As the 3rd leading cause of preventable death in the U.S., unhealthy alcohol use is often screened for during routine healthcare.
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As the 3rd leading cause of preventable death in the U.S., unhealthy alcohol use is often screened for during routine healthcare.
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The Veterans Health Administration (VA), screens over 90% of outpatient clients for unhealthy alcohol use and has created several initiatives to promote brief intervention for these patients.
This study by Williams and colleagues was a naturalistic investigation of the effectiveness of a screening and brief intervention program for unhealthy alcohol use in the Veterans Administration (VA) for post military veterans. The authors used data from VA outpatients receiving care in 30 medical centers in the northern and western U.S. Patients were considered “regular users of care” if they received two documented alcohol screens at least 270 days apart between January 2004 and December 2008.
The Veterans Administration (VA) protocol used the short, 3-item version of the Alcohol Use Disorders Identification Test (AUDIT-C) to assess for unhealthy alcohol use. The VA performance measure required brief intervention for patients scoring a 5 or greater on the AUDIT-C. Because this study evaluated the VA brief intervention performance measure in the earliest phases of implementation, only patients that screened positive for unhealthy alcohol use within the first six months of the program (between October 2007 and April 2006) were included in analyses. Unhealthy alcohol use severity was then categorized based on score as mild (5), moderate (6-7), severe (8-9), and very severe (10-12).
Patients were considered to have received a documented brief intervention if they received advice to reduce or abstain from drinking between initial and follow-up AUDIT-C screens. The main outcome, resolution of unhealthy alcohol use, was defined as scoring 5 or less on the follow-up AUDIT-C screen and having at least a 2-point reduction in score.
Of the 269,937 regular users of care receiving an initial AUDIT-C screen during the first 6 months of brief intervention implementation, 22,214 (8%) had a score greater than or equal to 5 (i.e., unhealthy alcohol use). Only 6210 (28%) of these patients had a follow-up screen and thus were included in the analysis. Of these, 1751 (28%) received a documented brief intervention. The amount of documented brief interventions varied considerably by facility with 0 to 68% of patients receiving a brief intervention.
Patients receiving a brief intervention were more likely to be older, use tobacco, have more severe unhealthy alcohol use, have a high level of physical comorbidity, mental health conditions and other substance use disorders than those who did not receive a brief intervention.
At follow-up screening, 2922 (47%) of all patients screened at both time points resolved their unhealthy alcohol use with an average decrease in AUDIT-C score of 2.63. Forty-eight percent of patients receiving a brief intervention resolved unhealthy alcohol use and 47% of patients not receiving a brief intervention resolved unhealthy alcohol use. There was no significant difference in the rate of unhealthy alcohol use resolution between these two groups.
Because screening and brief intervention is designed primarily to target individuals with unhealthy alcohol use not rising to the level of substance use disorder, the authors performed several other analyses to determine if individuals with less severe unhealthy alcohol use may have benefitted from the screening and brief intervention. However, outcomes for each group remained similar for those with and without brief intervention even when looking at patients only with AUDIT-C < 8, patients without documented alcohol use disorder, and patients who had not received Veterans Administration (VA) addiction treatment services in the past year.
Among patients at 30 Veterans Administration (VA) medical centers, rates of documented brief intervention were low (28%) and varied by facility (0 to 68%) despite all patients in this study meeting criteria to receive a brief intervention. However, regardless of whether or not a brief intervention was documented, almost half of patients resolved unhealthy alcohol use at follow-up.
Although there are several nuances here, including aggregating participants from four separate studies, this study is an important addition to the adolescent treatment/recovery literature in understanding unique clinical profiles and needs.
Patients with certain characteristics (e.g., more severe alcohol use and comorbidities) were more likely to receive a documented brief intervention. Further research is needed to understand why this was the case. Since there was no difference in rates of unhealthy alcohol use resolution between groups, there may be an effect of the screening instrument itself such that patients may decrease alcohol intake following screening alone. This kind of effect from simply being asked about one’s alcohol use has been shown before; it may help people think more deeply about how alcohol is affecting their health and consequently cause them to make changes in their drinking.
If brief intervention is successful in this setting, other systems of care may be able to adapt approaches from the VA’s model.
The AUDIT-C is a common screening tool for unhealthy alcohol use in clinical practice. Since this study used a cutoff of 5 for unhealthy alcohol use in this particular population (i.e. Veterans, Military), results may not generalize to other clinical settings which often use a cutoff of ≥3 for women and ≥4 for men. Brief interventions have previously been proven effective in primary care settings, so there may be specific challenges to implementation when working with a large healthcare system like the VA and populations with high rates of substance use issues.
Regarding implementing brief intervention protocols in the clinical setting, this study focused on the early stages of the implementation, so the analysis should be repeated in the future to determine if the program has become more effective and broadened its reach over time.
Williams, E. C., Rubinsky, A. D., Chavez, L. J., Lapham, G. T., Rittmueller, S. E., Achtmeyer, C. E., & Bradley, K. A. (2014). An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration. Addiction, 109(9), 1472-1481. doi:10.1111/add.12600
l
The Veterans Health Administration (VA), screens over 90% of outpatient clients for unhealthy alcohol use and has created several initiatives to promote brief intervention for these patients.
This study by Williams and colleagues was a naturalistic investigation of the effectiveness of a screening and brief intervention program for unhealthy alcohol use in the Veterans Administration (VA) for post military veterans. The authors used data from VA outpatients receiving care in 30 medical centers in the northern and western U.S. Patients were considered “regular users of care” if they received two documented alcohol screens at least 270 days apart between January 2004 and December 2008.
The Veterans Administration (VA) protocol used the short, 3-item version of the Alcohol Use Disorders Identification Test (AUDIT-C) to assess for unhealthy alcohol use. The VA performance measure required brief intervention for patients scoring a 5 or greater on the AUDIT-C. Because this study evaluated the VA brief intervention performance measure in the earliest phases of implementation, only patients that screened positive for unhealthy alcohol use within the first six months of the program (between October 2007 and April 2006) were included in analyses. Unhealthy alcohol use severity was then categorized based on score as mild (5), moderate (6-7), severe (8-9), and very severe (10-12).
Patients were considered to have received a documented brief intervention if they received advice to reduce or abstain from drinking between initial and follow-up AUDIT-C screens. The main outcome, resolution of unhealthy alcohol use, was defined as scoring 5 or less on the follow-up AUDIT-C screen and having at least a 2-point reduction in score.
Of the 269,937 regular users of care receiving an initial AUDIT-C screen during the first 6 months of brief intervention implementation, 22,214 (8%) had a score greater than or equal to 5 (i.e., unhealthy alcohol use). Only 6210 (28%) of these patients had a follow-up screen and thus were included in the analysis. Of these, 1751 (28%) received a documented brief intervention. The amount of documented brief interventions varied considerably by facility with 0 to 68% of patients receiving a brief intervention.
Patients receiving a brief intervention were more likely to be older, use tobacco, have more severe unhealthy alcohol use, have a high level of physical comorbidity, mental health conditions and other substance use disorders than those who did not receive a brief intervention.
At follow-up screening, 2922 (47%) of all patients screened at both time points resolved their unhealthy alcohol use with an average decrease in AUDIT-C score of 2.63. Forty-eight percent of patients receiving a brief intervention resolved unhealthy alcohol use and 47% of patients not receiving a brief intervention resolved unhealthy alcohol use. There was no significant difference in the rate of unhealthy alcohol use resolution between these two groups.
Because screening and brief intervention is designed primarily to target individuals with unhealthy alcohol use not rising to the level of substance use disorder, the authors performed several other analyses to determine if individuals with less severe unhealthy alcohol use may have benefitted from the screening and brief intervention. However, outcomes for each group remained similar for those with and without brief intervention even when looking at patients only with AUDIT-C < 8, patients without documented alcohol use disorder, and patients who had not received Veterans Administration (VA) addiction treatment services in the past year.
Among patients at 30 Veterans Administration (VA) medical centers, rates of documented brief intervention were low (28%) and varied by facility (0 to 68%) despite all patients in this study meeting criteria to receive a brief intervention. However, regardless of whether or not a brief intervention was documented, almost half of patients resolved unhealthy alcohol use at follow-up.
Although there are several nuances here, including aggregating participants from four separate studies, this study is an important addition to the adolescent treatment/recovery literature in understanding unique clinical profiles and needs.
Patients with certain characteristics (e.g., more severe alcohol use and comorbidities) were more likely to receive a documented brief intervention. Further research is needed to understand why this was the case. Since there was no difference in rates of unhealthy alcohol use resolution between groups, there may be an effect of the screening instrument itself such that patients may decrease alcohol intake following screening alone. This kind of effect from simply being asked about one’s alcohol use has been shown before; it may help people think more deeply about how alcohol is affecting their health and consequently cause them to make changes in their drinking.
If brief intervention is successful in this setting, other systems of care may be able to adapt approaches from the VA’s model.
The AUDIT-C is a common screening tool for unhealthy alcohol use in clinical practice. Since this study used a cutoff of 5 for unhealthy alcohol use in this particular population (i.e. Veterans, Military), results may not generalize to other clinical settings which often use a cutoff of ≥3 for women and ≥4 for men. Brief interventions have previously been proven effective in primary care settings, so there may be specific challenges to implementation when working with a large healthcare system like the VA and populations with high rates of substance use issues.
Regarding implementing brief intervention protocols in the clinical setting, this study focused on the early stages of the implementation, so the analysis should be repeated in the future to determine if the program has become more effective and broadened its reach over time.
Williams, E. C., Rubinsky, A. D., Chavez, L. J., Lapham, G. T., Rittmueller, S. E., Achtmeyer, C. E., & Bradley, K. A. (2014). An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration. Addiction, 109(9), 1472-1481. doi:10.1111/add.12600
l
The Veterans Health Administration (VA), screens over 90% of outpatient clients for unhealthy alcohol use and has created several initiatives to promote brief intervention for these patients.
This study by Williams and colleagues was a naturalistic investigation of the effectiveness of a screening and brief intervention program for unhealthy alcohol use in the Veterans Administration (VA) for post military veterans. The authors used data from VA outpatients receiving care in 30 medical centers in the northern and western U.S. Patients were considered “regular users of care” if they received two documented alcohol screens at least 270 days apart between January 2004 and December 2008.
The Veterans Administration (VA) protocol used the short, 3-item version of the Alcohol Use Disorders Identification Test (AUDIT-C) to assess for unhealthy alcohol use. The VA performance measure required brief intervention for patients scoring a 5 or greater on the AUDIT-C. Because this study evaluated the VA brief intervention performance measure in the earliest phases of implementation, only patients that screened positive for unhealthy alcohol use within the first six months of the program (between October 2007 and April 2006) were included in analyses. Unhealthy alcohol use severity was then categorized based on score as mild (5), moderate (6-7), severe (8-9), and very severe (10-12).
Patients were considered to have received a documented brief intervention if they received advice to reduce or abstain from drinking between initial and follow-up AUDIT-C screens. The main outcome, resolution of unhealthy alcohol use, was defined as scoring 5 or less on the follow-up AUDIT-C screen and having at least a 2-point reduction in score.
Of the 269,937 regular users of care receiving an initial AUDIT-C screen during the first 6 months of brief intervention implementation, 22,214 (8%) had a score greater than or equal to 5 (i.e., unhealthy alcohol use). Only 6210 (28%) of these patients had a follow-up screen and thus were included in the analysis. Of these, 1751 (28%) received a documented brief intervention. The amount of documented brief interventions varied considerably by facility with 0 to 68% of patients receiving a brief intervention.
Patients receiving a brief intervention were more likely to be older, use tobacco, have more severe unhealthy alcohol use, have a high level of physical comorbidity, mental health conditions and other substance use disorders than those who did not receive a brief intervention.
At follow-up screening, 2922 (47%) of all patients screened at both time points resolved their unhealthy alcohol use with an average decrease in AUDIT-C score of 2.63. Forty-eight percent of patients receiving a brief intervention resolved unhealthy alcohol use and 47% of patients not receiving a brief intervention resolved unhealthy alcohol use. There was no significant difference in the rate of unhealthy alcohol use resolution between these two groups.
Because screening and brief intervention is designed primarily to target individuals with unhealthy alcohol use not rising to the level of substance use disorder, the authors performed several other analyses to determine if individuals with less severe unhealthy alcohol use may have benefitted from the screening and brief intervention. However, outcomes for each group remained similar for those with and without brief intervention even when looking at patients only with AUDIT-C < 8, patients without documented alcohol use disorder, and patients who had not received Veterans Administration (VA) addiction treatment services in the past year.
Among patients at 30 Veterans Administration (VA) medical centers, rates of documented brief intervention were low (28%) and varied by facility (0 to 68%) despite all patients in this study meeting criteria to receive a brief intervention. However, regardless of whether or not a brief intervention was documented, almost half of patients resolved unhealthy alcohol use at follow-up.
Although there are several nuances here, including aggregating participants from four separate studies, this study is an important addition to the adolescent treatment/recovery literature in understanding unique clinical profiles and needs.
Patients with certain characteristics (e.g., more severe alcohol use and comorbidities) were more likely to receive a documented brief intervention. Further research is needed to understand why this was the case. Since there was no difference in rates of unhealthy alcohol use resolution between groups, there may be an effect of the screening instrument itself such that patients may decrease alcohol intake following screening alone. This kind of effect from simply being asked about one’s alcohol use has been shown before; it may help people think more deeply about how alcohol is affecting their health and consequently cause them to make changes in their drinking.
If brief intervention is successful in this setting, other systems of care may be able to adapt approaches from the VA’s model.
The AUDIT-C is a common screening tool for unhealthy alcohol use in clinical practice. Since this study used a cutoff of 5 for unhealthy alcohol use in this particular population (i.e. Veterans, Military), results may not generalize to other clinical settings which often use a cutoff of ≥3 for women and ≥4 for men. Brief interventions have previously been proven effective in primary care settings, so there may be specific challenges to implementation when working with a large healthcare system like the VA and populations with high rates of substance use issues.
Regarding implementing brief intervention protocols in the clinical setting, this study focused on the early stages of the implementation, so the analysis should be repeated in the future to determine if the program has become more effective and broadened its reach over time.
Williams, E. C., Rubinsky, A. D., Chavez, L. J., Lapham, G. T., Rittmueller, S. E., Achtmeyer, C. E., & Bradley, K. A. (2014). An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration. Addiction, 109(9), 1472-1481. doi:10.1111/add.12600
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