Article

Alcohol Screening and Brief Intervention (SBI)

Strategies for effective prevention

Anant Das
Solution Architect, CitiusTech

Renuka Belani
Tech Lead, CitiusTech

Sept - 11

Insights

The importance of recognizing the considerable morbidity and mortality caused by alcohol, the need of the hour is to reduce unhealthy drinking at the population level.
The WHO recommends developing tools to screen for unhealthy drinking and brief interventions to reduce it among general medical patients apart from only addressing alcohol use through specialty treatment facilities.
Alcohol Screening and Brief Intervention (SBI) seeks to reduce the consequences of unhealthy drinking (e.g., injuries) and to prevent progression to more serious alcohol use disorders (AUDs).

Introduction

Alcohol SBI is a preventive service, like blood pressure or cholesterol screening, which can be performed during a patient's wellness visit. It identifies and helps individuals who are drinking more than the recommended amounts. Alcohol SBI involves:

A validated set of screening questions, which only take a few minutes to complete, to identify patients' drinking patterns.
A short conversation with patients who are drinking more than the recommended amounts, as well as referral to treatment when appropriate.

A few common categories of excessive alcohol consumption include:

Binge drinking: Five or more drinks for men and four or more drinks for women within two hours. More than 37 million American adults binge drink.
Heavy drinking: More than 14 drinks a week for men and more than seven a week for women. According to the Behavioral Risk Factor Surveillance System’s recent survey, about 7% of adults reported heavy drinking.
Pregnant women: Any amount of alcohol consumption. On average, 11.5% of pregnant women aged 18–44 years in the United States reported drinking alcohol. Among pregnant women who reported consuming alcohol, one-third engaged in binge drinking.
Youth younger than 21 years of age: Any alcohol consumption. Around 60.4% of high school students reported having at least one drink of alcohol on at least one day during their life (i.e., ever drank alcohol)

Alcohol SBI – Strategies and its effectiveness

The effectiveness of Alcohol Screening and Brief Intervention strategies depends upon how the intervention has been conducted on different classes of people depending upon their alcohol consumption.The alcohol consumption has been classified into three categories:

Low-risk use: This covers usage such as abstention, experimental, or social use and thus requires very little to no intervention.
Harmful/Moderate risk use: This category covers alcohol usage such as abuse or binge use. People falling under this umbrella require brief interventions ranging from 10-15 minutes of more than one motivational session.
Dependent/High risk use: This category includes substance use disorder where a patient is alcohol addicted and cannot perform his/her daily life activities without alcohol. Here, the patient is expected to attend multiple sessions in addition to proper treatment.

Alcohol SBI - Effectiveness

Risky drinking can result in problems that create costs for the individual drinkers, their families, and entire communities. Communities are affected financially by the increase in health care, public safety, and social service costs and emotionally by the increase in illness, disability, and death. SBI can help reduce these costs and improve the health of communities. Hence, Community-Based Public Health Response to risky drinking is indispensable.

As per a study published in Journal of Medical Internet Research, conducted by Kim Donoghue and her team, a comprehensive systematic review and meta-analysis of the available literature to determine the effectiveness of Alcohol SBI over time in nontreatment-seeking hazardous/harmful drinkers considering a population health was carried out. The study concluded that a significant reduction in weekly alcohol consumption between intervention and control conditions was demonstrated between three months and less than 12 months follow-up, indicating Alcohol SBI is an effective intervention.

3-Sep-22-2023-03-11-59-8464-PM

Study Published in Journal of Medical Internet Research - Mean Difference in Grams of Ethanol Consumed Per Week Between Those Receiving An Alcohol SBI Versus Controls

To reiterate the effectiveness of Alcohol SBI, let's look into the use case given below.

Use Case - Cost-Saving opportunities through prevention

The client - a large health provider in New Mexico, observed excessive Alcohol Use was leading to widespread harm among its member population. Some of the common problems reported from excessive use of alcohol were miscarriage and stillbirth among pregnant women, motor vehicle crashes, violence, death, and so on. Hence, through clinical data integration, they endeavored to surface the population addicted to unhealthy use of alcohol, screen them, and provide proper care through a tool called Alcohol SBI.

Impact of SBI:

By implementing Alcohol SBI using CDI data, the client was successfully able to -

Reduce alcohol-related risks
Decrease incidences of violence
Reduce ER visits and admissions related to alcohol
Overall, a significant decrease in alcohol use health care costs

In the course of six months after implementation, a decrease of 20% was seen among ER visits and admissions related to alcohol use, which is expected to decrease further down the line.

Solution Highlights:

Reduced manual efforts: The tactical approach to integrate clinical data (ADT) manually was overcome with the CTOS solution - CDI.
Increased the revenue: The client could effectively enhance the member population’s health by implementing this health screening tool and providing the optimal care along with other initiatives. This has incurred lauds and monetary bonuses.
Streamlined processes: With clinical data container being highly available, the overall process to cleanse and enhance data with SDOH datasets, apply requirement algorithm, surface and filter alcohol users, provide screening and dedicated care has been automated. The whole process is automatic and generates smart alerts which are sent to care managers to outreach respective members and provide quality and dedicated care at optimal costs.

The below model shows how Alcohol SBI program is effective in reducing alcohol-related harms.

Model Showing Alcohol SBI’s Effectiveness in Reducing Alcohol-Related Risk

The below figure demonstrates the opportunities where the ER visit can be reduced through SBI and this can lead to cost saving for payers and improve quality of service for providers. This will in turn lead to quality of life for members.

Cost Saving Opportunities Through Prevention

Conclusion

Like blood pressure or cholesterol screening, Alcohol SBI is a preventive service. The effectiveness of the above-mentioned strategies depends upon how the intervention has been conducted and alcohol consumption. Alcohol abuse affects communities financially by the increase in health care, public safety, and social service costs and emotionally by the increase in illness, disability, and death. SBI can help reduce these costs and improve the health of communities. Hence, Community-Based Public Health Response to risky drinking is indispensable.