The Mixed Evidence for Brief Intervention in Emergency Departments, Trauma Care Centers, and Inpatient Hospital Settings: What Should We Do?

Abstract

The purpose of this review is to provide a broad overview of the status of brief intervention in the emergency department, trauma center and inpatient hospital setting. This review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism Field, et al., 2009;Monti et al., 2009; Saitz et al., 2009). While the general efficacy of brief alcohol interventions in these settings has been recognized, the evidence is increasingly mixed. Herein we discuss possible confounding factors; including the inconsistencies in interventions provided, differences in target population, study design and assessment procedures. Recent studies investigating potential moderators of treatment outcomes suggest that a more sophisticated approach to evaluating the effectiveness of brief interventions across varying patient populations is needed in order to further understand its effectiveness. Current dissemination efforts represent a significant advance in broadening the base of treatment for alcohol problems by providing an evidenced based intervention in health care settings and should not be curtailed. However, additional research is required to enhance treatment outcomes, refine current practice

The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers

“…This observation has led to enduring interest in understanding how different treatments could be more optimally allocated to those individuals most likely to benefit (Andrews, Bonta, & Wormith, 2006;Brown, Seraganian, Tremblay, & Annis, 2002a, 2002bIsenhart, 1994;Litt, Babor, DelBoca, Kadden, & Cooney, 1992;Tonigan, 2003). Nevertheless, in the substance abuse treatment field, where client-treatment matching has been an active research topic, considerable uncertainty still exists concerning how specific interventions work and how they may interact with individual characteristics to produce their outcomes (Duvall, Oser, & Leukefeld, 2008;UKATT Research Group, 2005;Field, Baird, Saitz, Caetano, & Monti, 2010;Morgenstern & McKay, 2007;Orford et al, 2009;Tober, Clyne, Finnegan, Farrin, & Russell, 2008;Vasilaki et al, 2006;Witkiewitz, Hartzler, & Donovan, 2010). With few exceptions (e.g., Wells-Parker, Dill, Williams, & Stoduto, 2006;Wells-Parker, Kenne, Spratke, & Williams, 2000), our knowledge of specific intervention responsivity to intervention in the DWI population is lacking.…”

Female Drivers Increasingly Involved in Impaired Driving Crashes: Actions to Ameliorate the Risk

“…70 Over two decades ago, EM clinicians and researchers recognized the need to systematically identify and intervene in unhealthy drinking ED populations. 71 While early alcohol ED-SBIRT studies initially provided mixed results, 72 today, several scientifically rigorous ED-SBIRT clinical trials empirically demonstrate reductions in drinking and harm. [73][74][75] For example, the Academic ED SBIRT Research Collaborative studied patients who drink over the National Institute on Alcohol Abuse and Alcoholism low-risk limits in 14 national ED sites.…”

The Impact of a Mandated Trauma Center Alcohol Intervention on Readmission and Cost per Readmission in Arizona

“…Although there is evidence that SBI provided in a trauma center can reduce alcohol use 2,16-18 and may reduce driving under the influence, 19,20 overall the evidence is mixed in trauma centers and EDs. 21,22 Recent reviews by Field et al 17 and Nilsen et al 21 point to heterogenous protocols and ethical and practical issues in implementing randomized controlled trials in trauma centers that contribute to recent null fundings. 21,22 Although the ACS-COT based its decision in part on the belief that SBI might reduce readmissions and health care costs to trauma centers, such effects have only been found in simulation models.…”

“…21,22 Recent reviews by Field et al 17 and Nilsen et al 21 point to heterogenous protocols and ethical and practical issues in implementing randomized controlled trials in trauma centers that contribute to recent null fundings. 21,22 Although the ACS-COT based its decision in part on the belief that SBI might reduce readmissions and health care costs to trauma centers, such effects have only been found in simulation models. 1,23 Of the 2 studies that have examined health utilization in trauma centers, one reports positive but insignificant effects, 23 and the other reports no differences.…”