Fast Facts

Prevalence & Impact of Hazardous & Harmful (“Risky”) Drinking

• 30% of Americans are risky drinkers, & another 9% meet diagnostic criteria for alcohol abuse or dependence.¹
• Third leading cause of preventable death in the U.S.: 85,000 deaths per year, representing 5% of all deaths.^1,2
• High morbidity & mortality related to injuries, liver disease, cardiovascular disease, cancer, motor vehicle crashes, suicide, and homicide.²
• Estimated economic cost = $185 billion.� This exceeds the cost of drug abuse ($100 billion), cancer ($107 billion) or coronary heart disease ($96 billion).^1,4

Efficacy of Brief Interventions

• 19 clinical trials between 1983 and 2001 found that brief interventions by primary care clinicians reduce alcohol consumption among hazardous and harmful drinkers by an average of 34%.⁵
• Follow-up of patients receiving brief interventions in Wisconsin found continued reductions in drinking for 48 months,⁶ as well as reductions in hospitalizations, reductions in emergency room visits, and net cost savings per intervention of $546 in medical costs and $7,780 in related social costs
• US Preventive Services Task Force now recommends screening and brief intervention for hazardous and harmful alcohol use for all primary care patients age 18 and over.⁷
  • Evidence for effectiveness is high (B rating)
  • Same rating as cholesterol screening & flu vaccine for the elderly
• Patient acceptance rates for routine alcohol screening procedures are high.⁸
• Single question screening can identify more than 80% of hazardous and harmful drinkers.⁹

The Importance of Clinician Training

• Less than half of self-reported problem drinkers are asked by their primary care physicians about their alcohol consumption or advised to quit drinking or cut back. ⁴
• Training increases clinician confidence and self-efficacy in performing brief intervention and increases rates of brief intervention.^10,11
• Trained clinicians typically intervene with more than 70% of patients.^12,13,14
• Effective models exist for implementing screening and brief intervention in residency training. ¹⁴

  
  REFERENCES

1. Saitz, R. Clinical practice. unhealthy alcohol use. N Engl J Med. 2005;352:596-607.

2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the united states, 2000. JAMA. 2004;291:1238-1245.

3. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347-1360.

4. D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: Results from a national survey. Med Care. 2005;43:229-236.

5. Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Reduction of alcohol consumption by brief alcohol intervention in primary care: Systematic review and meta-analysis. Arch Intern Med. 2005;165:986-995.

6. Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL. Brief physician advice for problem drinkers: Long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002;26:36-43.

7. U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement. Ann Intern Med. 2004;140:554-556.

8. Higgins-Biddle JC. Alcohol screening and brief intervention. 2001;Powepoint Presentation. Available from: http://www.jointogether.org/sa/action/dt/conference/instituteII/HigginsbiddleBI.ppt.

9. Williams R, Vinson DC. Validation of a single screening question for problem drinking. J Fam Pract. 2001;50:307-312.

10. Kaner EF, Wutzke S, Saunders JB, et al. Impact of alcohol education and training on general practitioners' diagnostic and management skills: Findings from a world health organization collaborative study. J Stud Alcohol. 2001;62:621-627

11 Babor TF, Higgins-Biddle JC, Higgins PS, Gassman RA, Gould BE. Training medical providers to conduct alcohol screening and brief interventions. Subst Abus. 2004;25:17-26.

12. Adams A, Ockene JK, Wheller EV, Hurley TG. Alcohol counseling: Physicians will do it. J Gen Intern Med. 1998;13:692-698.

13. Babor TE, Higgins-Biddle J, Dauser D, Higgins P, Burleson JA. Alcohol screening and brief intervention in primary care settings: Implementation models and predictors. J Stud Alcohol. 2005;66:361-368.

14. Seale JP, Shellenberger S, Tillery WK, Boltri J, Vogel R, Barton B, McCauley M: Implementing alcohol screening & intervention in a family medicine residency clinic. Substance Abuse 2004; 25: in press.