Reducing Risky Alcohol Use: What Health Care Systems Can Do.

Risky, non-dependent alcohol use is prevalent in the United States, affecting 25% of adults (Centers for Disease Control and Prevention, 2014b). Massachusetts has higher rates of alcohol use and binge drinking than most states (Substance Abuse and Mental Health Services Administration, 2015). Serious physical, social, and economic consequences result. Excessive alcohol use contributes to cancer, cardiovascular disease, sleep disorders, birth defects, motor vehicle injuries, and suicide, and it complicates management of chronic illnesses (Green, McKnight-Eily, Tan, Mejia, & Denny, 2016; Laramee et al., 2015; Mokdad, Marks, Stroup, & Gerberding, 2004; Rehm et al., 2009). Excessive alcohol use is one of the top causes of death, and over 240 alcohol-related deaths occur daily in the US (Mokdad et al., 2004; Stahre, Roeber, Kanny, Brewer, & Zhang, 2014). In comparison, 78 people die from an opioid overdose each day (Centers for Disease Control and Prevention, 2016). Excessive drinking is estimated to cost over $249 billion annually in the US and $5.6 billion in the Commonwealth (Sacks, Gonzales, Bouchery, Tomedi, & Brewer, 2015). This issue brief describes the scope of the risky drinking problem in the US and associated costs and consequences. The brief then examines the evidence base for tools to address risky drinking and outlines policy strategies that health care system stakeholders may employ to address further this critical public health issue. Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address risky alcohol use, typically using a short validated screening tool followed by a brief counseling session if a patient screens positive. Research shows SBI conducted in primary care outpatient settings significantly reduces alcohol use (Bertholet, Daeppen, Wietlisbach, Fleming, & Burnand, 2005b; Bien, Miller, & Tonigan, 1993; Kaner et al., 2009; Saitz, 2010a), hospitalizations (Fleming, Barry, Manwell, Johnson, & London, 1997b) and mortality (Cuijpers, Riper, & Lemmers, 2004). Alcohol SBI saves an estimated $217.95 per person screened (Barbosa, Cowell, Bray, & Aldridge, 2015).