In spite of efforts to prevent health problems and costs related to alcohol misuse, including fetal alcohol spectrum disorders (FASD), drinking problems continue to negatively impact individuals, families, and communities. Given that approximately one-third of U.S. adults has had an alcohol use disorder in their lifetime it is clear we need to take a population approach to prevention.
Preventing alcohol-related harms is challenging, particularly since healthy guidelines for "safe" alcohol use change based on sex, age, and health condition. Messages about drinking are especially confusing for women of childbearing age, given new research studies and controversial books that downplay risks of alcohol use during pregnancy.
Health care visits are one option where a person could talk about their alcohol use patterns and receive personalized information about strategies to reduce drinking. To assure consistency in communicating about alcohol, health-care providers need standardized tools and protocols based on the latest research evidence. The Centers for Disease Control and Prevention recommend that health-care providers use standardized alcohol screening and brief intervention (SBI) as to identify individuals whose drinking exceeds recommended guidelines, and provide tailored advice and resources to help patients avoid unhealthy consequences. Research studies on routine alcohol SBI in primary care settings have shown a net decrease in alcohol consumption, ranging from 12 to 34 percent, as well as cost savings to both the health-system and society. Research also shows that patients will listen to advice from their health provider about their drinking; and yet only one of six U.S. adults report discussing their alcohol use with their provider.
Although alcohol SBI has shown to be both feasible and effective in medical settings, there are barriers to making this happen as a routine part of health practice, particularly in Alaska, where our health-care delivery system is fragmented. Many health-care providers are strained and cite lack of time, changes in staff, and competing priorities as obstacles to preventive services. Specific to alcohol SBI are a lack of training in SBI techniques, worry about stigmatizing patients, and worry that identifying patients who have substance use disorders in areas with limited treatment services will increase the burden on the practice. Providers report not knowing where to refer severe patients, and what to expect from specific treatment programs, especially since substance abuse treatment has traditionally taken place separately from the medical system.
In Alaska, alcohol prevention efforts are currently underway to train health-care providers to talk to patients who are drinking at harmful levels and to communicate accurate information about healthy guidelines for alcohol use. The Arctic FASD Regional Training Center, located at UAA's Center for Behavioral Health Research and Services, received funding in 2011 from the CDC to partner with the State of Alaska Section of Public Health Nursing to pilot alcohol SBI in three health centers.
Nurses are trained to routinely screen and address alcohol use as part of standard public health services. The health system is implementing policies and procedures to ensure alcohol SBI is a consistent and sustainable piece of routine care for adolescents and adults. The pilot project has been successful and is in the process of being spread throughout the public health nursing system with potential to reach 250 communities across the state.
Additionally, UAA has received funding from Substance Abuse and Mental Health Services Administration to implement training for students planning to enter health professions so that they are prepared to provide alcohol screening, brief intervention and referrals to treatment.
Efforts like these increase practice competence among existing and future health-care providers in Alaska by addressing alcohol misuse. These sound strategies assure the message about alcohol is clear, consistent, and reaches everyone, given the health and social consequences of alcohol misuse and FASDs affects us all.
Diane King is project director and Becky Porter is project manager at the Arctic FASD Regional Training Center at the University of Alaska Anchorage. More information can be found at http://www.cdc.gov/alcohol/index.htm and www.uaa.alaska.edu/arcticfasdrtc.
By DIANE KING and BECKY PORTER