Alcohol Misuse: Impact , Screening , and Brief Interventions
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Transcript of Alcohol Misuse: Impact , Screening , and Brief Interventions
Alcohol Misuse: Impact, Screening, and
Brief Interventions
Vince Fonseca, MD, MPH, FACPM2011 State Agency Wellness Conference
Overview
• Background and prevalence• Impact• Screening and Brief Interventions
Background and Prevalence
Actual Causes of Death
Alcohol Misuse• A substance use disorder refers to misuse of,
dependence on or abuse of alcohol or other drugs.
• About 19.2 million U.S. workers (15%) reported using or being impaired by alcohol at work at least once in the past year.3
• Alcohol is by far the most widely used drug in the United States: 11% of workers have a problem with alcohol.3
3.“Prevalence and distribution of alcohol use and impairment in the workplace: A U.S. national survey,” J Stud. Alcohol, 67, 1: 147-156, January 2006.
National Objectives• Healthy Workforce 2010: Reduce the cost of lost productivity
in the workplace due to alcohol and drug use. (Developmental)
• Healthy People 2020:– SA14.3 Reduce the proportion of persons engaging in binge drinking
during the past month—Adults aged 18 years and older (27% NSDUH down to 24.3%)
– SA15 Reduce the proportion of adults who drank excessively in the previous 30 days (28.1 to 25.3%)
– SA17 Decrease the rate of alcohol-impaired driving fatalities (.08+ blood alcohol content [BAC]) (.4 to .38 per 100M miles driven)
Texas Adults, Binge-drinking, 2010 BRFSS
Age Group Drinker % 95% CI Binge (% of adults) Binge (% drinkers)
18-2443.9 (36.3-51.4) 21.4 (15.1-27.8)
48.7%
25-3453.9 (49.6-58.2) 21.3 (17.7-24.9)
39.5%
35-4454.5 (51.1-57.9) 16.7 (14.0-19.5)
30.6%
45-5452.6 (49.5-55.7) 14.8 (12.6-16.9)
28.1%
55-6449.4 (46.8-52.1) 9.7 (8.1-11.3)
19.6%
65+37 (35.0-39.1) 3.3 (2.7-4.0)
8.9%
SexMale 58.7 (56.3-61.2) 21.2 (19.1-23.4) 36.1%
Female 41.4 (39.6-43.2) 8.3 (7.2-9.4) 20.0%
Adult binge drinking, BRFSS
HP 2010 goal 13.4%
Adult binge drinking, Texas, 2007
14.313.6
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Impact
Alcohol Misuse Impact
• Third leading cause of preventable death in the U.S.
• Contributes to injuries resulting from motor vehicle
crashes, fires, falls, and drowning.
• Contributes to violence such as child abuse, homicide,
suicide and personal assault.
• Many chronic conditions are also attributable to
alcohol use, including gastrointestinal diseases, certain
cancers, mental disorders, and certain cardiovascular
diseases.
Alcohol Misuse Impact-Texas Deaths
Overall Males Females
Chronic Causes 2508 1829 680
Acute Causes 3371 2513 859Total for All Causes 5880 4341 1538
Chronic Causes 2,508
Liver 60%
CVD 15%
Alcohol Use Disorder 12%Acute Causes 3,371
Violence 35%
Unintentional 65%
CDC’s ARDI software estimateshttp://apps.nccd.cdc.gov/DACH_ARDI/Default/Default.aspx
Worksite Impact• Increased healthcare and insurance costs– Healthcare costs for employees with alcohol
problems are twice those for other employees.9 – People who abuse drugs or alcohol are 3.5x more
likely to be involved in a workplace accident than other workers.10
• More turnover – People with drug or alcohol problems were more
likely than others to report having worked for three or more employers in the previous year.13
9 Schneider Institute for Health Policy, Brandeis University, Substance Abuse, The Nation's Number One Health Problem, Princeton, NJ: Robert Wood Johnson Foundation, February 2001: 70.
10 US DHHS, SAMHSA, 1999 National Household Survey on Drug Abuse,Rockville, MD: US DHHS, 2000
13“Worker SubstanceUse and Workplace Policies and Programs,” DHHS Pub No. SMA 07-4273, Rockville, MD: SAMHSA, OAS, 2007.
Worksite Impact• Reduced productivity – More likely to exhibit job withdrawal behaviors,
such as spending work time on non-work-related activities, taking long lunch breaks, leaving early, or sleeping on the job.11
– More likely to experience hangovers that cause them to be absent from work; show up late or leave early; feel sick at work; perform poorly; or argue with their coworkers.11
11“The Cost to Employers of Employee Alcohol Abuse: A Review of the Literature in the USA,” Bulletin on Narcotics, Vol. LII, Nos. 1 & 2, Geneva: United Nations Office on Drugs and Crime, 2000.
Alcohol-related Excess CostsNumber of Workers 250,000
Number with alcohol problem 17,084
Excess workdays lost 683 Cost of excess lost days per year: $1,235,301
Alcohol-related health care costs $37,587,500
Excess Emergency Room Visits at $1,191.81/visit
3,605 excess visits
$4,296,475
Excess Days in the Hospital at $5,306.68/day 929 excess days
$4,929,906
Emergency Department and Hospital Costs $9,226,381
http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/costcalculators.htm
Screening and Intervention
Prevention in the Workplace• Primary Prevention: activities directed at
employed populations that are generally healthy– Below harmful alcohol consumption levels– No relationship, work, or injury problems
• Secondary Prevention: directed at individuals already at higher risk because of certain lifestyle practices (screening and risk reduction)– Consuming harmful amounts of alcohol– Relationship, work, or injury problems
• Tertiary Prevention: disease management– Treatment, referrals, and self-management
Assessment of Health Risk with Feedback and Health Education
Screening and Services Saves $
• When workers with substance use disorders get treatment both employers and employees benefit through: – Better employee health and lower total healthcare
costs over time – Less absenteeism – Improved job performance– Reduced costs associated with short- and long-term
disability and workers’ compensation – Fewer accidents and less corporate liability.14
14 SAMHSA, CSAT, “Substance Abuse in Brief: Effective Treatment SavesMoney,” Rockville, MD: SAMHSA CSAT, January 1999.
Stigma and Shame
• Substance abuse stigma and shame often increases the severity of the problem.
• Individuals may be reluctant to acknowledge that they suffer from alcohol or drug problems
• Individuals may be reluctant unwilling to seek treatment, even if it is available.
Screening and Brief Intervention (SBI)
• SBI identifies and helps people with alcohol problems.
• Through this technique, healthcare professionals use a short interview to learn whether a person has an alcohol problem. When a problem is discovered, a brief intervention of 1-5 short sessions can treat most people. People with more severe problems can be referred to more intensive treatment programs.
Elements of Brief Interventions
• Present screening (e.g. AUDIT) results
• Identify risks and discuss consequences
• Provide medical advice
• Solicit patient commitment
• Identify goal—reduced drinking or abstinence
• Give advice and encouragement
Screening and Brief Intervention (SBI) ROI
% Identified Savings
Cost Net Savings
80% $8,795,335 $2,788,109 $6,007,226
60% $6,596,501 $2,091,082 $4,505,419
40% $4,397,668 $1,742,568 $2,655,100
20% $2,198,834 $697,027 $1,501,807
Baseline: 8% identified …92% receive no services
http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/costcalculators.htm
Direct Medical CostsNational Commission on Prevention Priorities
Health Affairs, 29, no. 9 (2010): 1656-1660• Cost Saving per year
– Discuss daily aspirin use– Smoking cessation advice and help to quit– Alcohol screening and brief counseling– Obesity screening– Pneumococcal immunization (>65 years)– Vision screening (>65 years)
• <$10 per person per year– Tetanus booster– Chlamydia screening– Discuss folic acid use– Influenza immunization—adults 50+
• $15-$50 per person per year– Colorectal cancer screening– Hypertension screening and treatment– Cervical cancer screening– Depression screening – Hearing screening (>65 years)
• $61-$104 per person per year– Osteoporosis screening—women 60+– Breast cancer screening—women 40+ – Cholesterol screening and treatment—men 35+, women 45+
Target High Value Services• Insurance coverage doesn’t mean that high value
services will be delivered• Environmental, policy and system changes• Target high-value services to specific individuals– Use comprehensive HRA (anonymously)
• Behavior change support (tobacco, alcohol, physical activity, healthy eating, breastfeeding)
• Aspirin to prevent heart attack and cardiometabolic control• Cancer screening• Immunization need
– Tailor the message and program• Evaluate outcomes– Reports for ongoing and retrospective results
Workplace Strategies
• Provide employees access to counseling and referrals to treat substance abuse.
• Participate in community efforts to prevent substance abuse.
• Offer an anonymous HRA to all employees, and encourage follow-up services for those at risk.
• Establish or link EAP to health promotion initiatives.
• Establish worksite alcohol and drug policies.