Brief Intervention Reduces Drinking among Emergency Department Patients with Nondependent Unhealthy Use

The evidence for the efficacy of screening and brief intervention (BI) in the emergency department (ED) is decidedly mixed. Investigators now report the results of a randomized trial in which 899 adult ED patients drinking risky amounts* were assigned to either BI with a follow-up (booster) telephone BI a month later, a single BI, no BI, or no BI and no assessment. Patients with alcohol dependence were excluded.

• Brief intervention with or without booster was associated with significant decreases in alcohol consumption at 6 and 12 months:

• Drinks in the past 7 days decreased from 19–20 at baseline to 12–13 for BI with booster and 13–14 for BI alone, compared with 14–18 for no BI.
• Similarly, number of heavy drinking episodes in 28 days decreased from 7–8 at baseline to 4–5 for BI with booster and 5 for BI alone, compared with 6 for no BI.
• At 12 months, BI with or without a booster significantly decreased self-report of driving after drinking >3 drinks (38% to 29% and 39% to 31%, respectively).

• Brief intervention had no detectable effect on alcohol-problem scores or injuries. Assessment appeared to have no effect on drinking (an important observation for some researchers who have attributed negative BI study results as having been due to assessments).

Comments:

A prior study in the same institution found no effect of BI, likely because it included those with lower risk use. Because about half of BI studies in EDs are negative, questions arise. It appears BI may have modest efficacy for a slice of the population identified by screening—those who drink enough to risk health consequences (but not too much) and who are not dependent—under certain circumstances (BI by trained ED clinicians). Clearly, more needs to be done to improve efficacy and to help patients who screen positive but whose use is either less or more severe than those enrolled in this trial.

Richard Saitz, MD, MPH

Reference:

D’Onofrio G, Fiellin DA, Pantalon MV, et al. A brief intervention reduces hazardous and harmful drinking in emergency department patients. Ann Emerg Med. March 28, 2012 [Epub ahead of print]. doi:10.1016/j.annemergmed.2012.02.006