Effects of Training on Social Work, Nursing and Medical Trainees' Knowledge, Attitudes and Beliefs Related to Screening and Brief Intervention for Alcohol Use

INTRODUCTION Harmful alcohol use is a major public health concern worldwide, causing many medical, psychological, social and economic problems (World Health Organization [WHO], 2014). In the United States, definitive research on actual causes of death in the year 2000 ranked alcohol as the third leading cause, ahead of microbial agents, toxic agents, firearms and all illicit use of drugs (Mokdad, Marks, Stroup, & Gerberding, 2004). More recently, Kanny and colleagues (2015) reported that, between 2010 and 2012, an average of six deaths each day were attributable to alcohol poisoning. Nationally, other paradigms of alcohol use are widespread as well, with recent estimates of current drinking ranging from 52% for those age 12 or older (Center for Behavioral Health Statistics and Quality, 2015) to nearly 65% for those age 18 or older (Schoenborn, Adams, & Peregoy, 2013), with a median cost of $3.5 billion per state (Sacks, Gonzales, Bouchery, Tomedi, & Brewer, 2015). Cannon and colleagues (2015) report that nearly 2 million women of child-bearing age were at risk of an alcohol exposed pregnancy during a single month in the 2002-2003 calendar year in the United States. Additional national health behavior surveillance indicates a significant number of adults engage in heavy drinking (Center for Disease Control and Prevention [CDC], 2012), defined as five or more drinks for men and four or more drinks for women in a two-hour timespan--the amounts typically sufficient to reach a blood alcohol content of .08 (National Institute of Alcohol Abuse and Alcoholism [NIAAA], n.d.). The potential consequences of heavy drinking include a multitude of short- and long-term adverse effects that increase the likelihood of injury, chronic disease and early death (CDC, 2012). The WHO recently drew a previously undefined causal link between harmful alcohol use and infectious diseases, including tuberculosis and HIV/AIDS (WHO, 2014). These consequences exist in addition to other comparatively less severe outcomes associated with asymptomatic, but potentially harmful, alcohol use patterns that may go undetected because they do not meet diagnostic criteria (McCance-Katz & Satterfield, 2012; Saitz, 2005). Given the widespread nature of this problem, there is a great need for approaches to reduce alcohol use across the spectrum of severity, including harmful, hazardous and dependent use, as well as other synonymous categories of use as identified by different organizations (Reid, Fiellin, & O'Connor, 1999). Screening, brief intervention and referral to treatment (SBIRT) for alcohol use is one such evidence-based approach. Employing short screening tools, brief interventions (typically using motivational interviewing [MI]) and a referral process, SBIRT is an integrated method of early identification, prevention and treatment for the spectrum of problem alcohol use (Agerwala & McCance-Katz, 2012). Studies of screening in primary care have shown a positive impact for all levels of alcohol use severity (Fiellin, Reid, & O'Connor, 2000). Importantly, SBIRT has been shown to be effective at reducing alcohol consumption (Bertholet, Dacppen, Wietlisbach, Fleming, & Burnand, 2005; Cherpitel, Moskalewicz, Swiatkiewicz, Ye, & Bond, 2009; Kaner, Dickinson, Beyer, Pienaar, Schlesinger, Campbell, et al., 2009) and improving general and mental health (Madras et al., 2009). SBIRT can benefit both patients and their family members, who can be important partners in addressing substance use (CSAT, 2007); while 'standard' intake and diagnosis processes may identify dependent users, risky or problematic users who are non-dependent can be identified using SBIRT screening. In fact, brief interventions associated with SBIRT may be most efficacious in patients who exhibit risky or problematic use but who are not dependent or treatment-seeking (O'Donnell, Anderson, Newbury-Birch, Schulte, Schmidt, Reimer, et al., 2013). SBIRT also has the potential to benefit a large number of clients at significant economic savings (Quanbeck, Lang, Enami, & Brown, 2010; Solberg, Maciosek, & Edwards, 2008), and it can be efficient in terms of time utilization (McIntire et al. …