Screening with telephone intervention reduces risky alcohol use in Texas study

Researchers from the University of Texas Dell Medical School at Austin successfully implemented a screening and telephone intervention program for unhealthy alcohol use at a large Federally Qualified Health Center in Texas. The study demonstrated significant reductions in alcohol use among a diverse adult patient population, including those insured through national programs for otherwise uninsured or low-income individuals.

Unhealthy alcohol consumption contributes to an increased risk of multiple health problems, including liver disease, cardiovascular disease and several forms of cancer. Recommendations exist for universal screening for alcohol use (recommended by the US Preventive Services Task Force), but interventions based on screening results remain underutilized in many primary care settings.

In the study, “Screening and Telephone Intervention for Unhealthy Alcohol Use in a Diverse Federally Qualified Health Center System in Texas” published in the Journal of General Internal Medicineresearchers developed a versatile telehealth program to provide brief interventions to patients with positive screens.

The intervention included a two-session evidence-based counseling program delivered by a bilingual, social work-trained counselor. Patients identified as at serious risk for alcohol use were offered pharmacotherapy and referred to addiction medicine services. Follow-up assessments were completed within three to six months to evaluate changes in alcohol use patterns.

A total of 3,959 patients were screened using the AUDIT-C questionnaire. Of these, 16% (632) screened positive for risky alcohol use. Patients who are more likely to screen positive include men, English speakers and those with commercial insurance. Researchers successfully enrolled 412 patients and completed full AUDIT assessments to determine severity and risk levels of alcohol use.

Of the included patients, 68.2% (281) had AUDIT scores indicative of moderate risk (≤12), while 31.8% (131) had higher scores (>12). 97% of participants completed one counseling session and 72% completed two. Of those with high initial AUDIT scores, 19 patients received pharmacotherapy and 13 were involved in addiction medicine services.

Follow-up data were collected from 251 patients (61%). The results showed an average reduction in the AUDIT score of 4.1 points (95% CI -3.4, -4.7). The decrease was greater in Spanish-speaking patients than in English speakers, with no significant differences observed between other demographic groups.

Patients with higher initial AUDIT scores (>12) experienced more substantial decreases in scores (mean decrease of 7.99) compared to those with moderate scores (mean decrease of 2.25).

The study illustrates that a telephone screening and brief intervention program can effectively reduce unhealthy alcohol use in a diverse patient population within a Federally Qualified Health Center. The approach also reduced barriers to care, such as transportation and language, by offering bilingual, culturally responsive services.

Researchers emphasize that while significant progress has been made, further efforts are needed to increase pharmacotherapy engagement, increase provider capacity, and improve sustained patient follow-up, especially for those with higher AUDIT scores.

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