Impact of a brief intervention on reducing alcohol use and increasing alcohol treatment services utilization among alcohol- and drug-using adult emergency department patients

Abstract

Most previous brief intervention (BI) studies have focused on alcohol or drug use, instead of both substances. Our primary aim was to determine if an alcohol and drug use BI reduced alcohol use and increased alcohol treatment services utilization among adult emergency department (ED) patients. Our secondary aims were to assess when the greatest relative reductions in alcohol use occurred, and which patients (stratified by need for an alcohol use intervention) reduced their alcohol use the most. We studied a sub-sample of participants from a randomized, controlled trial of a BI vs. no BI whose responses to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) indicated a need for a BI for any drug use and who also reported alcohol use. Participants were stratified by their ASSIST alcohol subscore: (1) no BI needed, (2) a BI needed, or (3) an intensive intervention needed for alcohol use. Alcohol use and alcohol treatment services utilization were measured every three months for 12 months post-enrollment. Of these 833 participants, median age was 29 years-old, 46% were female; 55% were white/non-Hispanic, 27% black/non-Hispanic and 15% Hispanic. Although any alcohol use, alcohol use frequency, days of alcohol use, typical drinks consumed/day, and most drinks consumed/day decreased in both the BI and no BI arms, there were no differences between study arms. Few patients sought alcohol use treatment services in follow-up, and utilization also did not differ by study arm. Compared to baseline, alcohol use reduced the most during the first three months after enrollment, yet reduced little afterwards. Participants whose ASSIST alcohol subscores indicated a need for an intensive intervention generally had the greatest relative decreases in alcohol use. These results indicate that the BI used was not efficacious in reducing alcohol use among alcohol- and drug-using adult ED patients. There is a need to develop and test more robust interventions.

Factors related to substance use treatment attendance after peer recovery coach intervention in the emergency department

“…Severe alcohol withdrawal symptoms could be a driver of successful linkage to treatment if these were the reason for the ED visit. Thus, the present results may also be consistent with prior data showing that persons who needed more intensive intervention also showed greater reductions in alcohol use following brief intervention in the ED ( Merchant et al, 2017 ). Although we do not know whether withdrawal or severity were underlying the relationship between treatment linkage and a documented alcohol use disorder diagnosis in our sample, formal assessment of alcohol use disorder severity and withdrawal may be considered in future analyses of linkage to treatment from the ED.…”