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Background The impact of alcohol use has been widely studied and is considered a public health issue. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends Screening and Brief Intervention and Referral Treatment (SBIRT) but the actual practice in the Emergency Department (ED) is constrained due to limited provider time and financial resources. Objectives To assess the effectiveness of alcohol screening using Computerized Alcohol Screening and brief Intervention (CASI) compared to alcohol screening by triage nurse during Medical Screening Examination (MSE) in the ED. Methods Retrospective review of CASI/MSE database from January 2008 through December 2009, collected in the tertiary, level I Trauma ED was performed. Inclusion criteria included age ≥18, and completion of both the MSE and CASI. We analyzed the database by comparing age, gender, primary language (English, Spanish), and Alcohol Use Disorders Identification Test (AUDIT) scores using McNemar’s analysis. Results Data was available for 5,835 patients. CASI showed a significant increase in detection of at-risk drinking over MSE across all ages, gender, and primary language (p<.05). MSE found 2.5% at-risk drinkers while CASI found 11.5% at risk drinkers (Odds ratio 8.88, 95%CI 6.89–11.61). Similar results were found in 18 to 20 year-old patients. MSE identified 1.7% at-risk drinkers and CASI reported 15.94%. (Odds ratio 19.33, 95% CI 6.29–96.74) Conclusion CASI increased detection of at-risk alcohol drinkers compared with MSE across all ages, gender, and primary language. CASI is a promising innovative method for alcohol screening in the ED for the adult population including under-aged drinkers.

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Past literature suggests a link between certain psychotic states and adrenal androgen production, including Dehydroepiandrosterone (DHEA). A group of severely psychotic androgenized females, refractory to substantial amounts of neuroleptics, has been identified for whom endocrine testing revealed abnormally high levels of DHEA. A similar group has been identified among the severely psychotic male population. Improvement in psychosis appears to occur as DHEA returns to its normal range using standard low dose Dexamethasone suppression.

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