1. At Risk and Dependent Drinking: Scope of the Problem

2. Why is SBI Important? Alcohol problems are common Overall economic cost $185 billion/1998 Risk factor injury and illness Problems occur throughout the life cycle

3. Scope of the Problem 31% of adults presenting to and urban ED reported > to 2 CAGE positive (Bernstein, 1996) 24% of adults presenting by ambulance to an urban ED reported > 2 CAGE positive (Whiteman, 2000) ED patients are 1.5-3.0 times more likely to report heavy drinking or consequences than those in primary care (Cherpitel, 1999)

4. Morbidity and Mortality >107,000 alcohol related deaths each year 1/3 of adult admissions are alcohol related Attributable risk factor for multiple illnesses Major risk factor for all categories of injury Problem drinkers have 2x injury events/yr and 4x as many hospitalizations for injury A single alcohol-related visit predicts continued problem drinking

6. Alcohol-Related Fatalities Source: FARS

7. BAC Levels for Alcohol Positive Drivers Involved in Alcohol-Related Fatal Crashes Source: 2002 ARF FARS.16 = Median and Mode BAC

8. All Other Combined All Other Combined Safety Belts at 90% Use Impaired Driving Predicted Lives Saved by Countermeasure 30% 34% 36%

9. Youths and Young Adults Youths 20% of 8th graders and 48% or 12th graders report consuming alcohol in the past month 12% of 8 th graders and 28% of 12 th graders report 5 or more drinks on a single occasion (Johnson L, O’Malley P, Bachman J. Monitoring the Future, 2003) Young Adults Highest prevalence of alcohol consumption 1400 college students aged 18-24 die each year from alcohol related unintentional injuries Drivers between the ages of 16-25 account for 30% of alcohol-related fatalities

10. Elderly 10% of ED patients with alcohol problems are > 60 years of age Increased sensitivity to alcohol effects Associated with depression and suicide attempts, falls and fractures and motor vehicle crashes At risk for medication interactions

11. Drinking Patterns in the U. S. Dependent 7% Risky drinking 29% Grant et al. Drug and Alcohol Dependence, 2004 Low Risk 22% Abstain 49%