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

Alcohol Misuse: Impact , Screening , and Brief Interventions

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Alcohol Misuse: Impact , Screening , and Brief Interventions. Vince Fonseca, MD, MPH, FACPM 2011 State Agency Wellness Conference. Overview. Background and prevalence Impact Screening and Brief Interventions. Background and Prevalence. Actual Causes of Death. Alcohol Misuse. - PowerPoint PPT Presentation

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Page 1: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Alcohol Misuse: Impact, Screening, and

Brief Interventions

Vince Fonseca, MD, MPH, FACPM2011 State Agency Wellness Conference

Page 2: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Overview

• Background and prevalence• Impact• Screening and Brief Interventions

Page 3: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Background and Prevalence

Page 4: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Actual Causes of Death

Page 5: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.

Page 6: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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)

Page 7: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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%

Page 8: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Adult binge drinking, BRFSS

HP 2010 goal 13.4%

Page 9: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Adult binge drinking, Texas, 2007

14.313.6

18.0

9.9

23.8

17.4

12.6

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Page 10: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Adult binge drinking, Texas, 2007

13.1

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Page 11: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Adult drink and drive, BRFSS

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

2000 2002 2004 2006

Year

Per

cent

US TX Better than best

1%

Page 12: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Adult drink/drive, Texas 2006 BRFSS

0

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BTB 1%

Page 13: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Impact

Page 14: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.

Page 15: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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

Page 16: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.

Page 17: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.

Page 18: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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

Page 19: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Screening and Intervention

Page 20: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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

Page 21: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

Assessment of Health Risk with Feedback and Health Education

Page 22: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.

Page 23: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.

Page 24: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.

Page 25: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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

Page 26: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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

Page 27: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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+

Page 28: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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

Page 29: Alcohol Misuse: Impact , Screening , and  Brief  Interventions

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.