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
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.