Transcript Slide 1

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
• 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)
43.9
(36.3-51.4) 21.4
(15.1-27.8)
18-24
53.9
(49.6-58.2) 21.3
(17.7-24.9)
25-34
54.5
(51.1-57.9) 16.7
(14.0-19.5)
35-44
52.6
(49.5-55.7) 14.8
(12.6-16.9)
45-54
49.4
(46.8-52.1)
9.7
(8.1-11.3)
55-64
37
(35.0-39.1)
3.3
(2.7-4.0)
65+
Sex
Male
Female
58.7
41.4
(56.3-61.2)
(39.6-43.2)
Binge (% drinkers)
48.7%
39.5%
30.6%
28.1%
19.6%
8.9%
21.2 (19.1-23.4)
36.1%
8.3 (7.2-9.4)
20.0%
Adult binge drinking, BRFSS
20.0
18.0
16.0
14.0
HP 2010 goal 13.4%
12.0
10.0
8.0
2001
2002
2003
2004
US
2005
Texas
2006
2007
HP 2010 goal
2008
2009
2010
17.9
12.8
No HI
16.6
Has HI
16.0 16.1
$50,000+
17.4
$25,000 to < $50,000
12.6
< $25,000
14.1
College Graduate
Some College
High School Graduate
15 14.3 13.6
< High School
10
Female
Male
5
65+
45 to 64
18.0
30 to 44
25
18 to 29
Other
Hispanic
Afr Am
White
Percent
Adult binge drinking, Texas, 2007
23.8
21.7
20
16.8
17.8
14.0
HP 2010 goal 13.4%
9.9
8.8
4.0
0
13.1
10
5
0
13.5
13.8
Balance of State
HP 2010 goal 13.4%
Micropolitan
16.4
Other MSAs
18.4
Austin-Round
Rock
20
El Paso
15.6
San Antonio
15.5
Ft. WorthArlington
Dallas-PlanoIrving
15
Houston-Sugar
Land-Baytown
Percent
Adult binge drinking, Texas, 2007
25
19.2
15.7
Adult drink and drive, BRFSS
7.0
6.0
Percent
5.0
4.0
3.0
2.0
1%
1.0
0.0
2000
2002
2004
Year
US
TX
Better than best
2006
1
No HI
Has HI
$50K +
$25k to < $50K
< $25K
College +
Some college
HS grad
No HS diploma
Female
Male
65+
45-64
30-34
18-29
Other
Hispanic
African Am
White
Percent who drink & drive
Adult drink/drive, Texas 2006 BRFSS
7
6
5
4
3
2
BTB 1%
0
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
Total for All
Causes
3371
2513
859
5880
4341
1538
Chronic Causes
2,508
Liver
60%
CVD
15%
Alcohol Use Disorder
Acute Causes
12%
3,371
Violence
35%
Unintentional
65%
CDC’s ARDI software estimates
http://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 Costs
Number of Workers
250,000
Number with alcohol problem
17,084
Excess workdays lost
Cost of excess lost days per year:
683
$1,235,301
Alcohol-related health care costs
$37,587,500
Excess Emergency Room Visits at
$1,191.81/visit
3,605 excess visits
Excess Days in the Hospital at $5,306.68/day
$4,296,475
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 Costs
National Commission on Prevention Priorities
Health Affairs, 29, no. 9 (2010): 1656-1660
•
Cost Saving per year
–
–
–
–
–
–
•
<$10 per person per year
–
–
–
–
•
Tetanus booster
Chlamydia screening
Discuss folic acid use
Influenza immunization—adults 50+
$15-$50 per person 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)
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.