Brief Intervention May Reduce Drinking in Injured Emergency Department Patients with Alcohol Dependence but Not in Those with Nondependent Unhealthy Use

Few studies have examined the impact of screening, brief intervention, and referral to treatment (SBIRT) on alcohol-dependent patients. This secondary report from a larger randomized controlled trial (n=1493) compared brief motivational intervention (BMI) with treatment as usual (TAU)* among a subgroup of 1336 patients who were evaluated for dependence and who reported to an emergency department with injuries. Five hundred eighty-eight patients in the subgroup met criteria for alcohol dependence. Outcomes were assessed telephonically at 6 and 12 months by blinded interviewers with follow-up rates of 77% and 66%, respectively. Because this subgroup analysis loses the benefits of randomization, analyses were adjusted for potential confounders.

• Brief intervention was not significantly associated with any drinking outcomes among those without dependence.

• At 12 months, among patients with alcohol dependence,
  

   

  • average standard drinks† per week decreased by 12 in the BMI group compared with 9.5 in the TAU group.
  • maximum drinks consumed in a single day decreased by 9 in the BMI group compared with 7 in the TAU group.
  • number of days abstinent averaged 73% in the BMI group compared with 64% in the TAU group.
  • BMI had no effect on alcohol-related problems nor did it increase attendance at specialty-treatment or self-help meetings.
• Fewer alcohol-dependent patients assigned to BMI met dependence criteria at 6 months compared with patients assigned to TAU (45% versus 33%), but this effect was not significant at 12 months.

Comments:

These results suggest BMI may have a positive impact on patients with, but not without, alcohol dependence. This finding is surprising, however, and may be the result of the use of adjusted subgroup analyses. The greater response to intervention by people with more severe drinking problems in the BMI group also raises the possibility of a social-desirability bias. Finally, as this study included only injured patients, whether BMI helps alcohol-dependent patients without an injurious event also remains uncertain.

Hillary Kunins, MD, MPH, MS

Reference:

Field CA, Caetano R. The effectiveness of brief intervention among injured patients with alcohol dependence: Who benefits from brief interventions? Drug Alcohol Depend. May 19, 2010 [Epub ahead of print].