Alcohol Screening and Brief Intervention Efforts

Alcohol Screening and Brief Intervention (SBI) is Effective at Reducing Excessive Drinking. CDC is working to make alcohol SBI a routine part of health care in primary care settings.

What Is Alcohol SBI?

Alcohol SBI is a preventive service, like blood pressure or cholesterol screening, which can occur as part of 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; and
• A short conversation with patients who are drinking more than the recommended amounts, as well as referral to treatment when appropriate.

CDC is working to make alcohol SBI a routine part of health care in primary care settings.

 

MMWR Report: Screening for Alcohol Use and Brief Counseling of Adults

Why is Alcohol SBI Important?

Excessive Alcohol Use* is Common

Binge Drinking*: More than 37 million American adults binge drink.¹

Heavy Drinking*: In 2018, according to the Behavioral Risk Factor Surveillance System survey, about 7% of the adult population reported heavy drinking.²

Pregnant Women*: During 2018–2020, nearly 1 in 7 (14%) pregnant people aged 18–44 years in the United States reported drinking alcohol in the past 30 days, and about 1 in 20 (5%) reported binge drinking in the same time period.³

Youth Younger Than 21 Years of Age*: In 2017, 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).⁴

*Excessive alcohol use includes binge drinking (five or more drinks for men and four or more drinks for women within a 2-hour time period), heavy drinking (more than 14 drinks a week for men and more than seven a week for women), and any alcohol consumption by pregnant women or people younger than 21 years of age.¹¹

Excessive Alcohol Use Leads to Widespread Harm

Alcohol & Pregnancy: Drinking any amount of alcohol during pregnancy can cause a range of physical, behavioral, and learning problems in the baby, called fetal alcohol spectrum disorders (FASDs).⁵ Additionally, drinking during pregnancy is a risk factor for other poor pregnancy outcomes, such as miscarriage and stillbirth.⁶

Health & Social Harm: Excessive alcohol use contributes to a wide range of negative health and social consequences, including motor vehicle crashes and intimate partner violence; over time, it can result in serious medical conditions, such as high blood pressure, digestive problems, liver disease, and various cancers.

Costly & Fatal: According to the ARDI application, during 2015–2019, excessive alcohol use was responsible for more than 140,000 deaths and 3.6 million years of potential life lost each year, on average.

Effective Clinical Interventions are Available

Alcohol SBI Works: More than 30 years of research has shown that alcohol SBI is effective at reducing excessive alcohol use. Based on this evidence, the U.S. Preventive Services Task Force,⁸ as well as many other organizations, have recommended that alcohol SBI be implemented for all adults being seen in primary healthcare settings.

In 2012, the Community Preventive Services Task Force recommended the use of alcohol electronic SBI (eSBI).⁹

About CDC’s Alcohol SBI Activities

CDC’s alcohol SBI initiative includes efforts to support alcohol SBI implementation in medical and other settings, improve tracking of alcohol SBI implementation, and identify and partner with healthcare providers, health systems, and health plans to develop and implement system-level strategies that foster alcohol SBI implementation.

Putting Alcohol SBI into Practice

CDC Developed

• BRFSS Statistical Brief: Alcohol Screening & Brief Intervention Optional Module: This document provides guidance for Behavioral Risk Factor Surveillance System (BRFSS) data users when conducting analyses on the BRFSS Alcohol Screening & Brief Intervention Optional Module data.
• Alcohol SBI Implementation Guide [2 MB, 52 Pages, Print Only]: This Guide provides the process and resources necessary to help staff in any primary healthcare setting plan and implement alcohol SBI, an evidence-based approach recommended for all adults, including pregnant women. The Guide also provides information on excessive use and how it can be addressed through alcohol SBI.
• Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Tribal Communities [2 MB, 62 Pages, 508]: This Guide was adapted from Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices to improve cultural relevance for American-Indian/Alaska-Native communities.
• FASD Prevention Resources: Free, online trainings are available for healthcare providers who care for people at risk for alcohol use during pregnancy, and for those who work with individuals living with fetal alcohol spectrum disorders (FASDs). These online trainings provide strategies to improve the delivery of care related to FASDs and their prevention.

CDC Funded

• Improving Quality of Care through Alcohol SBI and Its Reporting in Electronic Clinical Data Systems: CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) worked with the National Committee for Quality Assurance (NCQA) to promote a Healthcare Effectiveness Data and Information Set (HEDIS) performance measure, Unhealthy Alcohol Use Screening and Follow-Up, or ASF, through a quality improvement learning collaborative with participating health plans. This resulted in the Screening and Follow-Up for Unhealthy Alcohol Use: Quality Improvement Change Package for Health Plans toolkit. This toolkit is designed to help health plans address excessive alcohol use among their members and includes examples of effective quality improvement tools, including strategies and best practices for improving HEDIS measure performance. Alcohol SBI is recommended in primary care settings for all adults aged 18 years and older, including pregnant women.
• Clinical Decision Support for Alcohol Screening and Brief Intervention: CDC funded the MITRE Corporation to develop standards-based clinical decision support (CDS) for alcohol screening and brief intervention. These CDS tools can assist with adoption of this important clinical preventive service in primary care settings. Users can integrate the tools into electronic health record (EHR) systems and other digital formats to inform decisions and improve healthcare delivery.
• Implementing Alcohol SBI in Healthcare Systems Providing Women’s Health Services: To prevent alcohol use during pregnancy, CDC, in 2018, funded organizations providing health services to women. These awardees are focusing on development, implementation, and evaluation of alcohol SBI protocols in primary care clinics, facilitation of system-level approaches, such as integration of electronic health records, and sharing of lessons learned.
• Studying Data: CDC is working to better understand provider behaviors by
  • Analyzing data from national surveys such as the Behavioral Risk Factor Surveillance System, the National Ambulatory Medical Care Survey, and the Pregnancy Risk Assessment Monitoring System.
  • Utilizing health marketing surveys (e.g., ConsumerStyles, DocStyles) to obtain data on provider behaviors.

Strengthening Partnerships to Improve System-level Strategies

CDC is collaborating with medical and professional organizations, academic institutions, non-profit groups, health plans, and other federal agencies to inform strategies that impede or support implementation of alcohol SBI in primary care settings.

• FASD Prevention Resources for Obstetrician-Gynecologists: Materials and online trainings that have been developed by the American College of Obstetricians and Gynecologists (ACOG) for use in OB/GYN settings.
• Resources for Youth: While more research is needed to develop effective brief intervention strategies for adolescents,⁸the American Academy of Pediatrics (AAP) recommends that pediatricians include substance use screening and appropriate intervention practices in their clinical care for adolescents.¹⁰  The following resources are available:

• • Pediatric SBI Implementation Guide: AAP has developed the Substance Use Screening and Intervention Implementation Guide: No Amount of Substance Use is Safe for Adolescents to help incorporate screening, brief intervention, and referral to treatment for use of alcohol, tobacco, marijuana, and other drugs among adolescent patients.
  • Adolescent Screening and Substance Use: In the article Adolescent Screening, Brief Intervention, and Referral to Treatment for Substance Use: An Application for School Social Workers school social workers are encouraged to incorporate adolescent screening, brief intervention, and referral to treatment for substance use. Highlights are drawn from the Pediatric SBI Implementation Guide listed above.

References

1. Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014;11:E109.
2. Centers for Disease Control and Prevention. “Data and Maps” Alcohol and Public Health, CDC. https://www.cdc.gov/alcohol/data-stats.htm, March 27, 2018.
3.  Gosdin LK, Deputy NP, Kim SY, Dang EP, Denny CH. Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years – United States, 2018–2020. MMWR Morbidity and Mortality Weekly Report 2022;71(1): 10-13.
4. Youth Risk Behavior Surveillance – United States, 2017 Morb Mortal Wkly Rep Surveil Summ 2018; 67 (No. SS: 1-479).
5. Riley EP, McGee CL. Fetal alcohol spectrum disorders: An overview with emphasis on changes in brain and behavior. Exp Biol Med (Maywood). 2005;230:357–365.
6. Bailey BA, Sokol RJ. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Res Health. 2011;34(1):86–91.
7. US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(18):1899-1909.
8. Tansil KA, Esser MB, Sandhu P, et al. Alcohol electronic screening and brief intervention: A Community Guide systematic review. Am J Prev Med. 2016;51(5):801–11.
9. American Academy of Pediatrics, Committee on Substance Use and Prevention. 2016 Substance use screening, brief intervention, and referral to treatment [Policy statement]. Pediatrics, 138, 1-3.
10. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8^th Edition. December 2015.