In an effort to combat growing rates of dangerous alcohol use, a program in Alabama is using personal interactions to help drinkers see the problems their drinking may cause.
In rural Alabama, that means providing one-on-one interventions to illustrate the dangers involved in heavy alcohol use, and following up with patients to assess their progress, Audra Morrison with the School of Social Work at the University of Alabama said.
Across the country, dangerous alcohol use has increased since the beginning of the pandemic. Rural communities are seeing similar, if not greater dangerous alcohol use.
Nationally, fatal and hazardous alcohol use went up in 2020 and 2021, reports indicate. According to the National Survey on Drug Use and Health, alcohol-related deaths, including deaths from liver disease and accidents, rose from 78,927 in 2019 to almost 100,000 in 2020, a 25% increase.
While communities across the country saw an increase in fatal or hazardous alcohol use, in rural areas the percentage of people reporting “heavy” alcohol use in the past month went up by 35% in 2020, according to the National Survey on Drug Use and Health from the Substance Abuse and Mental Health Service Administration.
In Alabama, a partnership between the Alabama Department of Mental Health and the University of Alabama School of Social Work developed VitAL to screen and counsel patients with risky alcohol use.
The system is called SBIRT, for Screening, Brief Intervention, and Referral to Treatment, Morrison said. Launched in Tuscaloosa County in 2017, the program currently screens patients in 19 clinics across the state.
In a meeting with a clinician, patients are evaluated for their alcohol use. Those with low-risk alcohol use – women drinking no more than seven drinks a week and men drinking no more than 14 drinks in a week – are given positive reinforcement for drinking within low-risk limits, she said.
Those with mild-risk alcohol use (higher usage than low-risk) are given a three-to-five-minute intervention to educate them on the risks of substance use. And those with moderate risk are given a brief treatment from a behavioral health clinician on site or referred out to behavioral health services. Those with severe risk are referred to an in-patient or out-patient treatment center.
Morrison said that across Alabama, screenings indicated alcohol use was up among the state’s residents. In 2019, only 5% of individuals who were screened were assessed as at mild risk. In 2020, that went up to 10.4%. In 2021, 11.8% of screened individuals were at mild risk, she said.
The program, she said, is working.
“We have seen that it is effective in helping patients cut back because oftentimes we screen again in a year,” she said. “In comparison to the patient’s prior screening and after providing education or services, oftentimes that does reduce their drinking or they’re self-reporting that their drinking is down.”
While there isn’t enough data to officially attribute the increases in drinking to the pandemic, she said, anecdotally, clinicians are telling her it is a contributing cause.
“They did say that many patients had expressed being not being amongst others, and being cooped up at home, as impacting their mental health,” she said. “We don’t have statistics on that, but that’s what our clinicians said they are hearing.”
In rural areas, a study published in the Lancet in November 2021 found that alcohol use is more of a major risk factor for death and disease than it is in urban areas.
“Internationally, most studies have found that rural, relative to urban, residence is associated with an increased likelihood of hazardous alcohol use and alcohol-related harm,” the study found. “This rural-urban disparity appears to be worsening over time, but also varies in magnitude between geographical regions, demographic subgroups, and outcome types. This finding suggests that improved public health strategies to reduce the burden of rural alcohol use are urgently required but must be tailored to the unique needs of the region they are designed for.”
Dr. Amanda Berger with the Distilled Spirits Council, a liquor-producers’ trade association, said alcohol-use data may have been skewed for technical reasons during the pandemic, not necessarily because of a change in drinking habits.
“An important caveat is that 2020 data collection was significantly impacted by Covid,” she said. “This included having smaller sample sizes, having to modify data collection locations and procedures, etc. This should be taken into consideration when looking at 2020 data and, in particular, comparing 2020 to previous years. So, the apparent increase in the 2020 past month heavy alcohol use among completely rural populations, for example, should be taken with caution.”