Objectives: To identify predictors of readiness to change drinking behavior by minor-injury patients who had positive saliva alcohol tests (SATs) in the ED. To develop and test a model intended to be prognostic of readiness to change, which included predispositional and injury-event-related variables.Methods: An on-site survey was conducted of minor-injury ED patients sampled consecutively during predesignated periods. Patients were identified as SAT-positive during their screening evaluations. After giving their consent, they were administered a self-report battery that assessed predispositional and injury-event-related variables as well as readiness to cha'nge their drinking. Predictors of readiness to change drinking were tested with regression analyses.Results: Twenty-four SAT-positive patients participated; there were 18 men and six women (average age 34 years). Preinjury predispositional variables were by themselves unrelated to the patient's readiness to change while in the ED. Aversiveness of the injury and perception of degree of alcohol involvement were injury-event-related variables predictive of readiness t o change (p < 0.008). Negative consequences attributed to drinking prior to the injury event strengthened the association of injury aversiveness and alcohol involvement with readiness to change ( p < 0.0075).Conclusion: Interventions to decrease drinking in this population should focus on increasing patient awareness of the association between drinking, injuries, and other alcohol-related negative consequences.Acad. Emerg. Med. 1995; 2:817-825.

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low preintervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population. Keywords brief intervention; alcohol use; emergency medicineBrief interventions in general (Bien, Miller, & Tonigan, 1993), and brief motivational interventions (BMIs) in particular (Burke, Arkowitz, & Dunn, 2002), have been shown to be effective for problem drinkers in reducing alcohol consumption and consequences in a variety of settings when compared with untreated controls. There is a great need in Emergency Departments (EDs) for effective treatments targeting alcohol use, because these settings have documented long-standing and high rates of admissions for minor and more serious alcoholrelated injuries (Cherpitel, 1992(Cherpitel, , 1996. BMIs adapted to the ED setting have been demonstrated to enhance alcohol-related outcomes (Blow et al., 2006;Longabaugh et al., 2001;Monti et al., 1999). However, not all studies of BMIs show positive results (e.g., Heather, Rollnick, Bell, & Richmond, 1996; Hungerford et al., 1999;Richmond, Heather, Wodak, Kehoe, & Webster, 1995). Therefore, it is important to examine the determinants of successful BMI interventions. As of yet, despite explicit theoretical formulation as to how and why motivational interventions (MIs) have their beneficial effects (Miller & Rollnick, 1991, empirical research supporting these putative mechanisms of change has not yet fully materialized (Apodaca & Longabaugh, in press;Burke et al., 2002;Dunn, Deroo, & Rivara, 2001). The lack of identification of mechanisms of change for alcohol and substance abuse interventions is not unique to MI. Other treatments for alcohol use disorders also have scant evidence for the mechanisms by which they are effective (Longabaugh & Wirtz, 2001;Morgenstern & Longabaugh, 2000). More generally, the search for mechanisms of change in behavioral treatments of most disorders has been found wanting (Kazdin & Nock, 2003;Noc...

Objective: Although the Short Index of Problems (SIP) is often used, little is known about the psychometric properties of the SIP in special populations. The present study seeks to determine the following: (1) whether it is possible to substitute items to enhance the psychometric properties of the SIP and (2) whether the SIP, or improved scale, is as sensitive as the Drinker Inventory of Consequences (DrInC) to assess intervention effectiveness. Method: The sample consisted of 404 injured patients who were treated in the Emergency Department (ED) of a major teaching hospital that serves southern New England. Three approaches were used to guide development of the 3-month SIP-R, the potential alternative to the SIP. Cronbach's alpha assessed intrascale reliability; hierarchical multiple regression assessed construct validity; performance of the scales assessing intervention change were compared to the total 3-month DrInC as a function of intervention using analysis of covariance (ANCOVA). Results: There was no evidence that changing the current SIP items will significantly improve performance. The 3-month SIP performed as well as the 3-month DrInC-2R in predicting 12-month DrInC scores and in determining intervention change at 12 months. Of the 45 Dr1nC items, 31 also predicted a difference across intervention groups. Conclusions: These results suggest there is no advantage to changing the current SIP items. The 3-month SIP is a psychometrically sound measure for assessing consequences of alcohol consumption in an ED sample and is almost as sensitive to intervention change as the full DrInC. (J. Stud. Alcohol 66: 433-437, 2005) M ILLER ET AL. (1995) developed the Drinker Inventory of Consequences (DrInC) to assess alcohol-related problems independent of alcohol consumption and dependence. The 50-item DrInC consists of 45 items that measure self-reported alcohol-related consequences in five domains: interpersonal, intrapersonal, physical, impulse control and social subscales, and a 5-item subscale to check for response acquiescence. The Short Index of Problems (SIP), a 15-item version of the DrInC, was developed for situations in which time was limited (Miller et al., 1995). Although these measures are increasingly used, the SIP remains untested in many special populations (Feinn et al.,