Washington State Institute for Public Policy
Brief intervention in a medical hospital
Substance Use Disorders: Early Intervention
Benefit-cost estimates updated May 2017.  Literature review updated September 2016.
Inpatients in medical hospitals are screened for "hazardous" alcohol use (not dependence). Those screening positive receive a brief intervention, delivered by health care staff or other professionals. 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.
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 $1,306 Benefits minus costs $3,958
Participants $2,717 Benefit to cost ratio $25.59
Others $85 Chance the program will produce
Indirect $10 benefits greater than the costs 75 %
Total benefits $4,119
Net program cost ($161)
Benefits minus cost $3,958
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 $2 $0 $3
Labor market earnings associated with problem alcohol use $1,226 $2,701 $0 $50 $3,977
Property loss associated with problem alcohol use $0 $4 $7 $0 $11
Health care associated with problem alcohol use $79 $13 $76 $41 $208
Adjustment for deadweight cost of program $0 $0 $0 ($80) ($80)
Totals $1,306 $2,717 $85 $10 $4,119
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $151 2011 Present value of net program costs (in 2016 dollars) ($161)
Comparison costs $0 2011 Cost range (+ or -) 20 %
This program consists of a single brief intervention during a visit to the hospital. The average duration of intervention in these studies was 0.65 hours. We assume it takes 15 minutes to screen patients and 20% of the screened patients meet eligibility requirements. We further assume that nurses conduct the screens and the intervention. To compute the cost per screened individual, we use salary information from the Bureau of Labor Statistics for registered nurses in surgical medical hospitals in 2011 multiplied by the time required by the intervention.
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
Death 1 59 -0.045 0.701 40 0.000 0.000 42 -0.045 0.949
Drinking and driving^ 1 62 -0.686 0.340 40 -0.094 0.509 42 -0.686 0.043
Problem alcohol use 15 1403 -0.170 0.050 40 -0.023 0.075 42 -0.170 0.001
Citations Used in the Meta-Analysis

Antti-Poika, I., Karaharju, E., Roine, R., & Salaspuro, M. (1988). Intervention of heavy-drinking-a prospective and controlled study of 438 consecutive injured male patients. Alcohol and Alcoholism, 23(2), 115-121.

Bager, P., & Vilstrup, H. (2010). Post-discharge brief intervention increases the frequency of alcohol abstinence-a randomized trial. Journal of Addictions Nursing, 21(1), 37-41.

Chick, J., Lloyd, G., & Crombie, E. (1985). Counseling problem drinkers in medical wards: A controlled study. British Medical Journal, 290, 965-967.

Elvy, G.A., J.E. Wells, and K.A. Baird. (1988). Attempted referral as intervention for problem drinking in the general hospital. British Journal of Addiction, 83(1), 83-89.

Freyer-Adam, J., Coder, B., Baumeister, S.E., Bischof, G., Riedel, J., Paatsch, K., Wedler, B., ... Hapke, U. (2008). Brief alcohol intervention for general hospital inpatients: A randomized controlled trial. Drug and Alcohol Dependence, 93(3), 233-243.

Heather, N., Rollnick, S., Bell, A., & Richmond, R. (1996). Effects of brief counseling among male heavy drinkers identified on general hospital wards. Drug and Alcohol Review, 15(1), 29-38.

Holloway, A.S., Watson, H.E., Arthur, A.J., Starr, G., McFadyen, A.K., & McIntosh, J. (2007). The effect of brief interventions on alcohol consumption among heavy drinkers in a general hospital setting. Addiction, 102(11), 1762-1770.

Kuchipudi, V., Hobein, K., Flickinger, A., & Iber, F.L. (1990). Failure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease. Journal of Studies on Alcohol, 51(4), 356-360.

Liu, S.-I., Wu, S.-I., Chen, S.-C., Huang, H.-C., Sun, F.-J., Fang, C.-K., Hsu, C.-C., ... Shih, S.-C. (2011). Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men. Addiction, 106(5), 928-940.

Saitz, R., Palfai, T.P., Cheng, D.M., Horton, N.J., Freedner, N., Dukes, K., Kraemer, K.L., . . . Samet, J.H. (2007). Brief intervention for medical inpatients with unhealthy alcohol use: A randomized, controlled trial. Annals of Internal Medicine, 146(3), 167-176.

Schermer, C.R., Moyers, T.B., Miller, W.R., & Bloomfield, L.A. (2006). Trauma center brief interventions for alcohol disorders decrease subsequent driving under the influence arrests. The Journal of Trauma, 60(1), 29-34.

Shiles, C.J., Canning, U.P., Kennell-Webb, S.A., Gunstone, C.M., Marshall, E.J., Peters, T.J., & Wessely, S.C. (2013). Randomised controlled trial of a brief alcohol intervention in a general hospital setting. Trials, 14, 345.

Shourie, S., Conigrave, K.M., Proude, E.M., Ward, J.E., Wutzke, S.E., & Haber, P.S. (2006). The effectiveness of a tailored intervention for excessive alcohol consumption prior to elective surgery. Alcohol and Alcoholism, 41(6), 643-649.

Smith, A.J., Hodgson, R.J., Bridgeman, K., & Shepherd, J.P. (2003). A randomized controlled trial of a brief intervention after alcohol-related facial injury RESEARCH REPORT. Addiction, 98(1), 43-52.

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