Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department: A Systematic Review

Abstract

IntroductionAlcohol use disorders (AUD) place a significant burden on individuals and society. The emergency department (ED) offers a unique opportunity to address AUD with brief screening tools and early intervention. We undertook a systematic review of the effectiveness of ED brief interventions for patients identified through screening who are at risk for AUD, and the effectiveness of these interventions at reducing alcohol intake and preventing alcohol-related injuries.MethodsWe conducted systematic electronic database searches to include randomized controlled trials of AUD screening, brief intervention, referral, and treatment (SBIRT), from January 1966 to April 2016. Two authors graded and abstracted data from each included paper.ResultsWe found 35 articles that had direct relevance to the ED with enrolled patients ranging from 12 to 70 years of age. Multiple alcohol screening tools were used to identify patients at risk for AUD. Brief intervention (BI) and brief motivational intervention (BMI) strategies were compared to a control intervention or usual care. Thirteen studies enrolling a total of 5,261 participants reported significant differences between control and intervention groups in their main alcohol-outcome criteria of number of drink days and number of units per drink day. Sixteen studies showed a reduction of alcohol consumption in both the control and intervention groups; of those, seven studies did not identify a significant intervention effect for the main outcome criteria, but nine observed some significant differences between BI and control conditions for specific subgroups (i.e., adolescents and adolescents with prior history of drinking and driving; women 22 years old or younger; low or moderate drinkers); or secondary outcome criteria (e.g. reduction in driving while intoxicated).ConclusionModerate-quality evidence of targeted use of BI/BMI in the ED showed a small reduction in alcohol use in low or moderate drinkers, a reduction in the negative consequences of use (such as injury), and a decline in ED repeat visits for adults and children 12 years of age and older. BI delivered in the ED appears to have a short-term effect in reducing at-risk drinking.

Emergency department screening and interventions for substance use disorders

“…alcohol-related injury, reduced drinking and driving, increasing seat belt use, etc. ), while interventions focused on dependent drinkers or those meeting criteria for moderate or several alcohol use disorder focus on enhancing motivation to enter treatment [ 17 , 18 , 20 , 37 , 38 ]. Importantly, one observational study found that patients who received a direct referral, including transfer directly from the ED to a specialized treatment facility, were 30 times more likely to enroll in treatment than those with an indirect referral who are discharged home from the ED [ 38 ] (Table 1 ).…”

“…A 2008 study of harmful and hazardous drinkers did not detect a difference between patients receiving a BNI and scripted discharge instructions [ 42 ], although a second study of harmful and hazardous drinkers, that included universal screening and interactive voice response methodology to reduce assessment reactivity found reduction in mean past 7-day alcohol use and past 28 day binge episodes at 6 and 12 month follow-up in the BNI group and BNI group with 30 day booster over standard care [ 17 ]. A 2017 systematic review of ED studies using brief intervention or motivational interview based intervention to reduce alcohol consumption identified 25 randomized controlled trials; 13 studies showed decreased alcohol consumption at primary outcome; 17 studies failed to demonstrate intervention effect for primary outcome of alcohol consumption, 11 of which found significant results for either a specific subgroup or a secondary outcome [ 37 ]. Overall, authors conclude that there is moderate quality evidence for the targeted use of brief interventions that showed a small reduction in alcohol use in low or moderate drinkers and a reduction in the consequences of use such as injury [ 37 ].…”

Trends in Alcohol‐Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014

“…Such techniques typically involve helping the patient examine their relationship with alcohol and consider decreasing their levels of use to reduce the risk of further alcohol‐related harm. Barata and colleagues () reviewed 35 randomized controlled trials examining the impact of brief interventions for alcohol performed in the ED on subsequent alcohol use and related outcomes. They identified 13 studies that reported significant differences between control and intervention groups in the quantity and frequency of drinking after discharge that lasted from weeks to months.…”

<p>Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives</p>

“…There is limited evidence to support a small reduction in subsequent instances of alcohol-related injuries. 84,85 More research is needed to establish effective interventions for individuals presenting to the ED with complications of alcohol use.…”