This document outlines a 15-step process for providers to conduct a Brief Negotiated Interview with patients regarding their alcohol and drug use. It involves raising the subject with the patient, providing feedback on their risk level, enhancing their motivation to change, and negotiating a plan for reducing substance use risks. The provider is to check off steps as they are completed and bill appropriately using Medicaid codes for alcohol and drug screening and brief intervention sessions lasting 15-29 minutes or 30+ minutes.

1. Raise the subject
1. Ask the patient for permission to discuss their health and wellness
questionnaire, including alcohol and drug use (AOD).
Provide feedback
2. Review patient’s AOD patterns & risk level.
3. Express concern about patient’s use patterns & risk level.
4. Ask about pros and cons of AOD use.
5. Summarize and restate in patient’s own words.
6. Provide medical facts and information that there is a connection
between AOD and negative consequences.
7. Compare screening responses to NIAAA low risk AOD guidelines.
Enhance motivation
8. Ask patient to identify readiness to change on the Readiness Ruler
tool and ask why they chose that number and not a lower one.
9. Elicit other reasons for changing.
10. Identify strengths and supports.
Negotiate a plan
11. Negotiate the goal (“What would you like to do?”).
12. Summarize (“This is what I’ve heard you say . . .”).
13. Have patient write out the change plan, if appropriate.
14. Provide Health Information handout.
15. Suggest Primary Care or other follow-up as needed.
Brief Negotiated Interview Provider Checklist
oYes oNo
oYes oNo
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oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
oYes oNo
Medicaid Billing Codes
99408 - AOD screening/BI (15–29 min.)
99409 - AOD screening/BI (30+ min.)
healthvermont.gov • sbirt.vermont.gov • 802-225-6066
Adapted from:
Miller, Rollnick, D’Onofrio, Bernstein
Boston University School of Public Health
Yale School of Medicine