SBIRT in the Emergency Department: No Effect at 6 and 12 Months

Although screening, brief intervention, and referral to treatment (SBIRT) has shown efficacy in primary-care settings, improvement is mostly limited to nondependent drinkers and scarcely used under busy real-life conditions. In 2007, researchers conducted a quasi-experimental nonrandomized study of SBIRT among 1132 patients presenting to 14 US academic emergency departments (EDs). Patients who received SBIRT reduced their drinking at 3 months compared with those who received a list of resources. This study reported 6- and 12-month results.

• The follow-up rate was 63%, 52%, and 38% at 3, 6, and 12 months, respectively.

• Although the SBIRT group showed an average reduction in drinking of 3 drinks per week at 3 months compared with controls,* this effect disappeared at 6 and 12 months despite the use of sophisticated statistical methods to account for patients lost to follow-up.

Comments:

Evidence for medium- to long-term effectiveness of SBIRT in the ED under real-life conditions continues to be lacking, and evidence for short-term efficacy from clinical trials is mixed. Booster sessions or more extensive interventions may increase or sustain any short-term effects, but the attrition demonstrated in this study under real-life conditions suggest this would be challenging in a hard-to-contact ED population.

Nicolas Bertholet, MD, MSc

Reference:

Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention and referral for treatment in emergency department patients’ alcohol use: a 3-, 6- and 12- month follow-up. Alcohol Alcohol. 2010; 45(6):514–519.