Implementation of Screening and Brief Intervention Had an Effect on Unhealthy Alcohol Use in a Large Integrated Health System

Many individuals’ drinking exceeds recommended limits without meeting criteria for alcohol use disorder (AUD). Guidelines recommend screening, brief intervention and referral to treatment (SBIRT) for individuals with unhealthy alcohol use, based on clinical trials showing efficacy. The effectiveness in real-world implementation of alcohol brief intervention (ABI) is less clear. Researchers at Kaiser Permanente Northern California investigated the effectiveness of an ABI initiative that included medical assistants administering a single-question screening for all adult patients at least annually.

• Over a 4-year period, 312,056 patients who screened positive, were continuously enrolled in the year prior and age ≤85 were included in this study.
• Of these eligible patients, 48% received an ABI. At 12 months, those who received the ABI had greater reductions in heavy drinking days (mean difference, -0.26), drinking days in a week (-0.05), and drinks in a week (-0.16). Improvements were not seen among those with an AUD diagnosis prior to screening.
• Patients who received an ABI were not more likely to receive specialty AUD treatment (either outpatient visits or pharmacotherapy), but those who did had significantly better drinking outcomes.

Comments: This study shows that a single-question screening had a modest effect on subsequent drinking among those with unhealthy alcohol use (but not AUD). This is consistent with prior studies showing efficacy for unhealth alcohol use but not AUD.  The intervention did not seem to have an effect on referral to treatment. Primary care clinicians are increasingly burdened with a long list of recommended screening measures (along with other expectations); it is unclear to what extent this intervention should be a priority.

Darius A. Rastegar, MD

Reference: Chi FW, Parthasarathy S, Palzes VA, et al. Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: results from a systematic alcohol screening and brief intervention initiative in adult primary care. Drug Alcohol Depend. 2022;235:109458.