Implementation of an Alcohol Screening Tool and a Treatment Referral Protocol by Providers at an Adult Outpatient Mental Health Clinic

Abstract

Many adults with a mental illness have a substance use disorder (co-occurring disorder) such as alcohol use disorder; therefore, integrating both screening and treatment for the substance use disorder, not only the mental illness, is recommended, yet some practices screen and treat for mental health disorders but not for problematic drinking behaviors. At the Center for Health Care Services outpatient adult mental health clinic, Eastside clinic, there was no use of a standardized screening tool for alcohol to aid providers in identifying and diagnosing alcohol use disorder. Also, there was no substance use treatment referral protocol for mental health patients diagnosed with alcohol use disorder, so providers failed to refer patients with problematic drinking patterns for appropriate treatment. The Doctor of Nursing Practice project design was a clinical practice change on alcohol screening and referral for treatment implemented at Eastside Clinic by four providers, three care managers, and the co-occurring psychiatric substance use disorder program director. The clinical practice change addressed the clinical practice gap of missed alcohol use diagnosis from providers' lack of use of an alcohol screening tool and lack of a treatment referral protocol for patients diagnosed with alcohol use disorder. Following education, the evidenced-based procedure was to implement the use of a standardized alcohol use disorder identification test-consumption (AUDIT-C) screening tool, provide brief intervention, then refer patients with an AUDIT-C score of greater than or equal to five to treatment that included follow-up on treatment referrals to track patients who enrolled in treatment services. Twelve-week data pre- and post-implementation were collected and analyzed using SPSS. Providers also completed pre- and post-education questionnaires to assess their knowledge level. There were increases in AUD diagnosis, alcohol treatment referrals, and treatment enrollment post-implementation. There was also an increase in provider knowledge level in relation to their use of AUDIT-C. In addition, identifying alcohol use disorder as a cooccurring disorder in patients with mental health illness through screening and advocating for patients to receive treatment through treatment referrals was a way of improving integrated care in clinical practice, advancing behavioral health equity, and improving access to substance use treatment.