Moderators and mediators of two brief interventions for alcohol in the emergency department

Abstract

Objective-Evaluate moderators and mediators of brief alcohol interventions conducted in the Emergency Department. (18-24 years; N = 172) in an Emergency Department received a motivational interview with personalized feedback (MI) or feedback only (FO), with 1-and 3-month booster sessions and 6-and 12-month follow ups. Gender, alcohol status/severity group (ALC+ Only, AUDIT+ Only, ALC+/AUDIT+), attribution of alcohol in the medical event, aversiveness of the event, perceived seriousness of the event, and baseline readiness to change alcohol use were evaluated as moderators of intervention efficacy. Readiness to change also was evaluated as a mediator of intervention efficacy, as were perceived risks/benefits of alcohol use, self-efficacy, and alcohol treatment seeking. Methods-PatientsResults-Alcohol status, attribution, and readiness moderated intervention effects such that patients who had not been drinking prior to their medical event, those who had low or medium attribution for alcohol in the event, and those who had low or medium readiness to change showed lower alcohol use 12 months after receiving MI compared to FO. In the AUDIT+ Only group those who received MI showed lower rates of alcohol-related injury at follow up than those who received FO. Patients who had been drinking prior to their precipitating event did not show different outcomes in the two interventions, regardless of AUDIT status. Gender did not moderate intervention efficacy and no significant mediation was found.Conclusions-Findings may help practitioners target patients for whom brief interventions will be most effective. More research is needed to understand how brief interventions transmit their effects. Keywords Alcohol; Brief Intervention; Emergency RoomAlcohol is one of the primary causes of injuries treated in trauma centers (1), and Emergency Department (ED) patients are up to three times more likely to report heavy drinking and negative consequences of drinking than patients in primary care settings (2).Corresponding Author: Nancy P. Barnett, Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, USA, Nancy_Barnett@brown. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMales and younger patients are more likely to have been drinking prior to treatment in an ED (3), and patients who are admitted to a trauma center with positive toxicology findings have twice the subsequent injury mortality rates than other patients (4).Use of early, brief interventions may prevent the development of more severe cases of alcohol problems (5), and may reduce the risk of future health problems or injury (6-8). The importance of treating alcohol problems among ED and trauma center patients is reflected in national recommendations (9), and a recent mandate that requires all trauma centers to provide screening and brief intervention services for alcohol problems (10). Motivational Interviewing (MI) (11) reduces drinking and/or associated problems with patients in EDs or trauma ce...

Reviewing and interpreting the effects of brief alcohol interventions: comment on a Cochrane review about motivational interviewing for young adults

“…The above‐mentioned concerns with risk of bias assessments relying on reported data only are compounded by the lack of specifically searching grey literature sources, where further information about ‘unclear’ risks of bias could potentially be found. Moreover, at least two reports thought by review authors to be from different studies appear to be the same study (Barnett et al ., 2010 32 and Monti et al ., 2007 33). Limitations in the search strategy's ability to identify and properly classify the primary literature in this area should further temper definitive conclusions.…”

Single-Session Alcohol Interventions for Heavy Drinking College Students: A Systematic Review and Meta-Analysis

“…Brief interventions may vary in effectiveness across demographics, such as gender (Fleming et al, 2002), ethnicity, or between volunteer versus mandated participants (e.g., Kazemi et al, 2013, but see also Terlecki et al, 2010). Effects may also vary by characteristics of the interventions themselves, including duration and theoretical approach (e.g., Barnett et al, 2010;Black et al, 2012, but see also McDevitt-Murphy et al, 2014). Last, intervention effects may vary depending on how primary study authors operationalize alcohol use outcomes (e.g., frequency vs. quantity of drinking) or the delay between intervention and outcome assessment (e.g., see Carey et al, 2007;Moreira et al, 2009, but see also Burke et al, 2004).…”

Readiness to Change and to Accept Help and Drinking Outcomes in Young Adults of Mexican Origin

“…Evidence from research studies is mixed, with findings ranging from higher readiness leading to reduced drinking (Vaca et al, 2011), low to moderate readiness resulting in lower consumption at follow-up (Barnett et al, 2010), higher readiness increasing alcohol-related consequences (Collins et al, 2010), to no association between RCD and drinking outcomes (Korcha et al, 2012). Thus, we may conclude that the relationship between RCD and brief intervention is poorly understood.…”