Nearly one-third of all persons using hospital emergency services use alcohol in hazardous or unhealthy ways. Millions more require hospital emergency services due to their use of illicit drugs or misuse of prescription medications. Emergency services patients with untreated alcohol problems are 81% more likely to be admitted to the hospital and 46% more likely to report at least one prior emergency service visit in the previous year. Research clearly shows that screening patients in emergency, ambulatory and inpatient settings for alcohol and drug use and providing them with immediate brief counseling can cut subsequent hazardous substance use, reduce injury and hospitalization, and cut health care costs. Unfortunately, very few hospitals and other health care settings routinely screen and treat the alcohol and drug problems of their patients. McGlynn and her colleagues at RAND (2005) found that only 5.5% of traumatically injured inpatients had any medical record indication that substance use had been assessed.

Within the health care system, however, recent steps have been taken to change this. As of May 1, 2007, the American College of Surgeons Committee on Trauma, the primary national organization that develops trauma center standards, requires all Level I trauma centers to screen admitted patients for unhealthy alcohol use and provide a brief intervention to those who screen positive as a requirement for verification of their trauma center status. The US Preventive Services Task Force (2005) reviewed the research evidence of the effectiveness of alcohol screening and brief intervention in emergency, inpatient and ambulatory health care settings, and recommended that all adolescents and adults receiving general medical services be routinely screened for hazardous alcohol use, and if positive, to receive brief counseling. The National Quality Forum (NQF) (2007) recently released national consensus standards for evidence based substance use treatment. Routine, periodic alcohol and drug screening and brief intervention in emergency, inpatient and ambulatory health care settings was strongly affirmed. Thirteen medical profession groups have developed evidence based clinical practice standards for the conditions seen by their specialties in which routine screening and brief intervention are recommended. The Substance Abuse and Mental Health Services Administration (SAMHSA), through its Screening, Brief Intervention and Referral to Treatment (SBIRT) grant program, has supported screening and brief intervention programs in hundreds of hospitals, community health clinics and other organizations. So far, more than 540,000 people have been screened through this program, approximately 18% of whom screened positive for unhealthy alcohol or drug use. The research evidence supporting the effectiveness and the cost-benefit of screening and brief intervention is substantial. Practical experience of training physicians and other health care providers to deliver SBI effectively and efficiently is extensive. Professional consensus is strong that screening for alcohol and other drugs should be moved toward the status of a vital sign (IOM, 2005).

Recent decisions by the CMS and the AMA may also offer incentives for health care providers to deliver these services. In 2006, CMS approved new HCPCS level II procedure codes for screening and brief intervention (H0049 and H0050). The AMA adopted new alcohol and drug screening and brief intervention CPT E&M codes that were published in the 2008 CPT manual, and have relative values that are consistent with other counseling procedures.

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