National Review of VHA’s Adherence to Alcohol Use Screening Requirements and Provision of Interventions

The VA Office of Inspector General (OIG) conducted a national review of the Veterans Health Administration’s (VHA’s) primary care staff’s adherence to alcohol use screening; provision of brief intervention; and general mental health, Primary Care Mental Health Integration (PCMHI), pharmacotherapy, and specialty substance use disorder care (SUD) engagement from October 1, 2023, through September 30, 2024. 

Unhealthy alcohol use, including heavy drinking, binge drinking, and alcohol use disorder, is a leading cause of preventable death in the United States. Veterans experience higher rates of unhealthy alcohol use than nonveterans, which is associated with increased risk of interpersonal violence and poor health outcomes. Furthermore, women are at increased risk for negative health implications from alcohol. 

VHA requires annual screening using the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C), which results in a score of 0 to 12. Alcohol use screening identifies patients with unhealthy alcohol use who may benefit from brief intervention, a five-minute counseling session about the risks of alcohol use, which can lead to decreased alcohol consumption and improved health outcomes. Despite established sex-specific thresholds that define a positive screening as a score of 3 or more for women and 4 or more for men, VHA’s electronic health record prompts clinicians to provide brief intervention for patients with a score of 5 or higher. 

The OIG found that more than 75 percent of patients with a score of 5 or more received brief intervention. However, less than 2 percent of patients with a score at the sex-specific threshold received brief intervention.  

The OIG made two recommendations related to alcohol use screening performance monitoring and consideration of sex-specific thresholds. The Under Secretary for Health provided an action plan to evaluate factors that affect screening, identify facilities for performance improvement, and evaluate the use of sex-specific alcohol use screening thresholds.