A broad coalition of Employee Assistance Programs (EAPs), employers, federal officials, researchers, and behavioral health care providers wants to see EAPs screen and provide brief intervention for problem drinking on a routine basis by October 2011.

The BIG initiative (named for the Brief Intervention Group) set the ambitious goal of increasing the number of people identified by EAPs as having alcohol problems by 100% between October 2008 and October 2011. 

According to The BIG Initiative Manual (PDF), 66 percent of people with alcohol abuse disorders work full-time, and 16 percent work part-time, which suggests that the workplace may be a good place to identify them and intervene where appropriate.

The manual goes on to say that 75 percent of businesses in the United States now use EAPs to provide behavioral health care for stress, depression, mental health, and substance use for their employees.

This means that EAP services are available to an estimated 100 million Americans, about five to seven million of whom use them each year. However, alcohol is identified as a significant issue in only about 160,000 EAP cases each year, although the incidence of problem drinking is thought to be much higher.

In three pilot studies the BIG Initiative undertook in the past year, EAP programs run by Aetna, OptumHealth, and ValueOptions implemented a screening and brief intervention and referral to treatment (SBIRT) protocol. Each increased the rate at which it identified problem drinking by 50% (PDF) or more. 

For example, in the six months prior to implementing the SBIRT protocol, OptumHealth only identified problem drinking in 7.5 percent of callers and referred fewer than 10 percent of those to treatment. By contrast, in the seven months of using the SBIRT protocol, EAP staff identified risky drinking in 20.1 percent of 383 callers, provided education and counseling to 13.3 percent, and discussed treatment options with 10.7 percent. 

“The cost to the EAP to deliver alcohol [strategic and brief interventions] routinely may be greater than usual and customary services, but it should produce savings to employers and benefits to EAP clients,” said the initiative's co-facilitator, Eric Goplerud, Ph.D., in an email. 

He said that unpublished preliminary data indicated that businesses can save as much as $1,400 a month per employee screened and identified by EAP staff using the SBIRT protocol. Savings come from improved productivity and reduced absenteeism. 

Based at George Washington University and supported with seed money from the National Highway and Traffic Safety Administration (NHTSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), the BIG Initiative has secured corporate sponsorships from nine employee assistance companies, and the participation of employers like Caterpillar, UPS, and J.P. Morgan Chase.

While BIG’s focus has been on North America, EAPs in the United Kingdom, European Union, Russia, Australia, and Kenya have participated as well. It has trained over 1,500 EAP counselors and call center workers, and created materials for providing alcohol screening and brief intervention training in the workplace. 

The initiative’s co-facilitator, Tracy McPherson, Ph.D., said in a phone interview that one of the reasons the BIG Initiative is important is because problem drinking is linked to drunk driving. “Although the connection is obvious, it doesn't get mentioned enough. Writers often ignore it, yet it's a huge problem in the use of alcohol for people of all ages.”

McPherson confirmed that the SBIRT protocol could be used by EAPs to identify client issues besides alcohol. “We'll keep alcohol as a core issue, but the initiative creates a platform to include SBIRT for tobacco, SBIRT for drug use, and SBIRT for depression, anxiety.”

Editor's note: Interested EAPs can visit the BIG Initiative website for more information and an enrollment form.