Veterans More Likely than Non-Veterans to Receive Both Alcohol Screening and Brief Intervention for Alcohol Misuse

BACKGROUND:
Both the U.S. Preventive Services Task Force and the National Institute on Alcohol Abuse and Alcoholism recommend routine screening and brief alcohol-related interventions for those who screen positive in primary care. Within the past 15 years, VA has implemented alcohol screening for all Veteran outpatients annually – and brief intervention for those screening positive for unhealthy alcohol use. However, only about one-third of Veterans receive VA healthcare, thus screening and intervention rates among Veterans overall are unknown. This study sought to describe receipt of alcohol screening and brief intervention across Veteran status in a sample of U.S. residents receiving healthcare. Investigators identified adults who responded to the CDC's 2014 Behavioral Risk Factor Surveillance System, reported visiting a doctor for a routine check-up at least once in the previous two years, and responded to an optional module assessing alcohol-related care [n=92,206; 14% were Veterans]. They then described rates of reporting screening and brief intervention among male and female Veterans and non-Veterans, after accounting for other factors associated with receiving alcohol-related care.

FINDINGS:

• Overall, Veterans were more likely than non-Veterans to be screened for both quantity of alcohol use (69% vs. 64%) and heavy episodic drinking (36% vs. 29%).
• Male Veterans were less likely than male non-Veterans to endorse heavy episodic drinking (15% vs. 22%) and unhealthy alcohol use (15% vs. 19%), while female Veterans did not differ from female non-Veterans on alcohol consumption measures.
• Among individuals who endorsed unhealthy alcohol use, Veterans were more likely than non-Veterans to report being offered advice about alcohol's harms (48% vs. 30%) and being advised to reduce or abstain from alcohol use (25% vs. 18%).
• Rates of brief intervention were low among females reporting unhealthy alcohol use: only 24% of female non-Veterans and 28% of female Veterans reported receiving advice about alcohol's harms.

IMPLICATIONS:

• Findings support earlier studies that suggest screening for unhealthy alcohol use is relatively common, yet providing care for those who screen positive is less so. QI in the implementation of alcohol screening and brief intervention in primary care settings and continued research to increase and improve delivery is needed, especially for vulnerable patients (e.g., women).

LIMITATIONS:

• The survey includes Veterans regardless of whether they get any VA care. Internal VA statistics suggest screening and advice are higher within VA clinics than figures reported here.
• Alcohol use was assessed during the past 30 days, while brief intervention receipt could have occurred at any point in the previous two years.
• Alcohol and care measures were based on self-report.

Bachrach R, Blosnich J, and Williams E. Alcohol Screening and Brief Intervention in a Representative Sample of Veterans Receiving Primary Care Services. Journal of Substance Abuse Treatment. December 2018;95:18-25.