During the mid-1980s, the New York Business Group on Health, Inc., under the leadership of Leon Warshaw, M.D., conducted a survey of 62 hospitals in the greater New York metropolitan area. It identified that, on average, 21 percent of the patients admitted to these hospitals were unrecognized or undiagnosed alcoholics. Findings by the New York State Department of Health indicate that patients with unrecognized alcohol problems are incurring an estimated 1.3 million patient days of inpatient hospital care and 720,000 emergency room visits costing over $500,000,000 per year. The American Medical Association also estimates that a minimum of 25 percent of all hospitalized patients have a significant alcohol problem. These findings underscore the need to identify individuals suffering from alcoholism early to avert the progression of alcohol-related health problems, reduce healthcare utilization, and link patients with necessary services.
Hospital Intervention Services (HIS) is an effort to identify problem drinkers at early stages in the progression of alcoholism, and motivate them to alter their drinking behavior. The HIS model utilizes a sequential process to identify and address the needs of patients experiencing problems with alcohol. A special screening questionnaire is administered to all patients admitted to hospitals as part of a health habits determination. This screening process involves specific questions with a high predictive quality that will identify a potential alcohol problem. When the probability of alcohol abuse has been identified in a patient, specially trained alcoholism professionals are called in to perform a complete assessment. This assessment reviews the patient's use patterns, negative consequences, and possible signs and symptoms of alcoholism. A determination is made concerning the extent of the patient's problem and the motivation to change.
Individuals who are assessed as experiencing earlier or less serious alcohol problems or are at risk for developing an alcohol problem receive a "brief intervention." The goal is to provide information and educational materials that will lead to a reduction or elimination of the individual's alcohol consumption in a timely and efficient manner. The approach is educational with an emphasis on personal responsibility for change, clear advice to change, a menu of alternative change options from which the patient can choose, empathy by the interventionist, and facilitation of patient self-efficacy. For the patient with a clinically significant alcohol problem, a full intervention is performed. Here the purpose is to convince the individual that specialized treatment is needed to address the alcohol problem, and to effect a scheduled referral to care. Follow-up contact with the treatment agency is made to determine whether the patient actually entered treatment.
During 1991 and 1992, HIS screened 73,698 patients, 14 percent of whom tested positive for potential issues. Of those that tested positive, 68 percent received full interventions, the rest received brief interventions. Seventy-four percent of those who received either form of intervention accepted referral to alcohol treatment. HIS has essentially removed these patients from the revolving nature of the medical problems associated with drug and alcohol abuse.