5.1 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 (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 commonly used with injured patients in hospital emergency departments and trauma centers. Patients are screened for alcohol abuse problems and, if appropriate, are counseled on how alcohol can affect injury risk and overall health. Patients also may be referred to follow-up alcohol treatment programs. A brief intervention takes advantage of a “teachable moment” when a patient can be shown that alcohol use can have serious health consequences.

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

Use: About half of all trauma centers screen patients for alcohol abuse problems and one-third use some form of brief intervention (Goodwin et al., 2005, Strategy A4; 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, Strategy A4). 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 reduce drinking and self-reported driving after drinking (D’Onofrio & Degutis, 2002; Moyer 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. Considering the variety of brief intervention implementations based on the clinician’s expertise and time constraints (they can be anywhere from 5 to 30 minutes, and use techniques such as motivational interviewing, brief negotiated interviewing, and/or cognitive behavioral therapy), brief interventions are more effective with some populations (National Academies of Sciences, Engineering, and Medicine, 2018). For example, patients with alcohol use disorders may need to be referred to increasingly intensive treatment plans (National Academies of Sciences, Engineering, and Medicine, 2018). In their 2015 meta-analysis Steinka-Fry et al. examined the effectiveness of brief interventions in reducing driving after drinking among young people 11 to 25 years old. Results based on 12 studies reported in 30 documents reported brief interventions were associated with modest but positive reductions in driving after drinking and the related consequences among young people. They also suggest that brief interventions may constitute cost-effective preventative approaches for addressing drinking and driving, which is widespread in young age groups.

However, a study of adult emergency department patients who screened positive for risky alcohol use did not find any impact of brief interventions (Baird et al., 2017). A limitation to the intervention tool used in this study was that none of the patients were screened for alcohol use disorder or were referred to treatment, which is often an integral part of the brief intervention process (National Academies of Sciences, Engineering, and Medicine, 2018). Participant outcomes were measured by self-reported drinking and driving behaviors (based on the 6 items from the Impaired Driving Scale) in follow-up interviews. One group of patients was administered a brief intervention program (3 telephone counseling intervention sessions based on the principles of motivational interviewing; n = 204) and the control group was given a placebo program on fire and burn home safety (n = 203). Neither participant groups’ pre-treatment self-reported readiness to change, nor the mechanism of injury (motor vehicle crash versus other) affected self-reported outcomes (Baird et al., 2017).

Costs: Alcohol screening and brief interventions in medical facilities require people with special training to administer the intervention. However, several studies show intervention is cost effective and substantially reduces future health care costs such as 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 issues:

• 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 injured while impaired by alcohol or a non-prescription drug (NHTSA, 2008). 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). As of April 2018 alcohol exclusion laws were in effect in 37 States (GHSA, 2018a), though the extent to which insurance companies deny payment is, at best, sporadic.