Alcohol Misuse: Impact , Screening , and Brief Interventions

1. Alcohol Misuse:Impact, Screening,and Brief Interventions Vince Fonseca, MD, MPH, FACPM 2011 State Agency Wellness Conference

2. Overview • Background and prevalence • Impact • Screening and Brief Interventions

3. Background and Prevalence

4. Actual Causes of Death

5. 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.

6. 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)

7. Texas Adults, Binge-drinking, 2010 BRFSS

8. Adult binge drinking, BRFSS HP 2010 goal 13.4%

9. Adult binge drinking, Texas, 2007 HP 2010 goal 13.4%

10. Adult binge drinking, Texas, 2007 HP 2010 goal 13.4%

11. Adult drink and drive, BRFSS 1%

12. Adult drink/drive, Texas 2006 BRFSS BTB 1%

13. Impact

14. 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.

15. Alcohol Misuse Impact-Texas Deaths CDC’s ARDI software estimates http://apps.nccd.cdc.gov/DACH_ARDI/Default/Default.aspx

16. 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 9Schneider 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.

17. 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.

18. Alcohol-related Excess Costs http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/costcalculators.htm

19. Screening and Intervention

20. 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

21. Assessment of Health Risk with Feedback and Health Education

22. 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.

23. 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.

24. 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.

25. Elements of BriefInterventions • 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

26. Screening and Brief Intervention (SBI) ROI Baseline: 8% identified …92% receive no services http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/costcalculators.htm

27. Direct Medical CostsNational Commission on Prevention PrioritiesHealth 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+

28. 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

29. 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.