|Brief Intervention Helps Emergency Patients
Asking emergency department patients about their alcohol use and
talking with them about how to reduce harmful drinking patterns
is an effective way to lower rates of risky drinking in these patients,
according to a nationwide collaborative study supported by the
National Institute on Alcohol Abuse and Alcoholism (NIAAA) and
the Substance Abuse and Mental Health Services Administration (SAMHSA).
Emergency department patients who underwent a regimen of alcohol
screening and brief intervention reported lower rates of risky
drinking at three-month follow-up than did those who received only
written information about reducing their drinking. A report of
the study by the Academic Emergency Department Screening, Brief
Intervention and Referral to Treatment (SBIRT) Research Collaborative* appears
in the December, 2007 issue of the Annals of Emergency Medicine.
"This encouraging finding raises the prospect of reaching
many individuals whose alcohol misuse might otherwise go untreated," says
NIAAA Director Ting-Kai Li, M.D.
"These new findings underscore the importance of using the
American Medical Association health care codes for substance abuse
screening and brief intervention," said SAMHSA Administrator
Terry Cline, Ph.D.
Codes established by the AMA serve as the most widely accepted
classification system for reporting medical procedures and services
to public and private health insurance programs. In January, 2008
new codes will allow physicians to report services they provide
to screen patients for alcohol problems and to provide a behavioral
intervention for high-risk drinking.
"Using these new codes will increase the likelihood that
an estimated 18.8 million Americans with serious alcohol abuse
problems will receive effective intervention services that could
possibly save their lives and promote wellbeing," adds Dr.
Previous studies of screening, brief intervention, and referral
conducted in primary care and in-patient trauma centers have shown
positive outcomes in decreasing or eliminating alcohol use, reducing
injury rates, and reducing costs to society.
In the current study, investigators at 14 university-based emergency
centers throughout the United States used a brief questionnaire
to assess the alcohol use patterns of 7,751 emergency patients,
regardless of whether they had signs of alcohol use on admission.
They found that more than one-fourth of the patients exceeded the
limits for low-risk drinking — defined by NIAAA as no more
than: four drinks per day for men and three drinks per day for
women; and not more than 14 drinks per week for men, and seven
drinks per week for women. More than 1,100 patients who exceeded
these limits agreed to continue to participate in the study and
were divided into intervention and control groups. The study enrolled
patients with all levels of risky drinking and visit type.
The primary intervention consisted of a Brief Negotiated Interview
(BNI) that emergency practitioners performed with each member of
the intervention group. Patients in the intervention group also
received a written handout explaining low-risk drinking and a referral
list of alcohol treatment providers. Patients in the control group
received only the low-risk drinking handout and referral list.
More than 400 emergency department providers including physicians,
nurses, social workers, nurse practitioners and physician's assistants
were trained in the BNI in either a two-hour interactive workshop
or via the Internet.
"The BNI, a conversation between emergency care providers and
patients that involves listening rather than telling, and guiding
rather than directing, is designed to review the patient's current
drinking patterns, assess their readiness to change, offer advice
about the low-risk guidelines and the next steps to pursue, and
negotiate a written prescription for change or a drinking agreement
with the patient," explains co-author Edward Bernstein, M.D., professor
and vice chair for academic affairs in the department of emergency
medicine at Boston University School of Medicine. Dr. Bernstein,
who coordinated the training of emergency department personnel
in the study, notes that the interview typically takes less than
10 minutes to complete.
Researchers contacted members of each group three months later
to assess any changes in drinking habits. The intervention group
reported drinking three fewer drinks per week than the controls,
and more than one-third of individuals in the intervention group
reported drinking at low-risk levels, compared with about one-fifth
of those in the control group.
"This study demonstrates that a broad group of emergency
practitioners can learn how to perform the intervention and that
it is effective across multiple practice sites," says co-author
Gail D'Onofrio, M.D., professor and chief of emergency medicine
at Yale University. "The emergency department visit is often
the only access to care for many patients and thus is an ideal
opportunity to begin the conversation regarding unhealthy alcohol
The researchers conclude that widespread use of these techniques
by emergency personnel could significantly reduce unhealthy alcohol
"Our results should provide the impetus for broader implementation
of screening, brief intervention, and referral for treatment in
the emergency department setting," notes co-author Robert
Aseltine, Ph.D., associate professor in the division of behavioral
science and community health and director of the Institute for
Public Health Research at the University of Connecticut Health
Clinical guidance for rapid screening, assessment and management
of at-risk drinking and alcohol use disorders is outlined in NIAAA's Helping
Patients Who Drink Too Much: A Clinician's Guide, available
on the Web at: http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm.
SAMHSA is a public health agency within the Department of Health
and Human Services. The agency is responsible for improving the
accountability, capacity and effectiveness of the nation's substance
abuse prevention, addictions treatment, and mental health services
The National Institute on Alcohol Abuse and Alcoholism, part of
the National Institutes of Health, is the primary U.S. agency for
conducting and supporting research on the causes, consequences,
prevention, and treatment of alcohol abuse, alcoholism, and alcohol
problems and disseminates research findings to general, professional,
and academic audiences. Additional alcohol research information
and publications are available at www.niaaa.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.
* The Academic Emergency Department
Screening, Brief Intervention and Referral to Treatment Research
Collaborative group includes 46 researchers at emergency medical
centers affiliated with the following institutions:
Boston University, Boston, MA; Brown University, Providence, RI;
Charles R. Drew University, Los Angeles, CA; Denver Health Medical
Center, Denver, CO; Emory University, Atlanta, GA; Howard University,
Washington, DC; Tufts University, Medford, MA; University of California,
San Diego, San Diego, CA; University of Medicine and Dentistry
of New Jersey, Camden, NJ; University of Michigan, Ann Arbor, MI;
University of New Mexico, Albuquerque, NM; University of Southern
California, Los Angeles, CA; University of Virginia, Charlottesville,
VA; Yale University, New Haven, CT