Screening, Brief Intervention and Referral to Treatment (SBIRT) and the related BIG (Brief Intervention Group) Initiative to advance use of screening/brief intervention in the employee assistance program (EAP) industry have become a hot topic in workplace assistance. Many in the EAP field already have become familiar with SBIRT and its interviewing techniques designed for alcoholism screening. This has led to resumption of a debate about whether EAP work should adopt a single focus or a broad-brush approach, and a discussion of how SBIRT might fit into those respective scenarios.
This article will recall some history as it relates to the current questions regarding SBIRT's introduction. Two corporate cases will be presented to illustrate how some companies have chosen slightly different paths toward the same goal. Finally, closing thoughts will be offered for consideration to assist in the decision-making process regarding usage of SBIRT protocol.
Occupational alcoholism program pioneer Lewis Presnall viewed alcoholism unlike any other type of problem in society. He was a visionary in understanding how extensively this disease process would affect people's health, jobs and overall lives. Presnall believed that a separate and unique view of alcoholism and its intervention, beyond other types of human problems, had to be established.1 He emphatically believed that if alcoholism were simply lumped in with other personal problems, there would be less success in identifying and successfully treating individuals with alcohol issues.
As director of the Central Intelligence Agency's (CIA's) EAP, Presnall titled the program the “Agency Alcohol Awareness Program.” This program consistently received numerous supervisor referrals and a significant number of self-referrals regarding alcoholism. After Presnall's death, successor Frank Robinson, MD, changed the CIA program to a “broad-brush” EAP model. In fact, many EAPs expanded to a broader philosophy in the early 1980s. These changes heated up the debate over single-focus EAPs vs. a broad-brush approach.
With the emergence of a brief screening tool for alcoholism, there appears to be a re-emergence of a similar debate. Last fall at the National Business Group on Health (NGBH) conference, Daniel J. Conti (managing director of the Employee Assistance & WorkLife Program at JPMorgan Chase), John Pompe (manager of disability and behavioral health programs at Caterpillar) and Eric Goplerud, PhD (director of Ensuring Solutions to Alcohol Problems) presented on the topic of workplace strategy and interventions for substance use disorders. Prior to the presentation, a pharmaceutical representative posed this question to the speakers: “Why should we fund a screening tool that focuses solely on alcohol-related issues?” The debate about a single focus vs. a more broad-brush approach was officially reborn.
SBI is a technique combining the use of validated screening instruments and short-term intervention to reduce or eliminate harmful alcohol use. When detected early, alcohol problems can be effectively treated in ways that are less costly and that prevent more serious illness from developing. One study found that heavy drinkers who received brief intervention over a two-month period had significantly fewer accidents, hospital visits and other events related to problem drinking during the following year. Savings for each brief intervention exceeded treatment costs by 3 to 1.
The prevalence of alcoholism in the general public is estimated to be about 7.7 percent, while the prevalence of this disease among employed individuals is slightly higher at 9.2 percent.2 It has been reported that nationwide, EAPs engage only one worker in 20 with a serious alcohol problem.3 EAPs, which are offered by about three-quarters of all businesses, thus are constantly looking for new and better ways to assess, diagnose and treat alcohol issues in the workplace.
The following two case studies are offered as an example of some of the behind-the-scenes issues that need to be considered in the decision-making process associated with introducing a new diagnostic tool, even when that tool is considered cutting-edge. Companies have a myriad of issues under consideration at any given moment on how best to support productive employees. These two scenarios exemplify some of the complicated issues involved in instituting treatment policy changes.
JPMorgan Chase, one of the oldest financial institutions in the United States, is considered one of the leading global financial service firms, with assets of $2 trillion. It operates in more than 60 countries with an employee population of approximately 240,000 worldwide and 185,000 in the U.S.
JPMorgan Chase's EAP uses a hybrid model with nine internal staff members who manage various sites across the country, with the majority of the assessment and referral process being handled by vendor Aetna Behavioral Health & Life Care. Aetna provides an EAP network and a work/life resource with a dedicated team for all JPMorgan Chase employees.