Estimating resource utilization demands in implementing statewide screening, brief intervention, and referral to treatment for alcohol-impaired drivers

Abstract

Objectives: The Alcohol Use Disorders Identification Test (AUDIT) is used to assess the level of alcohol use/misuse and to inform the intensity of intervention delivered within screening, brief intervention, and referral to treatment (SBIRT) programs. Policy initiatives are recommending delivery of SBIRT within health care settings to reduce alcohol misuse and prevent alcohol-impaired driving. Recent reports are considering extending delivery of SBIRT to criminal justice settings. One consideration in implementing SBIRT delivery is the question of resource utilization; the amount of effort required in delivering the 4 different intensities of intervention in SBIRT: Alcohol education, simple advice, brief counseling and continued monitoring, and brief counseling and referral to specialist (from least to most intense in terms of delivery time, the skill level of the provider, and personnel resources).

Methods: In order to inform expectations about intervention intensity, this article describes the AUDIT scores from 982 adults recently arrested for alcohol-impaired driving. The distribution of scores is extrapolated to state rates for individuals arrested for alcohol-impaired driving by intervention level.

Results: Though alcohol education was the most common intervention category, about one quarter of the sample scored in a range corresponding with the more intensive interventions using the brief counseling, continued monitoring for ongoing alcohol use, and/or referral to specialist for diagnostic evaluation and treatment.

Conclusions: This article provides local distribution of AUDIT scores and state estimates for the number of individuals scoring in each level of risk (AUDIT risk zone) and corresponding intervention type. Routine criminal justice practice is well positioned to deliver alcohol screening, education, simple advice, and continued alcohol monitoring, making delivery of SBIRT feasible for the majority of alcohol-impaired drivers. Challenges to implementing the full range of SBIRT services include resource demands of brief counseling, identifying the appropriate providers within a criminal justice context, and availability of community providers for referral to diagnostic and specialty care. Solutions may vary by state due to differences in population density and incidence rates of alcohol-impaired driving.

Keywords:

• Alcohol
• driving while intoxicated
• driving under the influence
• AUDIT
• SBIRT

Acknowledgments

We gratefully acknowledge the technical contributions of Dr. Stacy Ryan for clinical support; Philip Brink and Cecily Lawrence for data management; and Sergio Arambula, Luisana Campos, Stephanie Garcia, Dominic Gomez, Sebastian Mounetou, Sanjuana Rodriguez, Thalia Rodriguez, Isabela Santos, and Javier Torres for data collection.

Additional information

Funding

Participant assessment and sustainability planning was supported by the Texas Medicaid 1115 Waiver program DHHS 085144601.2.6. Funding from the National Institutes of Health (award numbers R01AA014988, T32DA031115, and UL1TR001120) supported development of knowledge and expertise for articulating the policy implications for screening brief intervention and referral to treatment for alcohol-impaired drivers. The authors are solely responsible for the article, which does not necessarily represent the official views of the National Institutes of Health or the Texas Health and Human Services Commission. Funders had no role in the design, collection, analysis, or interpretation of the data; writing the article; or the decision to submit the article for publication. Dr. Donald M. Dougherty acknowledges support from the William and Marguerite Wurzbach Distinguished Professor endowment. There are no conflicts of interest to declare.