Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency Department

Abstract

This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on ''Public Health in the ED: Screening, Surveillance, and Intervention.'' The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening-develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention-conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups-conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategiesa) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and followup; and d) examine alternatives to specialized treatment referral. 5) Translation-conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.

Disseminating alcohol screening and brief intervention at trauma centers: a policy-relevant cluster randomized effectiveness trial

“…A series of previous investigations and reviews describe attempts to integrate services for alcohol and other drug use problems in general medical settings including trauma center, emergency department, medical inpatient, and primary care contexts (54–56, 63). From an implementation science perspective, trauma center settings are distinct from other United States general medical settings in that the College has the ability to mandate alcohol SBI.…”

Emergency Screening and Brief Intervention for Alcohol in Adolescents

“…Several studies [9][10][11][12] obtained a good experience in BI with different groups of patients resulting in a significant decrease in alcohol consumption and also in alcohol abuse related problems, especially at short-term.…”

Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica

“…46 Intervention strategies can be delivered in individual sessions of 5-15 minutes aimed at motivating the patient in relation to the treatment. 47 According to Cunningham et al, additional evidence is necessary regarding the duration, performance, and intensity of interventions.…”