The goal of this clinical trial is to test the effectiveness of evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adult patients who screen positive to one or more risky alcohol or substance use behaviors while seeking care at a sexual and reproductive health (SRH) clinic. The main questions it aims to answer are: * Does SBIRT impact patients' alcohol and substance use, SRH, mental health, physical health, quality of life, and wellbeing? * Does SBIRT effectiveness differ by ethnicity, socioeconomic status, age, gender, and urbanicity? * Does SBIRT effectiveness differ by delivery mode (in-person vs. telemedicine)? Participants will receive in-person and telemedicine SBIRT, or usual care. Participants will complete surveys at interviews at baseline, 30 days, and 3 months. Researchers will compare patients who received SBIRT to patients who receive usual care to see if patients who receive the SBIRT intervention have a greater reduction in negative outcomes as compared to those who receive usual care. In this setting, usual care consists of basic quantity and frequency questions asked inconsistently as part of the admission process and varying by provider, with no standardized approach to screening, treatment, follow-up, or referral.
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Average Number of Drinks Per Drinking Day
Timeframe: Baseline, Day 30, Month 3
Number of Days of Drug Use
Timeframe: Baseline, Day 30, Month 3
Incidence of sex under influence of alcohol/drugs
Timeframe: Baseline, Day 30, Month 3
Number of events of sex under influence of alcohol/drugs
Timeframe: Baseline, Day 30, Month 3
Patient Health Questionnaire (PHQ-9)
Timeframe: Baseline, Day 30, Month 3
Number of Clinic Patients Receiving a Brief Intervention During Implementation Phase
Timeframe: During the 12-month implementation phase
Number of Clinic Patients Receiving a Brief Intervention During Sustainment Phase
Timeframe: During the 12-month sustainment phase
Number of Providers Using SBIRT During Implementation Phase
Timeframe: During the 12-month implementation phase
Number of Clinics Using SBIRT During Sustainment Phase
Timeframe: During the 12-month sustainment phase
Number of Providers Using SBIRT During Sustainment Phase
Timeframe: During the 12-month sustainment phase
Number of Completed BIOS Tracking Sheets to Achieve Competency
Timeframe: During the preparation phase
Brief Intervention Observation Sheet (BIOS) Score
Timeframe: During the 12-month implementation phase
Brief Intervention Observation Sheet (BIOS) Score - Motivational Style
Timeframe: During the 12-month implementation phase