Howard University Hospital (HUH) in collaboration with Unity Health Care (Unity) Inc., the largest Federally Qualified Health Center (FQHC) in Washington, DC, propose to implement a systematic program to address alcohol or other substance misuse among patients receiving services in their primary care or prenatal clinics, emergency department, or inpatient obstetrics, medical or surgical units. Specifically, we propose to provide universal Screening Brief Intervention and Referral to Treatment (SBIRT) in these settings; ensure linkage to and retention in substance use disorder (SUD) treatment for those needing treatment, and increase SUD treatment capacity, including medication assisted treatment (MAT). Together, HUH and Unity, serve a population of approximately 160,000, including adolescents and adults, primarily from low-income, diverse minority and ethnic groups residing in Washington D.C.'s most medically underserved areas and with the greatest need for SUD, mental health and other medical services. These populations disproportionately suffer from a range of health problems, including co-occurring mental health disorders,heart disease, diabetes, chronic liver failure, high blood pressure, psychiatric illness, HIV/AIDS, and SUD. Because of the health disparities and limited primary care resources, these underserved individuals often present late in the course of the illness, with servere substance-related disorders that could have been preventable or manageable with timely diagnosis. We anticipate serving 131,577 new patients over the lifetime of the program. HUH has a wealth of experience in providing service to underserved populations and 10 years of experience implementing SBIRT programs. Consequently, in addition to implementing universal SBIRT in Unity and HUH medical programs, we are also proposing to increase the capacity of both HUH and Unity to treat SUD in programs that are integrated along with other medical services. This approach will not only improve coordination of care but will also reduce barriers to SUD treatment, including stigma and the logistical and transportation difficulties of receiving care in multiple locations. HUH-Unity SBIRT Program will be sustainable and guided by the input of internal and external advisory boards, including representation by leading experts in SBIRT, addiction medicine, clinical faculty from both sides and representatives from the District of Columbia's Department of Behavioral Health (DBH).