Washington State Institute for Public Policy
Brief intervention in emergency department (SBIRT)
Substance Use Disorders: Early Intervention
Benefit-cost estimates updated May 2017.  Literature review updated September 2016.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) for patients in emergency departments is used to identify and address "hazardous" alcohol use (not alcohol dependence). Those screening positive receive a brief intervention, delivered by health care staff or other professional. The intervention includes feedback on the patients’ consumption compared to their peers and a 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. Patients meeting diagnostic criteria for abuse or dependence would be referred to chemical dependency treatment in lieu of brief intervention.
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 $1,099 Benefits minus costs $2,850
Participants $2,122 Benefit to cost ratio $7.56
Others $181 Chance the program will produce
Indirect ($117) benefits greater than the costs 62 %
Total benefits $3,285
Net program cost ($435)
Benefits minus cost $2,850
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 $2 $0 $4 $1 $7
Labor market earnings associated with problem alcohol use $949 $2,091 $0 $30 $3,071
Property loss associated with problem alcohol use $0 $3 $6 $0 $9
Health care associated with emergency department visits $148 $28 $171 $70 $416
Adjustment for deadweight cost of program $0 $0 $0 ($218) ($218)
Totals $1,099 $2,122 $181 ($117) $3,285
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $362 2005 Present value of net program costs (in 2016 dollars) ($435)
Comparison costs $0 2005 Cost range (+ or -) 20 %
This program consists of a single brief intervention during a visit to the emergency department. According to one multisite US study, of 7,751 patients screened, 1,132 were eligible and consented. (Academic ED SBIRT Research Collaborative. (2007). The impact of screening, brief intervention, and referral for treatment on emergency department patients' alcohol use. Annals of Emergency Medicine, 50(6), 699-710). In Washington State, cost estimates from 2005 indicate $53 per patient screened based on an analysis by Washington State Division of Alcohol and Substance Abuse, presented at the 2006 Co-Occurring Disorders Conference.
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^ 2 371 -0.012 0.073 34 -0.002 0.109 36 -0.012 0.867
Drinking and driving^ 4 776 -0.158 0.080 34 -0.022 0.120 36 -0.158 0.048
Emergency department visits 1 52 -0.317 0.321 34 -0.043 0.481 36 -0.317 0.322
Illicit drug use^ 2 721 -0.065 0.071 34 -0.009 0.107 36 -0.065 0.362
Injuries^ 1 122 -0.266 0.127 34 -0.036 0.191 36 -0.266 0.037
Opioid drug use^ 1 87 0.000 0.150 34 0.000 0.225 36 0.000 1.000
Problem alcohol use 27 4591 -0.139 0.032 34 -0.019 0.047 36 -0.139 0.001
Citations Used in the Meta-Analysis

Academic ED SBIRT Research Collaborative. (2007). The impact of screening, brief intervention, and referral for treatment on emergency department patients' alcohol use. Annals of Emergency Medicine, 50(6), 699-710.

Blow, F.C., Barry, K.L., Walton, M.A., Maio, R.F., Chermack, S.T., Bingham, C.R., Ignacio, R.V., . . . Strecher, V.J. (2006). The efficacy of two brief intervention strategies among injured, at-risk drinkers in the emergency department: impact of tailored messaging and brief advice. Journal of Studies on Alcohol,67 (4), 568-78.

Bogenschutz, M.P., Donovan, D.M., Mandler, R.N., Perl, H.I., Forcehimes, A.A., Crandall, C., Lindblad, R., . . . Douaihy, A. (2014). Brief intervention for patients with problematic drug use presenting in emergency departments: A randomized clinical trial. JAMA Internal Medicine, 174(11), 1736-1745.

Cherpitel, C.J., Korcha, R.A., Moskalewicz, J., Swiatkiewicz, G., Ye, Y., & Bond, J. (2010). Screening, brief intervention, and referral to treatment (SBIRT): 12-month outcomes of a randomized controlled clinical trial in a Polish emergency department. Alcoholism: Clinical and Experimental Research, 34(11), 1922-1928.

Crawford, M.J., Patton, R., Touquet, R., Drummond, C., Byford, S., Barrett, B., Reece, B., . . . Henry, J.A. (2004). Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet, 364(9442), 9-15.

Crawford, M.J., Csipke, E., Brown, A., Reid, S., Nilsen, K., Redhead, J., & Touquet, R. (2010). The effect of referral for brief intervention for alcohol misuse on repetition of deliberate self-harm: an exploratory randomized controlled trial. Psychological Medicine, 40(11), 1821-1828.

Daeppen, J.-B., Gaume, J., Bady, P., Yersin, B., Calmes, J.-M., Givel, J.-C., & Gmel, G. (2007). Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial. Addiction, 102(8), 1224-1233.

Dauer, A. R., Rubio, E. S., Coris, M. E., & Valls, J. M. (2006). Brief intervention in alcohol-positive traffic casualties: is it worth the effort?. Alcohol and Alcoholism , 41(1), 76-83.

D'Onofrio, G., Pantalon, M.V., Degutis, L.C., Fiellin, D.A., Busch, S.H., Chawarski, M.C., Owens, P.H., . . . O'Connor, P.G. (2008). Brief intervention for hazardous and harmful drinkers in the emergency department. Annals of Emergency Medicine, 51(6), 742.

D'Onofrio, G., Fiellin, D.A., Pantalon, M.V., Chawarski, M.C., Owens, P.H., Degutis, L.C., Busch, S.H., . . . O'Connor, P.G. (2012). A brief intervention reduces hazardous and harmful drinking in emergency department patients. Annals of Emergency Medicine, 60(2), 181-92.

Drummond, C., Deluca, P., Coulton, S., Bland, M., Cassidy, P., Crawford, M., Dale, V., . . . Kaner, E. (2014). The effectiveness of alcohol screening and brief intervention in emergency departments: A multicentre pragmatic cluster randomized controlled trial. Plos One, 9(6), e99463.

Field, C.A., Cochran, G., & Caetano, R. (2012). Ethnic differences in the effect of drug use and drug dependence on brief motivational interventions targeting alcohol use. Drug and Alcohol Dependence, 126, 21-26.

Goodall, C. A., Ayoub, A. F., Crawford, A., Smith, I., Bowman, A., Koppel, D., & Gilchrist, G. (2008). Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: A prospective randomised controlled trial. British Journal of Oral and Maxillofacial Surgery, 46(2), 96-101.

Havard, A., Shakeshaft, A.P., Conigrave, K.M., & Doran, C.M. (2012). Randomized controlled trial of mailed personalized feedback for problem drinkers in the emergency department: the short-term impact. Alcoholism, Clinical and Experimental Research, 36(3), 523-31.

Kunz, F.M.J., French, M.T., & Bazargan-Hejazi, S. (2004). Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department. Journal of Studies on Alcohol, 65(3), 363-70.

Longabaugh, R., Woolard, R.E., Nirenberg, T.D., Minugh, A.P., Becker, B., Clifford, P.R., . . . Gogineni, A. (2001). Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. Journal of Studies on Alcohol, 62(6), 806-816.

Mello, M. J., Baird, J., Lee, C., Strezsak, V., French, M. T., & Longabaugh, R. (2016). A randomized controlled trial of a telephone intervention for alcohol misuse with injured emergency department patients. Annals of Emergency Medicine, 67(2), 263–275.

Mello, M.J., Longabaugh, R., Baird, J., Nirenberg, T., & Woolard, R. (2008). DIAL: A telephone brief intervention for high-risk alcohol use with injured emergency department patients. Annals of Emergency Medicine, 51(6), 755-764.

Mello, M. J., Baird, J., Nirenberg, T. D., Lee, C., Woolard, R., & Longabaugh, R. (2013). DIAL: a randomised trial of a telephone brief intervention for alcohol. Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention, 19(1), 44-48.

Monti, P.M., Colby, S.M., Barnett, N.P., Spirito, A., Rohsenow, D.J., Myers, M., . . . Lewander, W. (1999). Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. Journal of Consulting and Clinical Psychology, 67(6), 989-994.

Monti, P. M., Barnett, N. P., Colby, S. M., Gwaltney, C. J., Spirito, A., Rohsenow, D. J., & Woolard, R. (2007). Motivational interviewing versus feedback only in emergency care for young adult problem drinking. Addiction, 102(8), 1234-1243.

Segatto, M. L., Andreoni, S., de, S. S. R., Diehl, A., & Pinsky, I. (2011). Brief motivational interview and educational brochure in emergency room settings for adolescents and young adults with alcohol-related problems: a randomized single-blind clinical trial. Revista Brasileira De Psiquiatria, 33(3), 225-33.

Sommers, M.S., Lyons, M.S., Fargo, J.D., Sommers, B.D., McDonald, C.C., Shope, J.T., & Fleming, M.F. (2013). Emergency department-based brief intervention to reduce risky driving and hazardous/harmful drinking in young adults: A randomized controlled trial. Alcoholism, Clinical and Experimental Research, 37(10), 1753-1762.

Woodruff, S.I., Clapp, J.D., Eisenberg, K., McCabe, C., Hohman, M., Shillington, A.M., Sise, C.B., . . . Gareri, J. (2014). Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: The Life Shift/Shift Gears study. Addiction Science & Clinical Practice, 9(8).

Woolard, R., Baird, J., Longabaugh, R., Nirenberg, T., Lee, C.S., Mello, M.J., & Becker, B. (2013). Project Reduce: Reducing alcohol and marijuana misuse: Effects of a brief intervention in the emergency department. Addictive Behaviors, 38(3), 1732-1739.

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