Government health agencies are promoting the use of screening and brief intervention programs by developing materials to be used in the process in healthcare settings and by funding research into the most effective methods for healthcare providers.
Screening and brief intervention programs are typically aimed at people whose levels or patterns of use are not diagnosable as alcohol abuse or dependence, but those who are drinking at harmful or hazardous levels.
What Is Screening?Screening is the process by which healthcare providers can identify at-risk drinkers. Screening is not the same as diagnostic testing, which provides a definite diagnosis of a disorder. Instead, screening identifies people who are likely to have the disorder.
Screening is typically accomplished by asking the person a series of questions about situations associated with drinking problems. In busy healthcare settings, these screening tests or quizzes are typically short -- sometimes as few as four or five questions -- and can be scored or evaluated very quickly.
How Do Screening Tests Work?Typically, people who have a drinking problem will minimize or deny how much they drink if they are asked directly about their alcohol consumption. Therefore, most alcohol screening tests ask questions about problems associated with drinking, rather than questions about the amount the person consumes.
There are many screening tests available for healthcare providers to use to determine if a patient may have a drinking problem or alcohol use disorder. The most effective tests are those which have a higher level of sensitivity and specificity. In other words, the test needs to be able to tell which patients have a drinking problem (sensitivity) and also determine which patients do not (specificity).
But none of the tests work unless the healthcare provider is willing to use them.
What Is Brief Intervention?Brief intervention is usually one-time or repeated short counseling sessions between a trained healthcare professional and a patient who has been identified as having a substance abuse problem. Usually, these interventions are conducted by professionals who do not specialize in alcohol treatment, but who will refer patients to treatment, if necessary.
The goal of the brief intervention session is to get patients to reduce their alcohol consumption to nonhazardous levels and to eliminate binge drinking, rather than insist that the person stop drinking altogether. Although total abstinence may be an appropriate goal for some patients referred to treatment, in the healthcare setting the aim is to reduce harmful drinking levels and problems associated with drinking, such as alcohol-related medical problems, domestic violence, accidents, arrests or birth defects.
How Does Brief Intervention Work?Brief intervention for alcohol problems has been found to be effective in the healthcare setting because typically the patient is seeking medical attention and is in a "teachable moment" in their lives. Whether the patient is in a primary care setting, emergency or urgent care center, hospital or ob-gyn office, the healthcare provider is in a unique position to identify patients with potential alcohol problems and intervene when appropriate.
The brief intervention sessions are designed to encourage patients to reduce their alcohol use without creating resistance. Because the suggestion to reduce alcohol consumption comes from an "authority figure" in a healthcare setting in which patients may be facing the consequences of their drinking, these interventions are proving to be very effective.
How Effective Is Screening and Brief Intervention?There is a growing body of research that shows that screening and brief intervention are useful in a variety of healthcare settings and are potentially cost-effective in reducing hazardous or harmful alcohol consumption. They are particular effective in primary care settings and emergency or trauma centers, when patients find themselves open to changes in their alcohol use.
However, some research has shown that the long-term effect of the brief intervention approach may be somewhat limited. Other studies have shown that brief interventions delivered via computer software or the Internet can be also be effective, but it is not known if these efforts are as effective as interventions delivered by an authority figure in person.
Help For Healthcare ProvidersThe National Institute on Alcohol Abuse and Alcoholism has developed a guide for health care providers to assist physicians, nurses, and other health care professionals in screening patients for alcohol problems and conducting brief interventions for those problems. The guide is available online.
National Institute on Alcohol Abuse. "Screening and Brief Intervention Part I – An Overview." 2005.
National Institute on Alcohol Abuse. "Screening and Brief Intervention Part II – A Focus on Specific Settings." 2005