A Moment of Clarity: Alcohol’s Impact Across Workers and Medical Management

The health effects of alcohol have been well-researched for decades, but they have done little to slow down excessive drinking, with an estimated 1 in 6 Americans regularly engaging in binge drinking,¹ and approximately 14.5 million suffering from alcohol use disorder (AUD), representing nearly 6% of the U.S. population 18 years of age or older.² Unfortunately, this is no surprise, considering how omnipresent alcohol has been in human history.

The earliest evidence of alcohol can be traced to 7,000 BC China in ancient rice wine.³ The Egyptians brewed beer as early as 3,400 BC,⁴ and alcoholic distillation is theorized to have begun in 3,000 BC in India.⁵ Virtually every culture has developed some unique alcoholic beverage, often rich with history and pride.

• 1 in 6 Americans – or 38 million people – binge drink¹
• 14.5 million Americans have alcohol use disorder (AUD)²
• Excessive drinking is responsible for 1 in 5 deaths among adults aged 20-49⁶

Drinking culture is unlikely to disappear anytime soon, and while alcohol can be enjoyed responsibly, far too often it is not. The sheer pervasiveness of alcohol in the world can often blind people to the real-world impacts it can have, and workers’ comp is no exception to these impacts.

Alcohol can increase the likelihood of workplace injury and create problems in the workplace. It can also cause a wide range of health consequences that can impact claims management and injured worker recovery, and it can interfere with various medications prescribed in workers’ comp, further complicating recovery.

Now more than ever, it is incredibly important to understand the impact alcohol has on the work environment, the health considerations across workers’ comp claims, and how alcohol can interfere with pharmacy management.

• Substance abusers, including heavy alcohol users, are 3-4x more likely to be involved in workplace accidents¹⁴
• Alcohol abusers are 5x as likely to file a workers’ comp claim¹⁴
• Workers with alcohol problems are 2.7x more likely to have injury-related absences⁹
• Chronic alcohol use decreases bone density and increases risk of fractures¹⁵

However, the initial step is identifying patients who need help and connecting them with resources that can help them. 14.5 million Americans have alcohol use disorder (AUD), but less than 10% of them receive treatment.²

Within the scope of workers’ comp, the larger conversation of gaining visibility into social and behavioral determinants of health has gained serious traction. With social and behavioral factors comprising upwards of 80% of modifiable factors impacting health outcomes,²³ it stands to reason this is such a strong area of focus. Traditionally, identifying claims where one or more social or behavioral determinants are a negative contributing factor could be compared to finding a needle in a haystack – especially a factor such as AUD, which affects less than 6% of the U.S. adult population. But identifying these factors needn’t be so difficult. We have the clinical tools and technology to get us there today at lightning speed.

Take physical therapist (PT) notes as an example. As a provider who spends significant, quality time with the injured worker, a PT is well positioned to gain insight about the injured worker that can help identify social and behavioral barriers to recovery (see A Golden Opportunity: The Physical Therapist’s Role in Behavioral Health in this issue of RxInformer ). And this needn’t be a heavy lift for provider or patient. A study utilizing a questionnaire used by the Institute of Medicine designed to capture social and behavioral determinants of health took an average of 5 minutes for patients to complete and garnered an 80% participation rate in the first week of the study.²⁴

By Healthesystems’ estimation, each PT episode of care generates, on average, more than 50 pages of PT notes. And these documents are rich with insights – including those of a social and behavioral nature. Here is where technology comes into play – helping to analyze data at scale, taking those individual, 1-on-1 PT interactions and aggregating them across a claims population. An analysis of evaluation and functional capacity forms from approximately 100,000 episodes of care conducted with natural language processing (NLP) technology revealed a SDoH documented in approximately 80% of claims.²⁵

Keep in mind that this is just the tip of the iceberg. PT documents represent just one of many documented data sources present on a claim. And within this, evaluation and functional capacity forms represent just a fraction of PT documents.

So what did this targeted analysis reveal about AUD? Substance abuse, including alcohol abuse, was in 1 of 50, or 2.5% of claims. Perhaps most impactful is the timing aspect, with approximately 1 in 3 of these claims being identified within the first 30 days of injury through data captured at the initial evaluation, and 85% identified within 90 days of injury. Early identification provides earlier opportunity to intervene, a significant advantage in helping to address the downstream clinical complexity of a behavioral risk such as AUD, which is associated with extended treatment durations as well as a higher frequency of missed PT appointments.