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Research Summary

Referral Is Effective for Reducing Alcohol Misuse

Questions remain about the applicability of brief intervention among various populations, including emergency department (ED) patients. Researchers in London studied whether a referral from an ED-physician for brief counseling could reduce alcohol misuse. ED physicians screened patients they thought were drinking excessively and/or had a possible alcohol-related condition. Patients with excessive drinking (>8 units* of alcohol for men and >6 units for women in any 1 session at least once per week) were randomized to receive either (1) health information and a referral (an appointment card) to see an alcohol worker after discharge (287 patients) or (2) health information only (312 patients).

  • At the 12-month follow-up, patients assigned to the referral group were drinking less per drinking day (means 13 units versus 16 units, P=0.04) and per week (means 57 units versus 71 units, P=0.09). They also had fewer emergency department visits (means 1.2 versus 1.7, P=0.05).
  • Weekly consumption did not differ between referred patients who actually attended the 30-minute session with the alcohol worker (only 29% of those referred) and referred patients who did not attend.


This study has several limitations. Over one-third of subjects were lost to follow-up, and alcohol consequences were not assessed. However, given its few exclusions and intervention by clinicians (not researchers), its findings are broadly applicable. The referral from a physician—and not the counseling session to which patients were referred—was associated with less drinking. The referral itself probably led patients to believe their drinking was excessive.

Richard Saitz, MD, MPH
*A unit of alcohol is slightly smaller than a standard drink in the United States.


Crawford MJ, Patton R, Touquet R, et al. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomized controlled trial. Lancet. 2004;364(9442):1334–1339.