Employee assistance programs (EAPs) offer short-term counseling and long-term referrals to employees as part of a health benefits package. The EAP setting presents a unique opportunity to conduct screening and brief interventions (SBIs) for at-risk drinking. Using an EAP to address at-risk drinking and to prevent more serious alcohol problems from developing may be critical to reducing the prevalence of these issues among employed individuals. Unfortunately, the majority of at-risk drinkers are not identified by clinicians through EAPs, nor are they provided services through EAPs for their drinking if identified. The main objective of this two-year services research study is to understand how to implement SBIs for at-risk drinking in a standard EAP setting. Substantial evidence supports the effectiveness of SBIs in other settings such as primary care and college settings. However, only a few published studies have examined the feasibility of implementing SBIs into workplace populations. These SBI interventions typically last about 20-30 minutes and utilize a Motivational Interviewing approach. The brief nature of these interventions may make it feasible to integrate, but there may be several barriers specific to the EAP from an organization and staff perspective that would make it challenging to implement. In the current study, we will first conduct focus groups with EAP staff to determine the barriers and facilitating factors associated with implementing and recruiting for a SBI for at-risk drinking within the EAP. Using this information, we will conduct a randomized trial of the SBI as an add-on to standard EAP care compared to standard EAP care alone. EAP Clinicians will deliver both the SBI intervention and EAP sessions. The intervention will be an add-on to the client's second session. Upon entering the EAP, clients will be screened for at-risk drinking using the AUDIT-C. Male clients scoring five or higher and female clients scoring three or higher on the AUDIT-C will be randomly assigned to either the intervention (n=50) or control (n=50) group. To assess the efficacy of the intervention, we will examine drinking and health outcomes at 3- and 6-month follow-ups. Finally, we will gather basic cost data associated with adding the SBI to standard EAP care and explore the feasibility of gathering administrative data for a future cost-effectiveness study. This R21 represents our first critical step in understanding potential barriers to bringing alcohol interventions into the workplace and examining potential efficacy and costs associated with this type of intervention. Results from this pilot trial have significant potential to influence standards of care for identifying and intervening with at-risk drinkers in the EAP setting.
Widely implementing SBIs in standard EAP care has a great potential for decreasing the prevalence of alcohol use disorders in the workplace as well as decreasing the costs of occupational, societal, and health problems associated with untreated at-risk drinking. To date, few studies have examined the implementation of an SBI in an EAP setting, and very little is known about the barriers that would be encountered. Results from this pilot trial have significant potential to influence standards of care for identifying and intervening with at-risk drinkers in the EAP setting.
