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Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders.

BACKGROUND AND AIMS
Alcohol screening, brief intervention (BI), and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care.


DESIGN
Regression analysis.


SETTING
U.S. Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders.


PARTICIPANTS
VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥5) (n=830,825) documented nationally 10/01/09-5/30/13.


MEASUREMENTS
Regression models estimated prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared with those without. Models, clustered on patient and adjusted for demographics and mental health and substance use conditions, were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor.


FINDINGS
Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment (adjusted incidence rate ratio [aIRR] 0.84, 95% confidence interval 0.83-0.84). Associations were similar for those with and without AUD (aIRR 0.83, 0.82-0.84 and 0.86, 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of >1 BI was associated with greater likelihood of treatment relative to no BI (aIRR 1.75, 1.68-1.83).


CONCLUSIONS
In a national sample of U.S. Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.