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The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score < or = 6). One half to two thirds of the students who screened positive drank 2 to 3 times a week, drank 7 or more drinks per typical drinking day, or had experienced alcohol dependence symptoms within the past year. Ninety-six percent of screen-positive students accepted counseling during their ED visit. Three quarters of those questioned at 3-month follow-up reported that counseling had been helpful and that they had decreased their alcohol consumption. The prevalence of alcohol problems, high rates of informed consent and acceptance of counseling, and improved outcomes suggest that the ED is an appropriate venue for engaging students at high risk for alcohol problems.

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Abstract. Objectives: To adapt screening and brief intervention for alcohol problems (SBI) to a high-volume emergency department (ED) setting and evaluate its acceptability to patients. Methods: Patients at a large public-hospital ED were screened with the Alcohol Use Disorders Identification Test (AUDIT). Screen-positive drinkers (AUDIT score Ն 6) were provided brief, on-site counseling and referral as needed. Three months later, project staff blinded to baseline measures reassessed alcohol intake, alcohol-related harm, alcohol dependence symptoms, and readiness to change. Results: Of 1,034 patients approached, 78.3% (810) consented to participate (95% CI = 75.5% to 81.2%), and 21.2% (172) screened positive (95% CI = 18.4% to 24.0%). Of 88 patients with complete intervention data, 94.3% (83) accepted an intervention (95% CI = 89.5% to 99.2%), with acceptance rates ranging from 93% to 100% across four alcohol-problem-severity levels (p = 0.7). A majority (59.0%) set goals to decrease or stop drinking (95% CI = 48.4% to 69.6%). The group recontacted (n = 23) experienced statistically significant decreases in alcohol intake, alcohol-related harm, and dependence symptoms, with measures decreasing for 68%, 52%, and 61% of the patients. Readiness to change also showed statistically significant improvement, with scores increasing for 43% of the patients. Moreover, two-thirds of the patients (15/23) reported at follow-up that SBI was a helpful part of their ED visit. Conclusions: High rates of consent and acceptance of counseling for alcohol problems by patients across a wide range of problem severity indicate that this protocol was acceptable to at-risk patients in a public-hospital ED. Improvements in alcohol-related outcome measures at follow-up were strong enough to warrant controlled studies of intervention efficacy. Key words: emergency service, hospital; alcoholism; mass screening; preventive health services; referral and consultation; alcohol drinking. ACADEMIC EMERGENCY MEDICINE 2000; 7:1383-1392 M ANY people with mild-to-moderate alcohol problems can be helped through wider use of innovative screening and brief counseling in health care settings.1 According to an Institute of Medicine (IOM) report published in 1990, ''all persons coming for care to medical settings should be screened for alcohol problems. If mild or moderate problems are present, a brief intervention should be provided in situation and observed for its effect; if substantial or severe problems are present, a referral to specialized treatment should be effected.'' 2 The U.S. Preventive Services Task Force also rec- ommends this strategy for all adult and adolescent patients and reviews similar recommendations made by several other professional bodies.3 Moreover, recent clinical trials have demonstrated the efficacy of screening and brief interventions for alcohol problems (SBI) in primary and community health care settings, even when people seek care for problems not overtly related to alcohol. 4,5 Despite support from an IOM report, consensu...

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This article is an introduction to brief motivational interventions, which is an effective strategy to address alcohol-use disorders and the public health issues these disorders present. In this article, we summarize core concepts and our clinical experiences. To explore the contrast between these interventions and more traditional approaches to patient-provider interaction, the article describes strategies used in brief motivational interventions, answers common questions about the process, and provides references and resources for those who would like to learn more.