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Research Summary

Brief Intervention May Have Efficacy for Alcohol Dependence in Emergency Departments

The evidence for alcohol screening and brief intervention (BI) efficacy is mixed for people in emergency departments and almost nonexistent for people who meet criteria for alcohol dependence. In this study, patients with suspected alcohol-related presentations to the emergency department of a university hospital and another general hospital were screened for alcohol use disorders. Some patients were hospitalized, some were not. Assessments were conducted by an alcohol specialist nurse in the university hospital and a research nurse in the other hospital. Patients with an AUDIT* score >16 were further assessed with the SADQ.** Those who scored positive for dependence and no intravenous drug use at the university hospital, but not the other hospital (n=100 at each), received a program of BI (at least 1 intervention; median, 4). The research nurse completed 6-month follow-up interviews with 52% of patients who received BI and 50% of those who did not.

  • In a descriptive analysis, 37% of patients in the BI group and 0% of the comparison group reported abstinence.
  • In statistical analyses adjusted for baseline imbalances, patients in the BI group reported lower severity-of-dependence and AUDIT scores. They also reported fewer drinks per day (8 versus 23) and drinking days (3.7 versus 5.6) in the past month.
  • There was a trend toward lower ED and hospital utilization among BI subjects, but the difference was not significant.

*Alcohol Use Disorders Identification Test.
**Severity of Alcohol Dependence Questionnaire.

Comments:

The study has some limitations, the main ones being substantial loss to follow-up and lack of randomization. The researchers appropriately suggest this study be followed up by a randomized trial. But, the work is important because it suggests patients with alcohol dependence (at least those with alcohol-related acute presentations), who have traditionally been excluded from BI trials, may benefit from identification and BI. Richard Saitz MD, MPH

Reference:

Cobain K, Owens L, Kolamunnage-Dona R, et al. Brief interventions in dependent drinkers: a comparative prospective analysis in two hospitals. Alcohol Alcohol. 2011;46(4):434–440.

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