The Impact of Screening, Brief Intervention, and Referral for Treatment on Emergency Department Patients' Alcohol Use
Study objective
We determine the impact of a screening, brief intervention, and referral for treatment (SBIRT) program in reducing alcohol consumption among emergency department (ED) patients.
Methods
Patients drinking above National Institute of Alcohol Abuse and Alcoholism low-risk guidelines were recruited from 14 sites nationwide from April to August 2004. A quasiexperimental comparison group design was used in which control and intervention patients were recruited sequentially at each site. Control patients received a written handout. The intervention group received the handout and a brief intervention, the Brief Negotiated Interview, to reduce unhealthy alcohol use. Follow-up surveys were conducted at 3 months by telephone using an interactive voice response system.
Results
Of 7,751 patients screened, 2,051 (26%) exceeded the low-risk limits set by National Institute of Alcohol Abuse and Alcoholism; 1,132 (55%) of eligible patients consented and were enrolled (581 control, 551 intervention). Six hundred ninety-nine (62%) completed a 3-month follow-up survey, using the interactive voice response system. At follow-up, patients receiving a Brief Negotiated Interview reported consuming 3.25 fewer drinks per week than controls (coefficient [B] −3.25; 95% confidence interval [CI] −5.76 to −0.75), and the maximum number of drinks per occasion among those receiving Brief Negotiated Interview was almost three quarters of a drink less than controls (B −0.72; 95% CI −1.42 to −0.02). At-risk drinkers (CAGE <2) appeared to benefit more from a Brief Negotiated Interview than dependent drinkers (CAGE >2). At 3-month follow-up, 37.2% of patients with CAGE less than 2 in the intervention group no longer exceeded National Institute of Alcohol Abuse and Alcoholism low-risk limits compared with 18.6% in the control group (Δ 18.6%; 95% CI 11.5% to 25.6%).
Conclusion
SBIRT appears effective in the ED setting for reducing unhealthy drinking at 3 months.
Supervising editor: David. L. Schriger, MD, MPH
Author contributions: EB, GD, JB, and RHA conceived the study and obtained the initial funding for the development of the curriculum and the training (R25), and RHA for the Data Coordinating Center (R21). All sites submitted (RO3s) for patient outcomes and participated in data collection. RHA analyzed the data. All authors participated in the interpretation of the data. EB, JB, GD, and RHA participated in drafting the article. All authors participated in the critical review of the article. EB, JB, GD, and RHA take responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Funding was provided by the National Institute of Alcohol Abuse and Alcoholism 1R25AA014957 (E. Bernstein, J. Bernstein, and G. D'Onofrio); 1R03AA01511-14 (all site authors); R21 AA015123 (R. H. Aseltine).
Reprints not available from the authors.
PII: S0196-0644(07)01256-5
doi:10.1016/j.annemergmed.2007.06.486
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
