Alcohol problems – including alcoholism, binge drinking, and impairment stemming from a wide range of drinking habits – cause untold pain for American families.¹ Nearly 8 million Americans have alcoholism; an additional 6 million have problems because of their drinking.² As a source of family hardship and on-the-job risk, problem drinking is a costly burden for businesses, yet only 2-3 million people are treated for alcoholism each year.³

Early treatment can make a great difference. Armed with knowledge of the health implications of problem drinking, awareness of a patient's medical situation and good old-fashioned understanding, physicians, nurses, and other health professionals can conduct brief interventions to help decrease the incidence of risky drinking.⁴

Brief interventions can be conducted by:

• Primary care practitioners

• Mental health and substance abuse specialists, including social workers, psychologists, psychiatrists, substance abuse counselors, marriage and family counselors and Employee Assistance Program (EAP) staff

Over a period of 6-12 months, drinkers who receive a brief intervention are twice as likely to reduce their drinking as others.⁵ United Behavioral Healthcare, a managed care organization, found that 64 percent of the people who took advantage of counseling in an EAP did not need further treatment to address their problem drinking.⁶ Because of brief intervention's significant impact, the National Business Coalition on Health encourages employers to monitor their health care plans to ensure that providers conduct the counseling.

For people with a high level of alcohol dependency, brief intervention is not a substitute for treatment. It can, however, motivate risky drinkers to seek help and significantly reduce the health and other risks that stem from drinking.⁷

Project TrEAT

In January 2000, Dr. Michael F. Fleming, a leading researcher in the field of addiction studies, published his study of nearly 800 heavily drinking patients in 17 Wisconsin community clinics.⁸ All Project TrEAT, or Trial for Early Alcohol Treatment, participants reported that they had at least 11 drinks weekly. People who had undergone treatment for an alcohol addiction, however, were not eligible.

Researchers divided the 18-65-year-old subjects into two groups. One group of patients, the control group, simply received written materials on the health risks of drinking. The other group had more personal interaction with the doctors and nurses at their clinic. Members of this group, called the “intervention” group, visited the doctor once a month for two months. In between the 15-minute face-to-face sessions, the clinic nurse followed up with a phone call to the patients.

The researchers found that, compared to the control group, the intervention group had significantly fewer accidents, hospital visits and other events related to problem drinking. The cost for each brief intervention was $166 per patient. Fleming found that the counseling sessions generated $523 in medical savings for each patient, and an additional savings in the costs of other factors such as alcohol-related criminal activity. In all, Fleming calculated that the brief intervention generated nearly $56,300 in savings for every $10,000 invested. In medical costs alone, the benefit-to-cost ratio of brief intervention was 3.2 to 1 over a 12-month period.

Footnotes

¹ For more on the range of drinking problems, see the Ensuring Solutions to Alcohol Problems Primer Understanding the Problem Drinking Continuum, available at www.ensuringsolutions.org.

² Grant, F.F. et al. 1994. Prevalence of DSM-IV Alcohol Abuse and Dependence: United States, 1992. Alcohol Health and Research World. 18 (3): 2243-248.

³ Substance Abuse and Mental Health Services Agency. 2002. The 2001 National Household Survey on Drug Abuse Report. National Institute on Drug Abuse. Washington, DC.

⁴ National Institute on Alcohol Abuse and Alcoholism. 1999. Brief Intervention for Alcohol Problems. Alcohol Alert. No. 43.

⁵ Babor, T.F. and Higgins, J.C. 2001. Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care. World Health Organization. Department of Mental Health and Substance Dependence.

⁶ Cuffel, B. 2003. E-mail to author. January 30.

⁷ U.S. Department of Health and Human Services. Public Health Service. Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment. 1999. Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP) Series 34. DHHS Publication No. (SMA) 99-3353.

⁸ Fleming, M.F. Mundt, M.P., French, M.T., Manwell, L.B., Stauffacher, E.A., Barry, K.L. 2000. Benefit-Cost Analysis of Brief Physician Advice With Problem Drinkers in Primary Care Settings. Medical Care. 38: 7-18.

⁹ Cost to patient includes travel and lost worktime; cost to clinic includes screening, assessment, intervention sessions, staff training sessions, and follow-up calls; medical savings were realized from services not being used; social savings were calculated as savings from legal events and vehicle accidents.

Eve Raskin and Lynora Williams, March 2003

Working with policymakers, employers and concerned citizens, Ensuring Solutions to Alcohol Problems at The George Washington University Medical Center in Washington, DC, provides research-based information and tools to help curb the avoidable health care and other costs associated with alcohol use. The project works to improve access to treatment for Americans who need it. It is supported by a grant from The Pew Charitable Trusts. For more information, please visit the Ensuring Solutions Website at www.ensuringsolutions.org.