Alcohol Screening and Brief Intervention

Alcohol screening uses a few questions to estimate the level and severity of alcohol use and to determine whether a person may be at risk of alcohol misuse or dependence (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015). Brief interventions are short, one-time encounters with people who may be at risk of alcohol-related injuries or other health problems. Brief interventions focus on awareness of the problem and motivation toward behavior change. The combination of alcohol screening and brief intervention is most common with injured patients in emergency departments or trauma centers. Patients are screened for alcohol misuse problems and, if appropriate, are counseled on how alcohol can affect injury risk and overall health. Patients also may be referred to a follow-up alcohol treatment program. Brief interventions take advantage of a “teachable moment” when a patient can be shown that alcohol use can have serious health consequences.

Higgins-Biddle and Dilonardo (2013) and Dill et al. (2004) provide a summary of alcohol screening and brief intervention studies. Also, NHTSA and the American Public Health Association (APHA) have produced an alcohol and brief intervention guide for public health practitioners (Guard & Rosenblum, 2008). Finally, NHTSA offers a toolkit to assist in conducting screening and brief intervention on college campuses (Quinn-Zobeck, 2007).

Use:

Approximately one-half of trauma centers screen patients for alcohol misuse problems and one-third use some form of brief intervention (Goodwin et al., 2005; Schermer et al., 2003). Alcohol screening and brief interventions also are used in colleges, primary care medical facilities, and social service settings (Goodwin et al., 2005). Brief interventions have also been used to reduce DWI among young adults and adolescents (Tanner-Smith & Lipsey, 2015).

Effectiveness:

Many studies show that alcohol screening and brief interventions in medical facilities can increase the likelihood of treatment referrals for alcohol misuse and reduce self-reported driving after drinking (D’Onofrio & Degutis, 2002; Moyer et al., 2002; Runge et al., 2002; Wilk et al., 1997). Dill et al. (2004) reviewed nine studies that evaluated alcohol screening and brief intervention effects on relevant outcomes, such as personal alcohol use and motor vehicle collision injuries. These studies generally found that alcohol screening and brief interventions reduced both drinking and alcohol-related traffic crashes and injuries. Brief interventions appear more effective with some populations than others. For example, patients with alcohol use disorder may need to be referred to a more intensive treatment plan (Teutsch et al., 2018).   

Costs:

Alcohol screening and brief interventions in medical facilities require people with special training to administer the intervention. However, several studies show the intervention is cost effective, and substantially reduces future health care costs (e.g., hospital and emergency room visits) (Guard & Rosenblum, 2008).

Time to implement:

Procedures for alcohol screening and brief interventions are readily available from APHA (Guard & Rosenblum, 2008), the American College of Emergency Physicians (ACEP, 2006), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2005), and can be implemented as soon as staff is identified and trained.

Other considerations:

Alcohol exclusion laws: An alcohol exclusion law (Uniform Accident and Sickness Policy Provision Law or UPPL) allows insurance companies to deny payment to hospitals for treating patients who are injured while impaired by alcohol or a non-prescription drug (NHTSA, 2008d). These laws may cause hospitals to be reluctant to determine the BACs of injured drivers and may limit the use of alcohol screening (although screening does not measure the patient's BAC).  The National Institute on Alcohol and Alcoholism maintains a list of States that permit or prohibit alcohol exclusion (NIAAA, 2022b).