“…We expected that observed variability might be a result of confounding due to differences across networks in recognition of mental health and substance use disorder comorbidity (Williams et al, 2014); patient satisfaction that could create a halo effect increasing rates of reported BI (Saitz et al, 2008; Simonetti et al, 2015); and geographic differences in drinking norms, all of which could vary across networks and potentially influence whether patients report receipt of BI (Substance Abuse and Mental Health Services Administration (SAMHSA), 2011). ICD-9 CM codes were used to identify any mental health diagnosis, including affective disorders, bipolar disorder, psychosis, schizophrenia and posttraumatic stress disorder, as well as any alcohol or other substance use disorder.…”