Asking emergency department patients about
their alcohol use and talking with them
about how to reduce harmful drinking
patterns is an effective way to lower rates
of risky drinking in these patients,
according to a nationwide collaborative
study supported by the National Institute on
Alcohol Abuse and Alcoholism (NIAAA) and the
Substance Abuse and Mental Health Services
Administration (SAMHSA).
Emergency
department patients who underwent a regimen
of alcohol screening and brief intervention
reported lower rates of risky drinking at
three-month follow-up than did those who
received only written information about
reducing their drinking.
A report of the study by the Academic
Emergency Department Screening, Brief
Intervention and Referral to Treatment (SBIRT)
Research Collaborative* appears in the
December, 2007 issue of the Annals of
Emergency Medicine.
“This encouraging finding raises the
prospect of reaching many individuals whose
alcohol misuse might otherwise go
untreated,” says NIAAA Director Ting-Kai Li,
M.D.
“These new findings underscore the
importance of using the American Medical
Association health care codes for substance
abuse screening and brief intervention,”
said SAMHSA Administrator Terry Cline, Ph.D.
Codes established by the AMA serve as the
most widely accepted classification system
for reporting medical procedures and
services to public and private health
insurance programs. In January, 2008 new
codes will allow physicians to report
services they provide to screen patients for
alcohol problems and to provide a behavioral
intervention for high-risk drinking.
“Using these new codes will increase the
likelihood that an estimated 18.8 million
Americans with serious alcohol abuse
problems will receive effective intervention
services that could possibly save their
lives and promote wellbeing,'' adds Dr.
Cline.
Previous studies of screening, brief
intervention, and referral conducted in
primary care and in-patient trauma centers
have shown positive outcomes in decreasing
or eliminating alcohol use, reducing injury
rates, and reducing costs to society.
In the current study, investigators at 14
university-based emergency centers
throughout the United States used a brief
questionnaire to assess the alcohol use
patterns of 7,751 emergency patients,
regardless of whether they had signs of
alcohol use on admission.
They found that more than one-fourth of the
patients exceeded the limits for low-risk
drinking -- defined by NIAAA as no more
than: four drinks per day for men and three
drinks per day for women; and not more than
14 drinks per week for men, and seven drinks
per week for women.
More than 1,100 patients who exceeded these
limits agreed to continue to participate in
the study and were divided into intervention
and control groups. The study enrolled
patients with all levels of risky drinking
and visit type.
The primary intervention consisted of a
Brief Negotiated Interview (BNI) that
emergency practitioners performed with each
member of the intervention group. Patients
in the intervention group also received a
written handout explaining low-risk drinking
and a referral list of alcohol treatment
providers. Patients in the control group
received only the low-risk drinking handout
and referral list.
More than 400 emergency department providers
including physicians, nurses, social
workers, nurse practitioners and physician’s
assistants were trained in the BNI in either
a two-hour interactive workshop or via the
Internet.
"The BNI, a conversation between emergency
care providers and patients that involves
listening rather than telling, and guiding
rather than directing, is designed to review
the patient's current drinking patterns,
assess their readiness to change, offer
advice about the low-risk guidelines and the
next steps to pursue, and negotiate a
written prescription for change or a
drinking agreement with the patient,"
explains co-author Edward Bernstein, M.D.,
professor and vice chair for academic
affairs in the department of emergency
medicine at Boston University School of
Medicine.
Dr. Bernstein, who coordinated the training
of emergency department personnel in the
study, notes that the interview typically
takes less than 10 minutes to complete.
Researchers contacted members of each group
three months later to assess any changes in
drinking habits. The intervention group
reported drinking three fewer drinks per
week than the controls, and more than
one-third of individuals in the intervention
group reported drinking at low-risk levels,
compared with about one-fifth of those in
the control group.
“This study demonstrates that a broad group
of emergency practitioners can learn how to
perform the intervention and that it is
effective across multiple practice sites,”
says co-author Gail D’Onofrio, M.D.,
professor and chief of emergency medicine at
Yale University.
“The emergency department visit is often the
only access to care for many patients and
thus is an ideal opportunity to begin the
conversation regarding unhealthy alcohol
use.”
The researchers conclude that widespread use
of these techniques by emergency personnel
could significantly reduce unhealthy alcohol
use.
“Our results should provide the impetus for
broader implementation of screening, brief
intervention, and referral for treatment in
the emergency department setting,” notes
co-author Robert Aseltine, Ph.D., associate
professor in the division of behavioral
science and community health and director of
the Institute for Public Health Research at
the University of Connecticut Health Center.
###
The National Institute on Alcohol Abuse and Alcoholism, part
of the National Institutes of Health, is the
primary U.S. agency for conducting and
supporting research on the causes,
consequences, prevention, and treatment of
alcohol abuse, alcoholism, and alcohol
problems and disseminates research findings
to general, professional, and academic
audiences. Additional alcohol research
information and publications are available
at
www.niaaa.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27
Institutes and Centers and is a component of
the U. S. Department of Health and Human
Services. It is the primary Federal agency
for conducting and supporting basic,
clinical, and translational medical
research, and it investigates the causes,
treatments, and cures for both common and
rare diseases. For more information about
NIH and its programs, visit
http://www.nih.gov.
SAMHSA is a public health agency within the
Department of Health and Human Services. The
agency is responsible for improving the
accountability, capacity and effectiveness
of the nation's substance abuse prevention,
addictions treatment, and mental health
services delivery system.
* The Academic Emergency Department
Screening, Brief Intervention and Referral
to Treatment Research Collaborative group
includes 46 researchers at emergency medical
centers affiliated with the following
institutions:
Boston University, Boston, MA; Brown
University, Providence, RI; Charles R. Drew
University, Los Angeles, CA; Denver Health
Medical Center, Denver, CO; Emory
University, Atlanta, GA; Howard University,
Washington, DC; Tufts University, Medford,
MA; University of California, San Diego, San
Diego, CA; University of Medicine and
Dentistry of New Jersey, Camden, NJ;
University of Michigan, Ann Arbor, MI;
University of New Mexico, Albuquerque, NM;
University of Southern California, Los
Angeles, CA; University of Virginia,
Charlottesville, VA; Yale University, New
Haven, CT
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