Back to Our Roots: Integrating a Screening and Brief Intervention in Addressing Alcohol Problems...
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Transcript of Back to Our Roots: Integrating a Screening and Brief Intervention in Addressing Alcohol Problems...
Back to Our Roots: Integrating a Screening and Brief
Intervention in Addressing Alcohol Problems
Karen Chan, PhDAssociate Behavioral Scientist
RAND Corporation
October 6, 2006EAPA Conference
Ray Mitchell, MS, CEAPSenior Vice President
APS Healthcare
Paul Davis, PhDRegional Clinical Manager
APS Healthcare
Objectives• Ray Mitchell
– EAP Roots – Recommendations for EAP clients with problem drinking
• Paul Davis– Process of conducting research in the EAP– Balancing clinical, research, and corporate needs for
successful collaboration• Karen Chan
– Outcome data on a brief intervention– Role-play brief intervention
• Ray Mitchell– Discussion with audience– Future Directions
Introduction
• Our Roots– EAPs originated from Occupational Alcoholism Programs
(consistent with the AA movement)
• The Winds of Change– Origins of EAPs have lost focus as EAPs broadened to
treat all types of problems
– While 15-31% of the workforce presents with problem drinking, 1.5% present to the EAP with alcohol and substance use concerns.
– Early identification and prevention/intervention is needed before problems get more severe and costly.
What we know about employee drinking
• 140 million Americans work (Dept of Labor, 2004)
• 82% of the labor force work full-time (Dept of Labor, 2004)
• 61% of employees drank in the last month (NSDUH, ‘04)
• 5% of the workforce meet alcohol abuse criteria and 4% of the workforce meet alcohol dependence criteria (Summers & Goplerud, 2005)
Drinking Continuum
(Institute of Medicine, 1990).
None Mild Moderate Substantial Severe
None Light Moderate Substantial Heavyabuse dependence
problem use addiction
PROBLEMS
ALCOHOL USE
Work Factors Affecting Drinking
• Performance regulation expectancies
• Workplace norms
• Job stress (unwinding time, skipped meals, job problems)
• Unsupportive supervisors
• Job visibility
• Job instability and dissatisfaction
Limited Research on EAPs
In general, cost-effective
– $5.1 million saved per year (Blum & Roman, 1995)
– $7,750 saved per employee & 75% reduction in inpatient costs (Marsh and McLennan Companies, 1994).
EAPs “succeeded” in returning employees with alcohol problems to effective performance (Roman & Blum, 2002)
– No comparison group, none to very brief follow-ups, selection bias, limited measures of outcome, no standardized EAP model
EAPs for Addictive Behaviors
– Receive fewer sessions, more likely to be referred out, and less likely to resolve their problems within the EAP; 6% identified for an addictive behavior (Chan, Neighbors, & Marlatt, 2004)
APS Involvement
• Based on Need – Client Needs– Corporate Needs
• Origins of APS Involvement
• Setting the Stage on a Corporate Level
Research in an EAP Setting
• Is research doable in an EAP setting?
• Cost-benefit analysis
• Research Liaison
• Areas of Focus:– Client Care – Clinician Support– Logistics– Recruitment– Balancing organizational/research needs
Research in an EAP Setting
• Client Care – Corporate Clients
• Addressing possible corporate concerns regarding employee participation
– EAP Clients• Participant Selection
– Safety – EAP and University response– Nature of the Presenting Concern– Individual vs. Couples/Family
• Ensuring Client Needs Are Addressed– Address needs during feedback– Additional Sessions
Research in an EAP Setting
• Clinician Support– Training
• 13 hours CEU for MI training by UW Faculty
• Checklists, Scripts, and Paperwork
• Equipment
– Incenting• Additional time/pay for transitioning
• Cheerleading for the mission
– Supervision/Feedback• Individual
• Group
Research in an EAP Setting
• Logistics– Client paperwork
• confidentiality
– Clerical support for Clinicians– After-hours services
Research in an EAP Setting
• Recruitment– Ongoing Clinician support/scripts– Incenting clients
• Normalizing paperwork
• Assuring needs will be met (extended sessions)
• Addressing resistance (studying range of etoh use)
• Emphasizing benefits
• Allowing choice/flexibility– Time/location for paperwork
– Taping
• Expressing appreciation
Research in an EAP Setting
• Balancing Organizational/Research Needs– More power! The never-ending search for more
subjects– University vs. corporate culture– Setting workable limits
A Brief Intervention for Screened Problem Drinking in
an EAP
Outline
• Description of Study
• Motivational Interviewing
• Study Findings and Implications
• Role-play the brief intervention
Acknowledgements
• G. Alan Marlatt• Mary Larimer• Clayton Neighbors• Franchesca Nguyen• Steve Zellmer• Paul Davis • Ray Mitchell• Kelly Bui• Bonnie Burlingham• EAP therapists and clients• Shirley Murphy• Meenakshi Jaim• Neha Chawla• Diane Logan• Michel Davila
Funding AgenciesNIAAA F31 #AA 14753UW Alcohol and Drug Abuse Institute
Background
• Low identification of problem drinking
• High referral of clients with addictive behaviors outside the EAP
• Research revealing the efficacy of a one-session brief intervention utilizing motivational interviewing in other settings
• Huge prevention and intervention potential with the short-counseling model of the EAP
Health Screen(49% screened
positive)1st Session
EAP Services as Usual (SAU)
Baseline Assessment
2nd Session(BI)
2nd Session(SAU)
Brief Survey(After 2nd Session)
Follow-up Assessment(3 months after BL)
Brief Intervention
Personalized Feedback
1) Typical Drinking Patterns
2) Beliefs About Alcohol
3) Drinking Situations
4) Negative Consequences
…conducted using a Motivational Interviewing style.
Stages of Change
Precontemplation
Contemplation
Preparation
ActionMaintenance
Relapse
Prochaska and DiClemente, 1982
Motivational InterviewingA Definition
• Motivational Interviewing is a – person-centered– directive– method of communication– for enhancing intrinsic motivation to change by
exploring and resolving ambivalence
MI Principles
• Express Empathy
• Develop Discrepancy
• Roll with Resistance
• Support Self-Efficacy
Motivational Interviewing Strategies
1. Open-Ended Questions2. Affirm and Support Your Client3. Reflectively Listening4. Summarizing
5. Roll with Resistance6. Elicit Self-Motivational Statements
(Change Talk)
Elicit – Provide – Elicit:Providing Feedback
• Information exchange
• Balanced Conversation
• Elicit readiness and interest
• Provide feedback neutrally
• Elicit the patient’s interpretation and follow it
(Rollnick, Mason, & Butler, 1999)
Project Findings1. Does MI make a difference on client outcomes?
2. How did the brief intervention compare to services as usual?
MI proficiency and client outcome
Peak Quantity Peak BAC Drinks Per Week
Low Empathy 5.44 0.07 12.20
High Empathy 4.24 0.04 10.45
Peak Quantity Peak BAC
Low MI Spirit 5.15 0.06
High MI Spirit 4.30 0.04
Brief Intervention vs. EAP Services-as-usual
0
2
4
6
8
BL FU
# d
rin
ks
BIEAP
Heaviest Drinking Occasion
Brief Intervention vs. EAP Services-as-usual
0
0.02
0.04
0.06
0.08
0.1
BL FU
BA
C
BIEAP
Peak Blood Alcohol Content
Brief Intervention vs. EAP Services-as-usual
Alcohol-related Problems
0
2
4
6
8
BL FU
Sum
Sco
re EAPBI
Brief Intervention vs. EAP Services-as-usual
0
2
4
6
8
10
BL FU
Problem Score
SAU (M) SAU (F)BI (M) BI (F)
Alcohol-related Problems by Group and Gender
How did the clients rate the BI?
1. Treatment satisfaction– Both groups rated equally high – 96.15% of BI clients would recommend this type of
session to a friend. 2. Number of sessions
- No additional EAP sessions needed for the BI group
3. Problem resolution for clients’ presenting problems– According to therapists’ ratings, 91% of clients had
their presenting problems resolved in the EAP.
Implications
• Screening may not be enough
• Talking and not avoiding
• “One stop shop”
• Cost-effectiveness
• Prevention and Intervention opportunity
Role-Play
• Charles: 55 Year old self-employed, married male, father of a 16 year-old daughter, seeking help with career development after losing his job as a manger in a high tech firm 2 years ago as a result of a RIF.