Acceptability of Emergency Department‐based Screening and Brief Intervention for Alcohol Problems

Abstract

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...

The half-life of the ‘teachable moment’ for alcohol misusing patients in the emergency department

“…Therefore, the patient's volition to re-attend to see the AHW fades too. This problem has not been delineated before, nor highlighted as a focus of future research in the USA (Hungerford et al, 2000;D'Onofrio & Degutis LC, 2002;Hungerford & Pollok, 2003) or in mainland Europe (Daeppen J-B, 2003).…”

Public Health Preventive Services, Surveillance, and Screening The Emergency Department's Potential

“…There are considerable data to support ED-based patient education projects. 17 This issue of AEM also contains an article by Hungerford et al, 18 in which a screening tool to identify problems related to alcohol use was studied, and a brief ED-based intervention was applied. The short-term outcome of the ED intervention was assessed at three months, to determine the status of those patients who screened positive for alcohol-related problems and who accepted the ED intervention.…”

Substance-related problems in patients visiting an urban Canadian emergency department

“…In other US studies involving direct patient interviews, researchers found evidence of alcohol problems in 54% of drinking college students presenting to ED, 7 in 43% of young adult drinkers 8 and in 21% of all adult ED patients. 9 In a British study, Thom and coworkers 10 found that 37% of young adults attending the accident and emergency department were drinking harmfully, and 15% considered their visit to be alcohol related. Cherpitel and colleagues 18 interviewed patients in 2 Canadian EDs and found that 22% of injured patients and 11% of noninjured patients in 2 Canadian EDs reported using alcohol in the 6 hours before their visit, and that 3% of injured patients and 2% of noninjured patients reported drug use in the previous 6 hours.…”

“…4 Numerous studies document a prevalence of substance abuse or dependence in approximately 20% of ED patients. [5][6][7][8][9][10][11][12] Substance abuse has been associated with up to 50% of all injuries. [13][14][15][16][17] Although the bulk of these data is from the United States, the Canadian situation is likely similar.…”