Unhealthy alcohol use is a public health problem with significant health, social and economic impacts. Alcohol screening and brief intervention (ASBI) in adult primary care is an evidence-based approach enabling early identification and intervention of unhealthy alcohol use. This observational study examined: 1) trajectories of ASBI performance over 5 years post systematic implementation, and 2) their associations with both later ASBI performance and alcohol use outcomes. Authors calculated annual screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive screen for 57 medical facilities from years 2014 to 2021.

Findings: Three distinct screening performance trajectory groups (low-, middle- and high-performance) and four distinct BI performance trajectory groups (low-, improving-, middle- and high-performance) were identified. Facilities in the low-BI-performance group had panels of patients living in more deprived neighborhoods compared to the other 3 BI performance groups. After accounting for repeated measures and adjusting for time and patient panel characteristics, authors found that screening and BI performance trajectories during 2014-2018 were significantly associated with screening and BI rates 2019-2021, respectively. They also observed a steeper decline in percentages reporting "exceeding daily drinking limits" and "having 5 + binge drinking days" over time among patients of facilities in the improving- and high-BI-performance groups. Authors conclude that early success in ASBI performance is associated with long-term sustainability and may be associated with long-term population-level drinking outcomes.