Brief Alcohol Counseling in the Emergency Department: The Details May Matter

Studies on the efficacy of brief alcohol counseling in emergency departments (EDs) have yielded mixed results. In a controlled clinical study, investigators randomized 494 patients identified by screening as consuming risky amounts of alcohol (12–14 drinks per week on average at baseline), or as having injury and alcohol use, to either participate in a brief negotiated interview with ED practitioners or to receive scripted discharge instructions about health behaviors including alcohol use. Likely alcohol or drug dependent individuals were excluded.

• At 12 months, with 92% follow-up, drinking decreased (for example, by 2 heavy drinking episodes per month) but did not differ significantly by group.

• There were also no differences between groups in consumption of risky amounts, number of drinks per week, driving after drinking, injury while drinking, missed work, contact with the legal system, alcohol treatment, or readiness to change.

Comments:

In primary care settings, brief counseling for excessive alcohol use has efficacy for decreasing consumption. In this study, brief clinician counseling in the ED had no more efficacy than simple instructions. Editorialists enumerated possible explanations for why the findings were negative (e.g., the relatively mildly affected population, the clinician, intervention effects in the control group from simple discharge instructions). They and the authors call for further research to sort it out. In the meantime, universal screening is recommended in primary care settings. Although excessive drinking should be identified and addressed in emergency settings too, how best to do it on a large scale remains less clear.

Richard Saitz, MD, MPH

Reference:

D’Onofrio G, Pantalon MV, Degutis LC, et al. Brief intervention for hazardous and harmful drinkers in the emergency department. Ann Emerg Med. 2008;51(6):742–750.

Bernstein E, Bernstein J. Effectiveness of alcohol screening and brief motivational intervention in the emergency department setting. Ann Emerg Med. 2008;51(6):751–754.