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Problem substance use makes a significant contribution to the burden of injuries and noncommunicable diseases in South Africa. In 2012, the Western Cape Department of Health funded a randomised controlled trial of substance use SBIRT in emergency centres (ECs). Based on the promising results, the programme was implemented in 2016 in three ECs, offering motivational interviewing-based counselling delivered at the acute EC visit by lay counsellors.This study utilised data from a novel EC SBIRT service (1 August 2016 – 31 July 2017) and compared the characteristics, process and substance use outcome data for injured and non-injured patients. A screening questionnaire was administered to less seriously ill or injured adult patients, and those scoring at moderate-high risk on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were eligible and received a motivational-interviewing-based session. Data collected included sociodemographics, presenting complaint, substance use days and the ASSIST. A three-month follow-up phone call was conducted to evaluate substance use in a small sample of service users. Process data was collected on the numbers of: patients screened, eligible patients, and sessions given.In total, 13 136 patients were screened. Over half were male, the mean age was 37 years and 43% presented with an injury. Of the non-injured patients, 23% met criteria for problem substance use, compared to 56% of injured patients. Of the eligible patients, 74% were male and 83% received a counselling session. At three-month follow-up there was a significant reduction in substance use days for all patients and injured patients’ alcohol use scores decreased by 6.4 points, compared to 4.7 in the non-injured patients.This EC SBIRT service delivered a substance use intervention to over 80% of eligible patients. Injured patients were more likely to report problem substance use, and showed a greater decrease in substance use scores.