Emergency Department Brief Intervention May Decrease Some Risky Driving and Drinking Behaviors in Young Adults
The results of alcohol brief intervention trials in emergency departments (EDs) have been mixed and in trauma centers largely disappointing (i.e., no effect of intervention). In this study, researchers targeted a subpopulation with two risks, randomizing 476 ED patients with risky driving and drinking,* aged 18 to 44 years, to: 1) an assessment followed by two brief interventions addressing both issues; 2) an assessment-only control; or 3) a no-contact control (no assessment, no intervention).
- 31% of participants were lost to follow-up, more in the brief intervention group than in the other groups
- At 3, 6, and 9 months, participants in the brief intervention group were less likely than those in the assessment-only group to report “not always wearing a seat belt” (39–45% versus 50–55%), but no less likely to report exceeding the speed limit by 20 mph.
- At 3 and 6 months, participants in the brief intervention group reported fewer maximum drinks per occasion (median 6 versus 8) and reports of ≥5 drinks in a day (27–30% versus 40–43%) than did the assessment-only group.
- Intervention had no effect on 4 secondary drinking outcomes or 6 measures of traffic offenses and crashes, although it was associated with fewer reports of 4 other risky driving behaviors (e.g., fewer times driving through yellow light as it turns to red).
- The brief intervention group did not differ with either control group on any risky driving and drinking outcomes at 12 months.
- Outcomes for the assessment-only group were not substantially different from the no-contact control group.
*Defined by the authors as: within the past month, ≥2 risky driving behaviors (partial or non-use of a seatbelt; ≥2 occasions of driving 20 mph over the speed limit; ≥2 occasions of driving through a yellow light as it turns to red), AND ≥2 risky drinking behaviors (≥11 standard drinks in a week for women and ≥14 for men; ≥4 drinks on a typical drinking day; ≥5 drinks on one occasion for women and ≥6 for men).
Comments:The mixed findings on self-report outcomes and differential loss to follow-up raise concerns about the validity of the findings, particularly in the context of prior studies. Interestingly, assessments—often thought to explain the many negative studies of brief intervention—had no effects on outcomes. Nonetheless, this study suggests that 2 brief counseling sessions for a select group of ED patients with two risky behaviors (risky driving and drinking) may modestly reduce some aspects of both in the short term. But it also suggests that better interventions are needed for more robust and longer-term success (e.g., booster interventions using electronic methods and/or in primary care settings). Kevin L. Kraemer, MD, MSc and Richard Saitz, MD, MPH