AAFP Updates Alcohol Use Practice Manual

The resources, developed with the support of a financial assistance award from CDC/HHS, also provide AAFP members with guidance on billing for SBIRT (screening, brief intervention and referral to treatment) services, and connect them with training programs and resources from various CDC consortium members on the management of alcohol and other substance use during pregnancy.

Excessive use of alcohol and tobacco is among the leading causes of preventable death in the United States. Alcohol use in pregnancy can lead to miscarriage, stillbirth and fetal alcohol spectrum disorders, a group of conditions that can result in physical abnormalities, speech and language delays, and difficulties with behavior and attention. At the same time, marijuana use is increasing, including among pregnant people, and the perception that substances such as marijuana are harmful has declined.

Other research has shown that polysubstance use (for example, marijuana and alcohol) can lead to more adverse health consequences compared with the use of just one substance.

Practice Manual Offers Steps for Change

The practice manual offers a method for using the SBIRT approach to determine patients’ use of alcohol, marijuana, tobacco and other substances.

First, the manual calls on clinicians to support the approach through techniques such as using the medical home model in their practices; establishing a practice culture that supports universal screening and intervention; and identifying at least one office champion to ensure that universal screening and intervention is implemented.

Next, the manual offers guidance to help family medicine practices evaluate how they currently function and identify any changes that may be needed to integrate the SBIRT approach.

Following the evaluation, the manual provides an extensive overview of SBIRT, with clear definitions of each step in the approach and recommendations on practice workflows, follow-up care, and considerations of patients’ social determinants of health, gender, cultural and ethnic backgrounds, and behavioral health.

The manual also includes steps for standardizing office systems to ensure that every patient who uses alcohol excessively and/or other substances is identified, counseled on reducing use or quitting, and referred to evidence-based treatment programs as needed.

Finally, the manual includes a brief section on how to anticipate resistance to changes in practice and develop strategies for addressing it, and a sample worksheet for practices to plan system-level changes and put them into action.

More Tools Address Alcohol Use

Two other resources have been added to the Excessive Alcohol Use page:

• A two-page Training and Resources sheet offers links to several free online programs from the CDC, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics, along with resources from CDC consortium members for clinicians, patients and their families.
• A six-page Reimbursement and Coding guidance document includes guidance on billing for and documenting SBIRT services, as well as recommendations for coding for alcohol misuse screening and behavioral counseling during pregnancy.

The updated resources complement the Academy’s existing collections of journal articles, research, policies and position papers, which are also available on the Excessive Alcohol Use page.