Washington State Institute for Public Policy
Brief intervention in primary care
Substance Use Disorders: Early Intervention
Benefit-cost estimates updated May 2017.  Literature review updated September 2016.
Patients in primary care are screened for "hazardous" alcohol and/or drug use (not dependence). Those screening positive receive a brief intervention. The intervention, commonly delivered by the primary care provider, includes feedback on the patients’ consumption compared to their peers and motivational interview to encourage reduction in consumption. Patients typically receive a single intervention lasting 15 minutes to one hour. Some interventions included up to two brief telephone booster calls.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $1,543 Benefits minus costs $4,559
Participants $3,153 Benefit to cost ratio $17.70
Others $154 Chance the program will produce
Indirect ($17) benefits greater than the costs 86 %
Total benefits $4,832
Net program cost ($273)
Benefits minus cost $4,559
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $1 $0 $3 $0 $4
Labor market earnings associated with problem alcohol use $1,419 $3,125 $0 $57 $4,601
Property loss associated with problem alcohol use $0 $4 $8 $0 $13
Health care associated with emergency department visits $123 $23 $143 $61 $351
Adjustment for deadweight cost of program $0 $0 $0 ($136) ($136)
Totals $1,543 $3,153 $154 ($17) $4,832
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $205 2000 Present value of net program costs (in 2016 dollars) ($273)
Comparison costs $0 2000 Cost range (+ or -) 20 %
This program consists of a single brief intervention during a visit to the doctor. Per-participant cost from Fleming, M.F., Mundt, M.P., French, M.T., Manwell, L.B., Stauffacher, E.A. & Barry, K.L. (2002). Brief physician advice for problem drinkers: Long-term efficacy and benefit-cost analysis. Alcoholism: Clinical and Experimental Research, 26(1), 36-43.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Cannabis use^ 7 519 -0.262 0.153 39 -0.036 0.230 41 -0.262 0.088
Drinking and driving^ 2 543 -0.307 0.284 39 -0.042 0.426 41 -0.307 0.279
Emergency department visits 2 784 -0.125 0.071 39 -0.017 0.107 41 -0.125 0.078
Hospitalization 2 652 -0.261 0.332 39 -0.036 0.498 41 -0.261 0.432
Illicit drug use^ 9 1773 -0.155 0.073 39 -0.021 0.109 41 -0.155 0.033
Opioid drug use^ 4 249 -0.396 0.184 39 -0.054 0.276 41 -0.396 0.031
Problem alcohol use 48 7318 -0.195 0.024 39 -0.027 0.037 41 -0.195 0.001
Citations Used in the Meta-Analysis

Aalto, M., Saksanen, R., Laine, P., Forsstrom, R., Raikaa, M., Kiviluoto, M., et al. (2000) Brief intervention for female heavy drinkers in routine general practice: A 3-year randomized controlled study. Alcoholism: Clinical and Experimental Research, 24(11), 1680-1686.

Aalto, M., Seppa, K., Mattila, P., Mustonen, H., Ruuth, K., , . . . Sillanaukee, P. (2001). Brief intervention for male heavy drinkers in routine general practice: a three-year randomized controlled study. Alcohol and Alcoholism, 36(3), 224-230.

Anderson, P. & Scott, E. (1992). The effect of general practitioners' advice to heavy drinking men. British Journal of Addiction, 87, 891-900.

Assanangkornchai, S., McNeil, E.B., Edwards, J.G., Nima, P., & Edwards, J.G. (2015). Comparative trial of the WHO ASSIST-linked brief intervention and simple advice for substance abuse in primary care. Asian Journal of Psychiatry, 18, 75-80.

Babor, T. F., & Grant, M. (1992). Project on identification and management of alcohol-related problems: Report on Phase II: A randomized clinical trial of brief interventions in primary health care. Geneva, Switzerland: World Health Organization.

Babor, T.F., Higgins-Biddle, J.C., Dauser, D., Burleson, J.A., Zarkin, G.A., & Bray, J. (2006). Brief interventions for at-risk drinking: patient outcomes and cost-effectiveness in managed care organizations. Alcohol and Alcoholism (oxford, Oxfordshire), 41, 6.

Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77(1), 49-59.

Chang, G., McNamara, T. K., Orav, E. J., Koby, D., Lavigne, A., Ludman, B., Vincitorio, N. A., . . . Wilkins-Haug, L. (2005). Brief intervention for prenatal alcohol use: a randomized trial. Obstetrics and Gynecology, 105(5), 991-8.

Chang, G., Fisher, N.D.L., Hornstein, M.D., Jones, J.A., Hauke, S.H., Niamkey, N., Briegleb, C., . . . Orav, E.J. (2011). Brief intervention for women with risky drinking and medical diagnoses: A randomized controlled trial. Journal of Substance Abuse Treatment, 41(2), 105-114.

Crawford, M.J., Sanatinia, R., Barrett, B., Byford, S., Dean, M., Green, J., Jones, R., . . . Ward, H. (2014). The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR). Health Technology Assessment, 18(30), 1-48.

Curry, S.J., Ludman, E.J., Grothaus, L.C., Donovan, D., & Kim, E. (2003). A randomized trial of a brief primary-care-based intervention for reducing at-risk drinking practices. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 22(2), 156-65.

Emmen, M.J., Schippers, G.M., Wollersheim, H., & Bleijenberg, G. (2005). Adding psychologist's intervention to physicians' advice to problem drinkers in the outpatient clinic. Alcohol and Alcoholism, 40(3), 219-226.

Fleming, M.F., Manwell, L.B., Barry, K.L., Adams, W. & Stauffacher, E.A. (1999). Brief physician advice for alcohol problems in older adults: A randomized community-based trial. Journal of Family Practice, 48, 378-384.

Fleming, M.F., Barry, K.L., Manwell, L.B., Johnson, K. & London, R. (1997). Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. Journal of the American Medical Association, 277, 1039-1045.

Fleming, M.F., Mundt, M.P., French, M.T., Manwell, L.B., Stauffacher, E.A. & Barry, K.L. (2002). Brief physician advice for problem drinkers: Long-term efficacy and benefit-cost analysis. Alcoholism: Clinical and Experimental Research, 26(1), 36-43.

Fleming, M., Brown, R., & Brown, D. (2004). The efficacy of a brief alcohol intervention combined with CDT feedback in patients being treated for type 2 diabetes and/or hypertension. Journal of Studies on Alcohol, 65(5), 631-7.

Fleming, M.F., Lund, M.R., Wilton, G., Landry, M., & Scheets, D. (2008). The healthy moms study: The efficacy of brief alcohol intervention in postpartum women. Alcoholism, Clinical and Experimental Research, 32(9), 1600-6.

Fleming, M. F., Balousek, S. L., Grossberg, P. M., Mundt, M. P., Brown, D., Wiegel, J. R., Zakletskaia, L. I., . . . Saewyc, E. M. (2010). Brief physician advice for heavy drinking college students: a randomized controlled trial in college health clinics. Journal of Studies on Alcohol and Drugs, 71(1), 23-31.

Freeborn, D. K., Polen, M. R., Hollis, J. F., & Senft, R. A. (2000). Screening and brief intervention for hazardous drinking in an HMO: effects on medical care utilization. The Journal of Behavioral Health Services & Research, 27(4), 446-53.

Gelberg, L., Andersen, R. M., Afifi, A.A., Leake, B.D., Arangua, L., Vahidi, M., Singleton, K., . . . Baumeister, S.E. (2015). Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care-based multi-component brief intervention to reduce risky drug use. Addiction, 110(11), 1777-1790.

Grossberg, P.M., Brown, D.D. & Fleming, M.F. (2004). Brief Physician Advice for High-Risk Drinking Among Young Adults. Annals of Family Medicine, 2(5), 474-480.

Heather, N., Campion, P.D., Neville, R.G., & Maccabe, D. (1987). Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (The DRAMS scheme). Journal of the Royal College of General Practitioners, 37(301), 358-363.

Humeniuk, R., Ali, R., Babor, T., Souza-Formigoni, M.L.O., de, L.R.B., Ling, W., McRee, B., . . . Vendetti, J. (2012). A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction, 107(5), 957-966.

Israel, Y., Hollander, O., Sanchez-Craig, M., Booker, S., Miller, V., Gingrich, R., & Rankin, J. G. (1996). Screening for problem drinking and counseling by the primary care physician-nurse team. Alcoholism, Clinical and Experimental Research, 20(8), 1443-50.

Kaner, E., Newbury-Birch, D., Bland, M., Coulton, S., Godfrey, C., Parrott, S., Cassidy, P., . . . Shepherd, J. (2013). Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): Pragmatic cluster randomised controlled trial. Bmj, 346, 7892.

Kristenson, H., Ohlin, H., Hulten-Nosslin, M.B., Trell, E., & Hood, B. (1983). Identification and intervention of heavy drinking in middle-aged men: Results and follow-up of 24-60 months of long-term study with randomized controls. Alcoholism: Clinical and Experimental Research, 7, 203-209.

Kypri, K., Saunders, J.B., Williams, S.M., McGee, R.O., Langley, J.D., Cashell-Smith, M.L., & Gallagher, S.J. (2004). Web-based screening and brief intervention for hazardous drinking: A double-blind randomized controlled trial. Addiction, 99, 11.

Kypri, K., Langley, J. D., Saunders, J. B., Cashell-Smith, M. L., & Herbison, P. (2008). Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Archives of Internal Medicine, 168(5), 530-536.

Lock, C. A., Kaner, E., Heather, N., Doughty, J., Crawshaw, A., McNamee, P., Purdy, S., . . . Pearson, P. (2006). Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial. Journal of Advanced Nursing, 54(4), 426-439.

Maheswaran, R., Beevers, M., & Beevers, D.G. (1992). Effectiveness of advice to reduce alcohol consumption in hypertensive patients. Hypertension, 19, 79-84.

Maisto, S.A., Conigliaro, J., McNeil, M., Kraemer, K., Conigliaro, R. L., & Kelley, M. E. (2001). Effects of two types of brief intervention and readiness to change on alcohol use in hazardous drinkers. Journal of Studies on Alcohol, 62(5), 605-614.

Manwell, L.B., Fleming, M.F., Mundt, M.P., Staffacher, E.A., & Barry, K.L., (2000). Treatment of problem alcohol use in women of childbearing age: Results of a brief intervention trial. Alcoholism: Clinical and Experimental Research, 24(10), 1517-1524.

Mertens, J.R., Ward, C.L., Bresick, G.F., Broder, T., & Weisner, C.M. (2014). Effectiveness of nurse-practitioner-delivered brief motivational intervention for young adult alcohol and drug use in primary care in South Africa: A randomized clinical trial. Alcohol and Alcoholism, 49(4), 430-438.

Nilssen, O. (1991). The Tromso Study: Identification of and a controlled intervention on a population of early-stage risk drinkers. Preventive Medicine,20, 518-528.

Noknoy, S., Rangsin, R., Saengcharnchai, P., Tantibhaedhyangkul, U., & McCambridge, J. (2010). RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol and Alcoholism, 45(3), 263-270.

Ockene, J.K., Adams, A., Hurley, T., Wheeler, E. & Hebert, J.R. (1999). Brief physician- and nurse practitioner-delivered counseling for high-risk drinkers: Does it work? Archives of Internal Medicine, 159(18), 2198-2205.

Richmond, R., Heather, N. Wodak, A. Kehoe, L., & Webster, I. (1995). Controlled evaluation of a general practice-based brief intervention for excessive drinking. Addiction 90(1), 119-132.

Romelsjö, A., Andersson, L, Barrner, H., Borg, S., Granstrand, C., Hultman, O., . . . Wikblad, O. (1989). A randomized study of secondary prevention of early stage problem drinkers in primary health care. British Journal of Addiction, 84(11), 1319-1327.

Roy-Byrne, P., Bumgardner, K., Krupski, A., Dunn, C., Ries, R., Donovan, D., West, I. I., . . . Zarkin, G.A. (2014). Brief intervention for problem drug use in safety-net primary care settings. Jama, 312(5), 492.

Saitz, R., Palfai, T.P., Cheng, D., Alford, D.P., Bernstein, J.A., Lloyd, T.C.A., Meli, S.M., . . . Samet, J.H. (2014). Screening and brief intervention for drug use in primary care: The ASPIRE randomized trial. Drug and Alcohol Dependence, 140.

Schaus, J. F., Sole, M. L., McCoy, T. P., Mullett, N., & O'Brien, M. C. (2009). Alcohol screening and brief intervention in a college student health center: A randomized controlled trial. Journal of Studies on Alcohol and Drugs, Suppl. 16, 131-141.

Scott, E. & Anderson, P. (1990). Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Drug and Alcohol Review, 10(4), 313-321.

Senft, R.A., Polen, M.R., Freeborn, D.K. & Hollis, J.F. (1997). Brief intervention in a primary care setting for hazardous drinkers. American Journal of Preventive Medicine, 13(6), 464-470.

Wallace, P., Cutler, S., & Haines , A. (1988). Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. British Medical Journal, 297(6649), 663-668.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov