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Alcohol screening and brief intervention

Health Factors: Alcohol Use
Decision Makers: Healthcare Organizations
Evidence Rating: Scientifically Supported
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Alcohol screening and brief intervention programs identify persons with harmful or hazardous alcohol consumption before health and social consequences become pronounced, and motivate individuals to do something about their real or potential alcohol problem (WHO-Screening and brief intervention). 

Expected Beneficial Outcomes

Reduced harmful alcohol consumption
Reduced illicit drug use
Reduced alcohol-related injuries

Evidence of Effectiveness

There is strong evidence that alcohol screening and brief interventions reduce harmful alcohol consumption among adults in primary care and general hospital settings (WHO-Screening and brief intervention, Cochrane-Kaner 2007, Cochrane-McQueen 2011, IAS-Anderson 2006, NICE-Jackson 2010). Such interventions have also been shown to modestly reduce alcohol-related injuries (NICE-Jackson 2010, Cochrane-Dinh-Zarr 2004).

Alcohol screening and brief interventions can reduce alcohol consumption among college students (NIAAA-College drinking 2002, Seigers 2011) and adolescents (Yuma-Guerrero 2012, NICE-Jackson 2010, IOM 2004); however additional evidence is needed to confirm the strength of this effect. Such interventions appear to be more effective for men and heavy drinkers (Cochrane-Kaner 2007, Cochrane-McQueen 2011) than for women and moderate drinkers.

Alcohol screening and brief interventions appear to be cost effective approaches to reducing harmful alcohol consumption (IAS-Anderson 2006, WHO-Screening and brief intervention, NICE-Jackson 2010).

Implementation Examples

United States

There are large-scale alcohol screening and brief intervention programs in Brazil, South Africa, Europe and the US. The Substance Abuse and Mental Health Services Administration (SAMHSA)'s SBIRT program conducts demonstration projects across the country that assess and disseminate information on new SBIRT methods (APHA-SBI Manual 2008, SAMHSA-SBIRT).

Wisconsin

Wisconsin is one of a number of states participating in a federal Screening, Brief Intervention, Referral and Treatment trial which aims to integrate substance abuse screening into regular primary care visits (UWSMPH-SBIRT).

Implementation Resources

APHA-SBI Manual 2008 - American Public Health Association (APHA), Education Development Center, Inc. Alcohol screening and brief intervention: A guide for public health practitioners. Washington, DC: National Highway Traffic Safety Administration (NHTSA), US Department of Transportation (US DOT). Accessed on July 1, 2012
Webpage: http://www.adp.cahwnet.gov/SBI/pdfs/Alcohol_SBI_Manual.pdf
CA-SBIRT toolkit - California Department of Alcohol and Drug Programs (ADP). Screening and brief intervention toolkits. Accessed on July 1, 2012
Webpage: http://www.adp.cahwnet.gov/SBI/screening.shtml
CDC-Higgins-Biddle 2009 - Higgins-Biddle J, Hungerford D, Cates-Wessel K. Screening and brief interventions (SBI) for unhealthy alcohol use: A step-by-step implementation guide for trauma centers. Atlanta: Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC); 2009. Accessed on July 1, 2012
Webpage: http://www.cdc.gov/injuryresponse/alcohol-screening/resources.html
NHMA-SBIRT - National Hispanic Medical Association (NHMA). NHMA screening and brief intervention toolkit for the Hispanic patient. 2006. Accessed on July 1, 2012
Webpage: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CFEQFjAA&url=http%3A%2F%2Fwww.nhtsa.gov%2FDOT%2FNHTSA%2FTraffic%2520Injury%2520Control%2FArticles%2FAssociated%2520Files%2F810953.pdf&ei=5t7tT7OjCYj88gSv_LmBDQ&usg=AFQjCNHZr4aEK-8JvcGiV0-rEOwF10TwDg

Citations - Description

WHO-Screening and brief intervention - World Health Organization (WHO). Screening and brief intervention for alcohol problems in primary health care. Accessed on July 27, 2011
Webpage: http://www.who.int/substance_abuse/activities/sbi/en/index.html#

Citations - Evidence

Cochrane-Dinh-Zarr 2004* - Dinh-Zarr T, Gross C, Heitman E, Roberts I, DiGuiseppi C. Interventions for preventing injuries in problem drinkers. Cochrane Database of Systematic Reviews. 2004;(3):CD001857. Accessed on July 1, 2012
Webpage: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001857.pub2/abstract
Cochrane-Kaner 2007* - Kaner E, Dickinson H, Beyer F, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews. 2007;(2):CD004148. Accessed on June 19, 2012
Webpage: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004148/frame.html
Cochrane-McQueen 2011* - McQueen J, Howe T, Allan I, Mains D, Hardy V. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database of Systematic Reviews. 2011;(8):CD005191. Accessed on July 1, 2012
Webpage: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005191.pub3/abstract
IAS-Anderson 2006 - Anderson P, Baumberg B. Alcohol in Europe: A public health perspective. London: Institute of Alcohol Studies (IAS); 2006. Accessed on June 18, 2012
Webpage: http://ec.europa.eu/health-eu/news_alcoholineurope_en.htm
IOM 2004 - Institute of Medicine (IOM), National Research Council (NRC), Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Board on Children, Youth, and Families (BCYF). Reducing underage drinking: A collective responsibility. (Bonnie RJ, O’Connell ME, eds.). Washington, DC: The National Academies Press; 2004. Accessed on June 8, 2012
Webpage: http://www.nap.edu/openbook.php?isbn=0309089352
NIAAA-College drinking 2002 - Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism, National Institutes of Health (NIH). A call to action: Changing the culture of drinking at US colleges. Rockville: National Institute on Alcohol Abuse and Alcoholism (NIAAA); 2002. Accessed on June 20, 2012
Webpage: http://www.collegedrinkingprevention.gov/NIAAACollegeMaterials/TaskForce/TaskForce_TOC.aspx
NICE-Jackson 2010 - Jackson R, Johnson M, Campbell F, et al. Screening and brief interventions for prevention and early identification of alcohol use disorders in adults and young people. Sheffield: ScHARR Public Health Collaborating Centre; NICE Centre for Public Health Excellence. Accessed on July 1, 2012
Webpage: http://www.nice.org.uk/nicemedia/live/11828/45665/45665.pdf
Seigers 2011* - Seigers DKL, Carey KB. Screening and brief interventions for alcohol use in college health centers: A review. Journal of American College Health. 2011;59(3):151-8. Accessed on July 1, 2012
Webpage: http://www.tandfonline.com/doi/abs/10.1080/07448481.2010.502199
WHO-Screening and brief intervention - World Health Organization (WHO). Screening and brief intervention for alcohol problems in primary health care. Accessed on July 27, 2011
Webpage: http://www.who.int/substance_abuse/activities/sbi/en/index.html#
Yuma-Guerrero 2012* - Yuma-Guerrero PJ, Lawson KA, Velasquez MM, et al. Screening, brief intervention, and referral for alcohol use in adolescents: A systematic review. Pediatrics. 2012;130(1). Accessed on July 1, 2012
Webpage: http://pediatrics.aappublications.org/content/early/2012/05/29/peds.2011-1589.short

Citations - Implementation Examples

APHA-SBI Manual 2008 - American Public Health Association (APHA), Education Development Center, Inc. Alcohol screening and brief intervention: A guide for public health practitioners. Washington, DC: National Highway Traffic Safety Administration (NHTSA), US Department of Transportation (US DOT). Accessed on July 1, 2012
Webpage: http://www.adp.cahwnet.gov/SBI/pdfs/Alcohol_SBI_Manual.pdf
SAMHSA-SBIRT - SAMHSA-HRSA Center for Integrated Health Solutions. SBIRT: Screening, brief intervention, and referral to treatment. Accessed on July 1, 2012
Webpage: http://www.integration.samhsa.gov/clinical-practice/sbirt
UWSMPH-SBIRT - Department of Family Medicine. Screening, brief intervention and referral to treatment (SBIRT). University of Wisconsin School of Medicine and Public Health (UWSMPH). Accessed on June 20, 2012
Webpage: http://www.fammed.wisc.edu/research/external-funded/screening-brief-intervention-and-referral-treatment-sbirt

* Journal subscription may be required for access.

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Health Factors

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Evidence Rating

Level of effectiveness based on a scan of academic literature and key recommendations of leading organizations.

  • Scientifically Supported Numerous studies or systematic review(s) with positive results
  • Some Evidence Research suggests positive impacts; further study may be warranted
  • Expert Opinion Recommended by credible groups*; research evidence limited
  • Insufficient Evidence Evidence limited or unavailable; further study warranted
  • Mixed Evidence Evidence mixed; further study warranted
  • Evidence of Ineffectiveness Research consistently shows program is detrimental or has no effect

Although many policies and programs are recommended by credible groups, we apply the rating ‘expert opinion’ only when policies are recommended but limited scientific evidence of effectiveness is available.

* The American Heritage Dictionary defines credible as 'capable of being believed; plausible.' and 'worthy of confidence; reliable.' To be considered an 'expert recommendation,' policies and programs must be recommended by one or more organizations that are recognized for their impartial expertise in the area of interest and have limited evidence available.

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Impact on Health Disparities

Likely impact of a given policy or program on racial/ethnic, socioeconomic, geographic or other disparities in Wisconsin based on its characteristics (e.g., target audience, mode of delivery, etc.) and best available evidence related to disparities.

  • Likely to decrease disparities
  • No impact on disparities likely
  • Likely to increase disparities