Background:
Screening, brief intervention and referral to treatment (SBIRT) is a validated means of identifying those at risk for substance use disorders, decreasing substance abuse and improving clinical outcomes.

Objective:
We examined the prevalence of substance use disorders using SBIRT at a public STD clinic along with 3 primary care clinics.

Method:
We used the CAGE-AID and NIAAA screening instruments to determine which patients were at risk for or had a probable diagnosis of a substance use disorder. For those positively identified, we provided a brief intervention consisting of one 5-minute counseling session that included motivational interviewing and staging the patient's readiness for change. Those with a probable diagnosis of a substance use disorder were referred to treatment. All were provided with educational materials identifying the health risks associated with substance use.

Result:
: Whereas 3 to 9% of primary care clinic patients screened positive for at-risk or probable diagnosis of a substance use disorder, a striking 46.8% prevalence was found among those attending the STD Clinic. Of these, >50% were in the pre-contemplative stage of change and 24.5% were contemplating or were preparing to take action to decrease their use. As a result, we have incorporated substance use screening with the CAGE-AID/NIAAA instrument and referral to treatment as a standard practice of our STD counseling process.

Conclusion:
STD screening is feasible and acceptable to STD and primary care patients and clinical staff. There is a high prevalence of at risk and probable diagnosis of substance use in the STD setting.

Implications:
This is the first report of the high prevalence of substance related disorders in STD patients diagnosed using a validated instrument, SBIRT and the use of brief interventions an STD clinic setting. Future studies may determine that SBIRT may be useful in STD control.