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'Tis the Season for At-Risk Drinking: A Reminder to Health Care Providers -- Screen, Intervene and Refer

During the holiday season at-risk alcohol use is common, either because of holiday parties and celebrations or in response to stressors such as grief and loss, depression or financial troubles.
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During the holiday season at-risk alcohol use is common, either because of holiday parties and celebrations or in response to stressors such as grief and loss, depression or financial troubles.

There tend to be more opportunities to drink alcohol at social events and in other venues. For example, in large cities like New York, there are "seasonal pop-up bars" that cater to the drinking season by offering seasonal drinks in holiday-themed pop-up bars.

The increased use of alcohol during the holiday season highlights the issue that at-risk use increases the risk for harm. In addition to harm associated with acute use, persons who have a history of at-risk alcohol use are at an increased risk for long term alcohol-related harm such as cardiovascular disease and cancer.

Substance use-related harm isn't restricted to those who may have a substance use disorder. For some individuals, even small amounts can increase the risk of harm. For example, older adults may increase their risk for falls or they may have problematic interactions with medications. Pregnant women should not use any alcohol because of the possible effects on the fetus. Adolescents and adults who drink and drive are at increased risk for a motor vehicle crash. Adults with health issues such as diabetes or cardiovascular disease need to take special precautions when consuming alcohol.

Drinking during pregnancy is particularly harmful -- alcohol use during pregnancy is harmful to the expectant mother's baby. Pregnant women need to watch what they eat, drink and smoke during this holiday season. Alcohol use during pregnancy increases the risk of the infant developing life-long health problems and increases the risk of learning, behavioral and physical problems. Women who are pregnant or likely to become pregnant should avoid alcohol this holiday season.

Reducing substance use-related harm requires the application of harm reduction strategies. The term "harm reduction" in this context refers to any program, policy, and/or intervention that seeks to reduce the harm related to substance use. Harm reduction methods and treatment goals are free of judgment or blame and they attempt to directly involve clients in their own goal setting.

Nurses and other health care providers can, and do, perform harm reduction interventions. Nurses, and there are about 2.7 million of us employed, routinely come in contact with persons whose current or past at-risk drinking places them at increased risk for harm or adverse outcomes.

Thus it is imperative for nurses, and other health care providers, to be reminded to universally screen their patients for substance use.

What is screening and brief intervention?

Screening and Brief Intervention (SBI) are strategies that nurses and others can do to help reduce the harm associated with the use of alcohol. And the U.S. federal government agrees -- the Substance Abuse and Mental Health Services Administration (SAMSHA) supports Screening and Brief Intervention for all drugs and alcohol as the standard of care for nurses and other health care providers.

So how do you do it?

Screen

  • First, use one brief (and valid) pre-screening tool such as: How many times in the past year have you had X or more drinks in a day?" (X = 5 for men and 4 for women). One is a positive result. Or, use the National Institute on Drug Abuse (NIDA) Quick Screen, Drug Screening Tool. Or, the three question AUDIT C.
  • Then, determine the number of drinks per drinking occasion and the number of drinks per week. The National Institute on Alcohol Abuse and Alcoholism's (NIAAA) recommended limits: For men it's no more than four in a day and no more than 14 in a week. For women and for anyone 65 years of age or older, no more than three drinks in a day and no more than seven drinks in a week.
  • If this indicates a positive screen for at-risk drinking, then intervene.

Intervene

  • Provide a brief intervention such as a motivational, awareness-raising, shared agenda-setting conversation with patients whose substance use puts them at risk and could potentially creates problems with their health and wellness.

Refer

  • Provide a referral to specialty treatment for those with a positive substance use disorder screen.

We know that nurses and other health care providers have multiple demands on their limited time with patients but we implore them to consider using the screening and brief intervention approach. And it's reimbursable. For your handy reference, here are the billing codes:

  • Use Medicare/Medicaid Billing Codes for SBIRT: 1) H0049 Alcohol and Drug Screening, 2) H0050 Alcohol and Drug Services (15 minutes)
  • Bill higher-level codes as appropriate for complex patients requiring longer interventions.

Screening and Brief Intervention, and Referral to Treatment (SBIRT) is especially important during the holidays. It could make a real difference in the lives of our patients and their families.

Co-authored by Christine Savage PhD, RN, CARN, FAAN, professor and chair at Johns Hopkins University; Deborah Antai-Otong MS, APRN, PMHCNS-BC, FAAN, psychiatric mental health consultant at the Department of Veteran's Affairs; Mona Shattell, PhD, RN, FAAN, professor and associate dean at DePaul University.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.