Millions of patients visit US emergency departments (EDs) each year because of substance use and behavioral disorders. Caring for these people is daunting, given the high patient volumes and increasing acuity of illness that EDs are experiencing. The nation’s primary care system has limited capacity to treat these individuals, who are often uninsured, poor, and sick. A growing body of evidence suggests that screening, providing a brief intervention, and referring these patients to treatment—an approach known as SBIRT—can be effective in the ED. Typically requiring just five to ten minutes, SBIRT incorporates principles of motivational interviewing, an evidence-based counseling technique that uses empathy, positive framing, reflective listening, and gentle education to encourage people to change risky behavior. This article describes what is known about the clinical and cost-effectiveness of SBIRT when applied to ED patients with substance use and behavioral disorders. The article recommends adopting SBIRT broadly to help EDs become a coordinated part of the health care system, offering opportunities to improve the health of millions of Americans.