Brief Intervention for Hazardous and Harmful Drinkers in the Emergency Department

Abstract

Study Objective-To determine efficacy of emergency practitioner performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an Emergency Department (ED) setting.Methods-A randomized clinical trial (Project ED Health) was conducted in an urban ED from 5/2002 to 11/2003 for hazardous/harmful drinkers. Patients ≥ 18 who screened above National Institute for Alcohol Abuse and Alcoholism guidelines for "low risk" drinking or presented with an injury in the setting of alcohol ingestion were eligible. The mean number of drinks per week and binge drinking episodes over the past 30 days were collected at 6 and 12-months; negative consequences and use of treatment services at 12-months. A Brief Negotiation Interview (BNI) performed by emergency practitioners was compared to scripted discharge instructions (DI).Results-A total of 494 hazardous/harmful drinkers were studied. The two groups were similar with respect to baseline characteristics. In the BNI group the mean number of drinks per week at 12 months was 3.8 less than the 13.6 reported at baseline. The DI group decreased 2.6 from 12.4 at baseline. Likewise, binge drinking episodes per month decreased by 2.0 from a baseline of 6.0 in the BNI group and 1.5 from 5.4 in the DI group. For each outcome the time effect was significant and the treatment effect was not. Conclusion: Among ED patients with hazardous/harmful drinking, we did not detect a difference in efficacy between emergency practitioner-performed BNI and DI. Further studies to test the efficacy of brief intervention in the ED are needed.

Factors Associated with Favorable Drinking Outcome 12 Months After Hospitalization in a Prospective Cohort Study of Inpatients with Unhealthy Alcohol Use

“…The SIP is a 15-item questionnaire that assesses, over the past 3 months, the presence of alcohol-related consequences in various dimensions: physical, interpersonal, intrapersonal, impulse control and social responsibility. 10,[25][26][27] . The course of unhealthy alcohol use tends to involve self-change with or without formal help, with a substantial proportion of individuals either abstaining or drinking moderate amounts without consequences a year later.…”

SBIRT in Emergency Care Settings: Are We Ready to Take it to Scale?

“…There were no differences in consumption, but three studies (with 785 people) found differences in recurrent injury. 33 Another highquality randomized controlled trial by D'Onofrio et al 9 (88% enrollment and 92% 12-month follow-up) showed no differences in consumption measures.…”

“…Project ASSERT was next established in 1999 at the Yale-New Haven Hospital ED. 7 Both programs are current line items in their hospital budgets, provide reimbursable services, and have led to NIH-funded research trials of motivational interviewing 8,9 and training curricula. 10,11 A 14-site Academic ED SBIRT Research Collaborative trained 402 ED nurses, nurse practitioners, residents, faculty, social workers, and physician assistants who intervened with at-risk and dependent drinkers, with resulting declines in consumption and a parallel increase in the number of persons drinking within the NIAAA's low-risk guidelines.…”

Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency Department

“…Several studies suggest that it is the optimal instrument for medical settings, 69,[73][74][75] but this is not without controversy in the literature. 69,76,77 Although there are a variety of efficacious screening instruments, 39,42,56,78,79 their effectiveness when implemented in the clinical setting varies, not only in light of their test characteristics, but also because of factors such as ease of administration in routine clinical care. For example, the AUDIT is long and needs to be scored.…”

“…[35][36][37][38][39][40][41][42] Several studies demonstrated a beneficial effect on negative consequences. 35,38,42,43 While the Academic SBIRT trial, using a quasi-experimental methodology, found reduced consumption at 3 months, 12 effects on decreasing alcohol consumption have not been consistent in other studies. 35 Further confounding interpretation of the evidence is that the published studies include a wide variety of patient populations: some only young adults, 44 many only with injured patients.…”