Back to Our Roots: Integrating a Screening and Brief

Intervention in Addressing Alcohol Problems

Karen Chan, PhDAssociate Behavioral Scientist

RAND Corporation

October 6, 2006EAPA Conference

Ray Mitchell, MS, CEAPSenior Vice President

APS Healthcare

Paul Davis, PhDRegional Clinical Manager

APS Healthcare

Objectives• Ray Mitchell

– EAP Roots – Recommendations for EAP clients with problem drinking

• Paul Davis– Process of conducting research in the EAP– Balancing clinical, research, and corporate needs for

successful collaboration• Karen Chan

– Outcome data on a brief intervention– Role-play brief intervention

• Ray Mitchell– Discussion with audience– Future Directions

Introduction

• Our Roots– EAPs originated from Occupational Alcoholism Programs

(consistent with the AA movement)

• The Winds of Change– Origins of EAPs have lost focus as EAPs broadened to

treat all types of problems

– While 15-31% of the workforce presents with problem drinking, 1.5% present to the EAP with alcohol and substance use concerns.

– Early identification and prevention/intervention is needed before problems get more severe and costly.

What we know about employee drinking

• 140 million Americans work (Dept of Labor, 2004)

• 82% of the labor force work full-time (Dept of Labor, 2004)

• 61% of employees drank in the last month (NSDUH, ‘04)

• 5% of the workforce meet alcohol abuse criteria and 4% of the workforce meet alcohol dependence criteria (Summers & Goplerud, 2005)

Drinking Continuum

(Institute of Medicine, 1990).

None Mild Moderate Substantial Severe

None Light Moderate Substantial Heavyabuse dependence

problem use addiction

PROBLEMS

ALCOHOL USE

Work Factors Affecting Drinking

• Performance regulation expectancies

• Workplace norms

• Job stress (unwinding time, skipped meals, job problems)

• Unsupportive supervisors

• Job visibility

• Job instability and dissatisfaction

Limited Research on EAPs

In general, cost-effective

– $5.1 million saved per year (Blum & Roman, 1995)

– $7,750 saved per employee & 75% reduction in inpatient costs (Marsh and McLennan Companies, 1994). 

EAPs “succeeded” in returning employees with alcohol problems to effective performance (Roman & Blum, 2002)

– No comparison group, none to very brief follow-ups, selection bias, limited measures of outcome, no standardized EAP model

EAPs for Addictive Behaviors

– Receive fewer sessions, more likely to be referred out, and less likely to resolve their problems within the EAP; 6% identified for an addictive behavior (Chan, Neighbors, & Marlatt, 2004)

APS Involvement

• Based on Need – Client Needs– Corporate Needs

• Origins of APS Involvement

• Setting the Stage on a Corporate Level

Research in an EAP Setting

• Is research doable in an EAP setting?

• Cost-benefit analysis

• Research Liaison

• Areas of Focus:– Client Care – Clinician Support– Logistics– Recruitment– Balancing organizational/research needs

Research in an EAP Setting

• Client Care – Corporate Clients

• Addressing possible corporate concerns regarding employee participation

– EAP Clients• Participant Selection

– Safety – EAP and University response– Nature of the Presenting Concern– Individual vs. Couples/Family

• Ensuring Client Needs Are Addressed– Address needs during feedback– Additional Sessions

Research in an EAP Setting

• Clinician Support– Training

• 13 hours CEU for MI training by UW Faculty

• Checklists, Scripts, and Paperwork

• Equipment

– Incenting• Additional time/pay for transitioning

• Cheerleading for the mission

– Supervision/Feedback• Individual

• Group

Research in an EAP Setting

• Logistics– Client paperwork

• confidentiality

– Clerical support for Clinicians– After-hours services

Research in an EAP Setting

• Recruitment– Ongoing Clinician support/scripts– Incenting clients

• Normalizing paperwork

• Assuring needs will be met (extended sessions)

• Addressing resistance (studying range of etoh use)

• Emphasizing benefits

• Allowing choice/flexibility– Time/location for paperwork

– Taping

• Expressing appreciation

Research in an EAP Setting

• Balancing Organizational/Research Needs– More power! The never-ending search for more

subjects– University vs. corporate culture– Setting workable limits

Research in an EAP Setting

• Celebrating Success– Clinician feedback– Clinical results to follow….

Research in EAP is Doable!

A Brief Intervention for Screened Problem Drinking in

an EAP

Outline

• Description of Study

• Motivational Interviewing

• Study Findings and Implications

• Role-play the brief intervention

Acknowledgements

• G. Alan Marlatt• Mary Larimer• Clayton Neighbors• Franchesca Nguyen• Steve Zellmer• Paul Davis • Ray Mitchell• Kelly Bui• Bonnie Burlingham• EAP therapists and clients• Shirley Murphy• Meenakshi Jaim• Neha Chawla• Diane Logan• Michel Davila

Funding AgenciesNIAAA F31 #AA 14753UW Alcohol and Drug Abuse Institute

Background

• Low identification of problem drinking

• High referral of clients with addictive behaviors outside the EAP

• Research revealing the efficacy of a one-session brief intervention utilizing motivational interviewing in other settings

• Huge prevention and intervention potential with the short-counseling model of the EAP

Health Screen(49% screened

positive)1st Session

EAP Services as Usual (SAU)

Baseline Assessment

2nd Session(BI)

2nd Session(SAU)

Brief Survey(After 2nd Session)

Follow-up Assessment(3 months after BL)

Brief Intervention

Personalized Feedback

1) Typical Drinking Patterns

2) Beliefs About Alcohol

3) Drinking Situations

4) Negative Consequences

…conducted using a Motivational Interviewing style.

What has been your experience working with clients with problem drinking?

Stages of Change

Precontemplation

Contemplation

Preparation

ActionMaintenance

Relapse

Prochaska and DiClemente, 1982

Motivational InterviewingA Definition

• Motivational Interviewing is a – person-centered– directive– method of communication– for enhancing intrinsic motivation to change by

exploring and resolving ambivalence

MI Principles

• Express Empathy

• Develop Discrepancy

• Roll with Resistance

• Support Self-Efficacy

Motivational Interviewing Strategies

1. Open-Ended Questions2. Affirm and Support Your Client3. Reflectively Listening4. Summarizing

5. Roll with Resistance6. Elicit Self-Motivational Statements

(Change Talk)

Elicit – Provide – Elicit:Providing Feedback

• Information exchange

• Balanced Conversation

• Elicit readiness and interest

• Provide feedback neutrally

• Elicit the patient’s interpretation and follow it

(Rollnick, Mason, & Butler, 1999)

Project Findings1. Does MI make a difference on client outcomes?

2. How did the brief intervention compare to services as usual?

MI proficiency and client outcome

Peak Quantity Peak BAC Drinks Per Week

Low Empathy 5.44 0.07 12.20

High Empathy 4.24 0.04 10.45

Peak Quantity Peak BAC

Low MI Spirit 5.15 0.06

High MI Spirit 4.30 0.04

Brief Intervention vs. EAP Services-as-usual

0

2

4

6

8

BL FU

# d

rin

ks

BIEAP

Heaviest Drinking Occasion

Brief Intervention vs. EAP Services-as-usual

0

0.02

0.04

0.06

0.08

0.1

BL FU

BA

C

BIEAP

Peak Blood Alcohol Content

Brief Intervention vs. EAP Services-as-usual

Alcohol-related Problems

0

2

4

6

8

BL FU

Sum

Sco

re EAPBI

Brief Intervention vs. EAP Services-as-usual

0

2

4

6

8

10

BL FU

Problem Score

SAU (M) SAU (F)BI (M) BI (F)

Alcohol-related Problems by Group and Gender

How did the clients rate the BI?

1. Treatment satisfaction– Both groups rated equally high – 96.15% of BI clients would recommend this type of

session to a friend. 2. Number of sessions

- No additional EAP sessions needed for the BI group

3. Problem resolution for clients’ presenting problems– According to therapists’ ratings, 91% of clients had

their presenting problems resolved in the EAP.

Implications

• Screening may not be enough

• Talking and not avoiding

• “One stop shop”

• Cost-effectiveness

• Prevention and Intervention opportunity

Role-Play

• Charles: 55 Year old self-employed, married male, father of a 16 year-old daughter, seeking help with career development after losing his job as a manger in a high tech firm 2 years ago as a result of a RIF.

Questions or Comments?

Please contact Karen at karenc@rand.org