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Wisconsin Initiative to Promote Healthy Lifestyles

Joan Fischer, MA

Someday soon, all patients will be asked about their drinking and drug habits in the same way that health care providers now routinely ask about smoking. That is the goal of the Wisconsin Initiative to Promote Healthy Lifestyles, (WIPHL, pronounced WIFF-el). A $12.6 million program for:

  • Screening
  • Brief intervention
  • Referral
  • Treatment

It is funded by SAMHSA ((U.S.) Substance Abuse and Mental Health Services Administration), administered by the Wisconsin DHFS (Department of Health and Family Services), and coordinated by the UW-Madison Department of Family Medicine under the leadership of Richard Brown, MD, MPH.

This spring, twenty clinics around the state, in settings as diverse as inner-city Milwaukee, the Menominee Reservation, and rural Polk County, began offering SBIRT (Screening, Brief Intervention, Referral and Treatment) services under the auspices of WIPHL. The program seeks to help the nearly one in four Wisconsin residents who engage in risky or harmful substance use. Alcohol and drug use are the fourth leading cause of death in Wisconsin, a state that regularly lands at or near the top in national rankings for at-risk or harmful levels of alcohol use. Dr. Brown stated, "Everyone in Wisconsin is touched by alcohol and drug problems, either through their own substance use or through problems in their families and communities. We all pay for the higher costs of health care, social services, and criminal justice. Widespread delivery of alcohol and drug screening, intervention, and referral services would reduce the terrible suffering and enhance the quality of life throughout the state."

The screening and assistance program is simple and effective in early detection of at-risk or harmful substance use, numerous studies show. Four key questions that can easily be included in any health care visit indicate which patients are at risk. The program then provides for these patients to meet with on-site, trained health educators to discuss their substance use and agree together upon options for change. For many patients, this early and brief intervention, which includes one to three follow-up consultations, is enough to help them significantly decrease their alcohol and drug use, studies show.

Mia Croyle, a WIPHL health educator at UW Health Belleville Family Medical Clinic, can attest to the success of the program firsthand. "Thanks to the tools and training provided by WIPHL and the ongoing cooperation and efforts of the physicians and staff at the Belleville Family Medical Clinic, I have had the opportunity to work with several patients who are making significant changes to their levels of alcohol use," says Croyle. "The changes these patients have made have been inspiring. I admire the courage and dedication shown by my patients as they work at changing what are often long-standing patterns of hazardous or harmful drug and alcohol use."

Not only are people's lives improved through the kind of assistance WIPHL provides, a Wisconsin study shows that the state saves nearly $1,000 in health care and criminal justice costs for every patient receiving screening and brief intervention services. Currently only ten to twenty percent of Wisconsin residents receive help for alcohol problems. The time to provide such assistance is long overdue. Dr. Brown notes, "For twelve years, government agencies and professional organizations have recommended that health care settings routinely provide alcohol and drug screening, intervention, and referral services to all patients. So far, few settings in the United States are doing so. This project is providing the training and resources that health care settings need to start delivering these services in urban, suburban, and rural settings around Wisconsin."

Over the next five years, the twenty clinics involved in the WIPHL project are expected to provide an initial screening to approximately100,000 patients ages eighteen and older; of these initial screenings, around 25,000 people will be in need of brief intervention or additional treatment. The effort includes a focus on changing public policy and standards of care so that services continue to be delivered on a permanent basis.