Centerstone Screening, Brief Intervention, and Referral to Treatment (C-SBIRT) will expand the continuum of care for SUD by integrating SBIRT in 14 west central Florida counties. C-SBIRT will provide screening for an unduplicated total of 42,675 adults seeking medical attention/intervention in catchment area primary care and community health settings (Yr 1: 6,000; Y 2: 9,500; Yr 3: 10,375; Yr 4: 10,600; Yr 5: 6,200) to identify risky substance use and substance use disorder (SUD) and initiate appropriate evidence-based response. C-SBIRT’s focus population comprises an estimated 3,452,580 primary care/community health patients in Charlotte, Collier, Desoto, Glades, Hardee, Hendry, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, and Sarasota counties. Consistent with catchment area demographics, the focus population is composed of 48% male, 52% female, 73% white, 9% African American, and 14% Hispanic/Latino adults. Subpopulations include the nearly 30% of focus population adults who are racial/ethnic minorities and the 11% who are Veterans. Approximately 23% of catchment area adults are expected to screen positive for risky substance use or substance use disorder, and 14% report poor mental health. C-SBIRT will use validated screening instruments, including the National Institute of Drug Abuse’s and National Institute of Alcoholism and Alcohol Abuse’s Single Question Screen universal pre-screenings, as well as AUDIT, DAST-10, and PHQ-9 full screening tools. SAMHSA’s Treatment Improvement Protocol (TIP) 34: Brief Interventions and Brief Therapies for Substance Abuse will provide a framework for delivering the evidence-based brief intervention, Brief Negotiated Interview, and evidence-based brief treatments, Cognitive Behavioral Therapy and Motivational Interviewing. Key C-SBIRT program components include establishing/implementing the project’s Electronic SBIRT Screening and Response System; conducting outreach, initial training, and ongoing technical assistance among catchment area providers; providing/linking patients to comprehensive SUD and co-occurring SUD and mental health disorder (COD) treatment, as appropriate; assembling the Policy Steering Committee; implementing C-SBIRT’s Quality Improvement Plan; executing C-SBIRT’s Sustainability Plan; and disseminating a comprehensive evaluation. C-SBIRT goals include: (1) Implement the project to provide comprehensive, cost-effective SBIRT; (2) Develop infrastructure and capacity to expand, enhance, and sustain project services; (3) Improve client health status/outcomes; and (4) Develop and disseminate a service model for replication. C-SBIRT will offer brief intervention, brief treatment, and/or referral to treatment to 100% receiving Intervention Team response and achieve the following measurable objectives among clients screening positive for risky substance use/SUD/COD: reduced substance/alcohol use, opioid use, mental health symptomatology, and inpatient/ER use, and increased abstinence from use. C-SBIRT will achieve 80% participant retention. C-SBIRT has secured commitments from partners dedicated to the project’s success, and will collaborate with the Central Florida Behavioral Health Network, as well as primary care, community health, specialty treatment, and Medication Assisted Treatment providers to increase implementation of cost-effective SBIRT and behavioral health expertise in primary/medical care settings; identify, reduce, and prevent risky use/SUD in the catchment area; and increase treatment engagement/retention among those with SUD/COD in the focus population.