Screening and Brief Intervention

Screening and brief intervention (SBI) is effective at reducing risky drinking and alcohol-related problems. Problem drinking occurs when alcohol is used in a way that can be harmful to the drinker or others, causing injury, disease or other health problems. SBI has been rigorously studied in a variety of settings and delivered by a variety of providers, and research has shown consistent effectiveness in reducing drinking and alcohol-related problems. An analysis of over 360 rigorous research studies found that SBI is the most cost-effective alcohol treatment strategy.

The traffic safety community is taking notice of SBI as an effective strategy to help reduce impaired driving. The National Highway Traffic Safety Administration (NHTSA) is promoting alcohol screening and brief intervention in medical and community settings. In fact, SBI is one of three of NHTSA’s priority initiatives to reduce driving while impaired, joining high visibility law enforcement and support for prosecutors and DWI courts as strategies that work.

How does it work?
SBI can be a quick and easy intervention. It works by first identifying when someone has risky drinking behaviors through a set of simple questions. Trained interviewers use a tested, validated questionnaire. Popular questionnaires include the ten-question Alcohol Use Disorders Identification Test (AUDIT). The World Health Organization has a guide for administering and scoring AUDIT (PDF download). Answers to AUDIT can be quickly tallied and scored. The ten questions are:
1. How often do you have a drink containing alcohol?
2. How many drinks containing alcohol do you have on a typical day when you are drinking?
3. How often do you have six or more drinks on one occasion?
4. How often during the last year have you found that you were not able to stop drinking once you had started?
5. How often during the last year have you failed to do what was normally expected from you because of drinking?
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
9. Have you or someone else been injured as a result of your drinking?
10. Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?

Shorter questionnaires are also available when there may not be time for 10 questions.

After identifying risky drinking behavior, a brief educational intervention can be held to give feedback. This is a series of short one-on-one discussions or counseling sessions appropriate for people who have harmful drinking habits. It is not treatment for alcoholism, which has different goals. The goal of brief intervention is to moderate the consumption of alcohol and help eliminate risky use. For example it may seek to reduce excessive binge drinking to a more sensible level, rather than abstinence from alcohol. There are a variety of ways to do a brief intervention, but typically it is one or several short counseling sessions conducted by a trained medical, counseling or social work professional. The discussions can be 5-15 minute interviews where outcomes could include creating a plan of action to reduce harmful drinking patterns, or possibly seek substance abuse treatment if needed. The outcomes depend on the person’s readiness to change.

How is SBI delivered?
SBI is delivered in many settings. It is commonly conducted in the emergency room and trauma center either for all patients or after an alcohol-related injury, through Employee Assistance Programs, workplace health risk assessments, online self-assessment surveys, and through behavioral health providers. SBI is also conducted in primary care doctor’s offices and health clinics. Recently patient care codes have been established so insurers can reimburse providers for SBI delivered in medical settings. As of 2008, the Federal Employees Health Benefits program—the largest employer-sponsored health insurance program in the country covering 5.6 million workers—now includes coverage for SBI.

Why is this significant for the workplace?
Consider these statistics:
-- Over 23 million Americans meet the clinical definition of substance abuse or addiction, according to the 2007 National Survey on Drug Use and Health. It is estimated that 95.5 percent of these individuals are unaware of their problem or have not sought treatment or other interventions.
-- Most of these people with a treatable alcohol problem are 18 to 49 years old and are employed full-time.
-- Less than one percent of people with a diagnosable alcohol problem are actually diagnosed.
-- According to the Ensuring Solutions to Alcohol Problems program at George Washington University Medical Center, fewer than 10 percent of working people with serious alcohol problems receive any kind of treatment.
-- One employee in 26 has the disease of alcoholism and one employee in 19 has an alcohol abuse disorder, according to the 2004 and 2005 National Survey on Drug Use and Health.
-- The Ensuring Solutions to Alcohol Problems program found that although these issues affect all industries, some have higher rates than others. Alcohol dependence rates are higher in the hospitality/leisure and construction/mining industries. Also in all industries, men show higher rates of alcohol problems than women.
-- Employees who abuse drugs or alcohol are 3.5 times more likely to be involved in a workplace accident, according to the Substance Abuse and Mental Health Service Administration.
-- Alcohol is a major factor in traffic crashes, injuries and fatalities .

For an extensive discussion of statistics, substance abuse among workers, and impact on the workplace, visit the Department of Labor’s Working Partners for an Alcohol and Drug-Free Workplace.

Screening and Brief Intervention

SBI Resources