Reducing Hazardous Alcohol Use:
How Can Screening and Brief Intervention
in Health Care Settings be Expanded?
In August, 2008, more than 100 college presidents called for lowering the legal drinking age, claiming that current restrictions encourage binge drinking among students. While the proposal sparked widespread controversy, it also called attention to a broad public health problem:
- 43.6 percent of college students engage in binge drinking, defined as five or more drinks on the same occasion at least once over the past 30 days.
- 17 million Americans age 12 or older - 6.9 percent of the population - are heavy drinkers.
- Almost 80,000 adults and 4,600 people under the age of 21 die every year from alcohol-related events,
A clinical tool called screening and brief intervention (SBI) has proven highly successful in reducing college binge drinking. A new report by The George Washington University School of Public Health and Health Services (GW/SPHHS) describes the consequences of alcohol misuse, the proven benefits of screening and a brief intervention, and the opportunities to widen its routine use in clinical settings.
Several validated alcohol screening tools are available that take no more than five or ten minutes to administer. For those at risk, a brief intervention typically involves a series of one to four short counseling sessions with a trained clinician, such as a physician, psychologist or social worker. The total intervention takes an hour or less.
Screening and brief intervention techniques work, according to the U.S. Preventive Services Task Force, the Cochrane Database of Systematic Reviews, and an array of research journals. Based on those evaluations, the American Medical Association, the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, and numerous other associations have recommended their routine use.
Moreover, reimbursement for SBI services is increasingly available. In 2008, the Centers for Medicare and Medicaid Services and the American Medical Association approved reimbursement codes that make it easier for physicians to be compensated for identifying and treating patients with alcohol problems. AETNA, Blue Cross/Blue Shield and CIGNA are among the major health plans that now cover the service.
Nonetheless, obstacles remain to the widespread use of SBI, including physicians' lack of knowledge about its value. One survey found that while most primary care physicians and psychiatrists ask new patients whether they drink alcohol, less than half ask about their maximum consumption on a given occasion, and only 13 percent use a formal screening tool.
Potential opportunities to expand the use of the proven SBI technique include:
- More training for clinicians, either as part of initial medical education or in continuing education venues.
- Using health educators to provide SBI in primary care settings.
- Ensuring that physicians know where they can refer patients with serious alcohol problems for further services.
Further research to identify models for integrating SBI into primary care settings is getting underway, with funding from the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration.
A clear course has been set - the need to combat alcohol misuse is obvious, the value of a standardized intervention technique has been extensively documented, and reimbursement is increasingly available. But more activity in primary care settings across the country will be the real indicator that SBI is catching on.
Click to view the full report
For more information about alcohol-related screening and brief intervention, contact:
Eric Goplerud, PhD
Director, Center for Integrated Behavioral Health Policy
Research Professor, Department of Health Policy
School of Public Health and Health Services
The George Washington University
Washington, DC 20052
(202) 994-4303
goplerud@gwu.edu
