Online screening for alcohol use: online alcohol screening programs address privacy concerns of employees and thus encourage greater participation, opening the door to further intervention and treatment and helping reduce healthcare costs.

According to the Pew Internet and American Life Project, 80 percent (93 million) of U.S. Internet users have searched online for information about one or more major health topics. Of those, 8 percent (7.4 million) have searched for information about problems with drugs or alcohol. These "health seekers," as they are called, also want more diagnostic tools, ways to connect with local resources, and better privacy protection. (1)

Providing these tools and resources online while also guaranteeing privacy can go a long way toward helping reduce healthcare expenses. It is estimated that healthcare costs for employees with alcohol problems are twice as high as for other employees, (2) and total productivity losses attributable to alcohol were estimated at $119 billion for 1995. (3) According to the 2003 National Survey on Drug Use and Health, of the 16 million people who self-reported as heavy drinkers, 79.9 percent (12.4 million) were employed at the time. (4) Numerous studies have shown that these workers have a deleterious effect on the workplace in the form of reduced productivity, absenteeism, and turnover, increased accidents and injuries, and higher physical and mental health expenditures.

The programs that are most effective in preventing alcohol abuse are those that include screening for alcohol problems. Screening, according to the Department of Veterans' Affairs, is beneficial because "given appropriate support and assistance, people who are not alcohol dependent may reduce or stop their consumption." (5) This is particularly important given that 60 percent of alcohol-related absenteeism, tardiness, and poor work quality is caused by non-dependent drinkers, those who drink lightly to moderately. (6)

Screening programs offer employees a tool to explore their own drinking behavior and that of their family and friends, which they might not otherwise do. Once employees are more self-aware of their drinking problem, they are better able to make behavioral changes.

ANONYMITY AND CONFIDENTIALITY

Typically, screening programs are conducted in-person and are poorly attended. Their low utilization rates may reflect fear among workers that employers will punish those who are found to have a drinking problem. According to a 2004 poll conducted by Peter D. Hart Research Associates, 80 percent of the general public believe that discrimination in the workplace against people in recovery is a problem in the United States. (7) Without anonymity and confidentiality, screening programs will never be able to grow and succeed.

To maintain anonymity and confidentiality, people are now turning to the Internet for health information and resources. The trend toward seeking health tools and information on the Internet prompted the creation of AlcoholScreening.org, a free public Web site created by Join Together, a project of the Boston University School of Public Health. Join Together (www.JoinTogether.org) is a leading source of information for professionals working in the substance abuse field and is funded primarily by the Robert Wood Johnson Foundation.

AlcoholScreening.org aims to help users understand how their drinking may be affecting their health. Since its launch during National Alcohol Awareness Month 2001, Alcohol Screening.org has been visited by almost 600,000 people, who've completed nearly 300,000 screens. Hundreds of Web sites have linked to it, including the Montana State University Employee Wellness Program, the Massachusetts State Health Department, Delta Airlines, Employee Resource Systems (Chicago), the New York State Office of Alcoholism and Substance Abuse Services, Employee & Family Resources (Iowa), WebMD, and many universities.

AlcoholScreening.org has three sections: Screening, Learn More, and Find Help. Learn More provides information about a wide range of alcohol-related health topics, including alcohol consumption guidelines, how to cut down on drinking, tips for teens, what to do if someone you know has a problem, and so on. The Find Help section contains links to additional support resources and a database of 11,000 local treatment programs in the United States. Users can search the database for treatment providers in their area simply by providing their ZIP code.

CHANGES IN BEHAVIOR

The screening section of the site consists of 13 questions that are a modified version of the AUDIT (alcohol use identification test), which was created by the World Health Organization and is one of the most widely validated alcohol self-screening tools. After answering the questions, the user receives personalized feedback.

The feedback pages were created using the brief intervention model as a foundation. Brief interventions are counseling sessions (typically conducted in-person) that can be as short as five minutes. In face-to-face situations, they have been shown to be highly effective: drinkers who receive a brief intervention are twice as likely to reduce their drinking as others. (8) Most often, brief interventions incorporate the six elements of FRAMES: feedback, responsibility, advice, menu of strategies, empathy, and self-efficacy,

The feedback pages discuss whether the visitor's alcohol consumption is likely to be within safe limits or may be harmful to the person's health, either now or in the future. It also compares the visitor's alcohol consumption with that of other people of the same age and gender to illustrate whether the person drinks more or less than his/her peers. It refers likely dependent drinkers to additional treatment resources, advises risky (non-dependent) drinkers to cut back, and educates all visitors about moderate drinking guidelines.

The feedback on AlcoholScreening.org is meant to be supportive but also to instigate changes in behavior. It does not label anyone as an alcoholic; instead, it focuses on the health risks to visitors, both immediate and over the long term.

A recent study published in Preventive Medicine looked at the behavior of visitors to AlcoholScreening.org after receiving their personalized feedback. The results showed that visitors' actions after receiving feedback were in line with what one would expect to see relative to their drinking behavior. For example, of those immediately "clicking through" to the Learn More or Find Help sections after receiving feedback, 21 percent reported possible alcohol abuse or dependence and 16 percent were hazardous drinkers (binge drinkers), while only 9 percent were non-hazardous drinkers. In addition, of those who continued navigating the site after receiving feedback, 33 percent who reported possible alcohol abuse or dependence immediately clicked through to Get Help instead of Learn More, while only 8 percent of binge and non-hazardous drinkers did the same.

In other words, visitors with greater drinking severity levels were much more likely to take the next step toward getting help rather than simply learning more about the topic. Although no research on the effectiveness of brief interventions provided via Web-based feedback has yet been published, this study does indicate some level of influence on visitors to AlcoholScreening.org.

ESSENTIAL IN THE WORKPLACE

In addition to the many Web sites linking to AlcoholScreening.org, dozens of "syndication partner" sites have seamlessly integrated (syndicated) the content of AlcoholScreening.org into their own design and structure. The syndication tool is a free product of Join Together and AlcoholScreening.org that comes with many benefits. For example, visitors can screen themselves, receive personalized feedback, browse a library of alcohol and health information, and seek out support and treatment resources without ever leaving a syndication partner's site.

Want your EAP's phone number and office location to be the first listing in the Find Help section? No problem--the syndication tool allows for the addition of local resource information into the Learn More and Find Help sections. The syndication tool also captures anonymous usage data that enable reports to be generated on the number of screens completed daily, the percentage of binge drinkers and dependent/non-dependent drinkers, and the age and gender of those screened. For some current syndication partners, the data have been of considerable help in measuring campaign effectiveness and creating a case for additional resources and/or funding.

These data, combined with the results from the Pew Internet and American Life Project, further demonstrate why a Web-based alcohol screening program is so essential in the workplace. Providing a validated diagnostic tool via the Internet helps employees screen themselves confidentially and anonymously, either in the workplace or from the privacy of their homes. It also provides them with easy access to local resources and additional information on alcohol and health. Offering such a tool allows an EAP to reach employees who otherwise may not participate in screening programs and thus to have a positive impact on the workplace.

Workplace prevention programs such as screening tools significantly reduce costs through improved productivity and fewer injuries on and off the job. And it's been proven time and again that the general health of employees will rise if they are encouraged to use, and provided with, tools for change.

April is here, and with it comes National Alcohol Awareness Month (and National Alcohol Screening Day on April 7). There's no better time than now to think about how alcohol is affecting the workplace and what EAPs can and should do about it.

References

(1) Fox, Susannah and Deborah Fallows. 2003. "Internet Health Resources: Health Searches and E-mail Have Become More Commonplace, but there is Room for Improvement in Searches and Overall Internet Access." Washington, D.C.: Pew Internet and American Life Project.

(2) Schneider Institute for Health Policy. 2001. "Substance Abuse: The Nation's Number-One Health Problem." Princeton, N.J.: Robert Wood Johnson Foundation.

(3) Harwood, H., D. Fountain, and G. Livermore. 1998. "The Economic Costs of Alcohol and Drug Abuse in the United States." Rockville, Md.: National Institute on Drug Abuse.

(4) Substance Abuse and Mental Health Services Administration. 2003. "National Survey on Drug Use and Health." Washington, D.C.: U.S. Department of Health and Human Services.

(5) U.S. Department of Veterans Affairs. 2002. "Creating Opportunities for Reducing Alcohol-Related Harm in the Veteran Community: A Training Program for Veteran Service Providers." Washington, D.C.: U.S. Department of Veterans Affairs.

(6) Robert Wood Johnson Foundation. 2000. "Study on Worksite Prevention of Alcohol Problems and its Dissemination: Grant Results Report." Princeton, N.J." Robert Wood Johnson Foundation.

(7) Hart, Peter D. and Robert M. Teeter. 2004. "Faces and Voices of Recovery: Public Survey." Washington, D.C.: Peter D. Hart Research Associates.

(8) Babor, T.F. and J.C. Higgins. 2001. "Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care." Geneva, Switzerland: World Health Organization.

Marc Belanger works for Join Together as the project manager of AlcoholScreening.org. He earned his master's degree in health communications from Emerson College in Boston. He can be reached at [phone] or at [e-mail].