinks on one occasion? 0 Never 1 or 2 1 2 3 4 Score Monthly 2-3 times 2-3 times 4 or more or less per month per week times per week 3 or 4 5 or 6 7 to 9 10 + Less than Daily or Monthly Weekly monthly almost daily A standard drink in the US is any drink that contains about 14 grams of pure alcohol. One drink equals: AUDIT-C Score (add items 1-3) 12 oz. beer, 5 oz. wine, or 1.5 oz. liquor. Never Recommended Level and Focus of Brief Intervention Based on Screening Results z NEGATIVE SCREEN < 4 for men/ 3 for women - Inform client that they are at low risk. Congratulate clients at low risk and encourage them to remain that way. Simple advice can be offered. z POSITIVE SCREEN > 4 for men/ 3 for women - Inform client that they screen positive for hazardous alcohol use and are at risk for health and other problems. Either provide a brief intervention and/or continue by giving the patient a copy of: "Alcohol: It May Be Legal, But It Can Hurt Your Health," which contains the full AUDIT and referral sources. DAST PRE-SCREENER FOR OPIATES 1. In the past 12 months, have you used drugs other than those required for medical reasons? Yes | No A YES response to the DAST pre-screener indicates a POSITIVE drug prescreen – either provide a brief intervention and/or continue by giving the patient a copy of: "Opiates: When Pain Medications Become A Problem," which contains the full DAST and referral sources. Brief Treatment Intervention – “FLO” and “SEW” Feedback Listen and Elicit Options (Goal Setting) Summarize patient’s statements in favor of change Emphasize their strengths What agreement was reached Reimbursement Use of the codes below requires documentation in the clinical record. Services provided under these codes are separate and distinct from all other Evaluation & Management (E/M) services performed during the same clinical session (i.e., date of service). Screening & Brief Intervention 15 to 30 minutes Screening & Brief Intervention > 30 minutes Commercial CPT 99408 CPT 99409 Medicare G0396 G0397 Medicaid H0049 H0050 Online Resource for Screening and Brief Intervention: http://sbirt.samhsa.gov/about.htm Prepared by a collaboration of National Behavioral Consortium, George Washington University, and Reckitt Benckiser Pharmaceuticals