Original contributionEffects of an Intervention Brochure on Emergency Department Patients' Safe Alcohol Use and Knowledge
Introduction
Alcohol abuse is a leading cause of morbidity and mortality in the United States, contributing to over 100,000 deaths and costing society over 185 billion dollars each year (1). Most individuals with alcohol-related problems, however, would not be classified as alcoholics (i.e., dependent drinkers) by standard Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria, but rather as persons who engage in hazardous drinking (i.e., problem drinkers) (2). The ratio of problem drinkers to dependent drinkers has been estimated at about four to one (3). This difference is important because, unlike dependent drinkers, problem drinkers may be motivated for behavior change when expectations of the effects of alcohol on their behavior, mood, and emotions become more negative than positive. In particular, problem drinkers are motivated to change their excessive alcohol use when they suffer medical consequences (4, 5). Because alcohol abuse has been estimated to be involved in 28.7 Emergency Department (ED) visits per 1000 population, the ED could be an important site for alcohol abuse interventions, despite the brevity of the typical ED encounter (6, 7, 8, 9, 10).
Several studies have indicated that brief (5–30-min) outpatient interventions, tailored to problem drinkers' behavioral-stage-of-change status, can decrease their alcohol use (11, 12, 13, 14, 15, 16). In addition, a recent meta-analysis of 19 randomized, controlled trials (using intent-to-treat analyses) indicates that brief alcohol interventions are effective in reducing alcohol consumption at 6 and 12 months among individuals attending primary care facilities but not specifically seeking help for alcohol-related problems (17). Even though these interventions can be brief, they still rely on some form of motivational interviewing technique that is time-consuming for a busy Emergency Physician. Based upon the stages-of-change model, it may be possible that a simple brochure presented during an ED encounter may be sufficient to promote drinking behavior change among individuals who are problem drinkers (18, 19).
With grant support from the National Highway Traffic Safety Administration (NHTSA), an American College of Emergency Physicians (ACEP) task force recently developed a resource kit for screening and intervention of patients presenting to EDs with alcohol-related problems (20). This kit includes an intervention brochure to provide patients with information about excessive alcohol use as well as an alcohol use screening and brief counseling tool (21). The effectiveness of this brochure alone as a specific intervention strategy for reducing alcohol use in general ED patients is not known and has not been previously studied. We undertook this study to assess the effects of utilizing ACEP's intervention brochure on ED patients' drinking behavior and knowledge of safe alcohol use.
Section snippets
Study Design and Setting
We conducted a controlled trial to evaluate the effects of using ACEP's brief alcohol use intervention brochure on ED patients' drinking behavior and knowledge of safe alcohol use at 1-month follow-up. The study was conducted from February through March 2004 in the ED of Northwestern Memorial Hospital in Chicago, Illinois. This is a university-based teaching hospital in an urban setting with an annual census of 70,000 demographically diverse patients. The Northwestern University Institutional
Results
Of 277 screened eligible study subjects, 252 (91.0%) agreed to participate in our study and were allocated to the intervention or control groups (Figure 1). There were no significant race/ethnicity or gender differences between the participants and non-participants, but participants tended to be younger than non-participants (p = 0.01). Sociodemographic and baseline alcohol use characteristics for the intervention and comparison groups are presented in Table 1. Although the comparison group
Discussion
Our findings indicate that ACEP's brief alcohol use intervention brochure does not seem to affect ED patients' number of hazardous drinking days or knowledge of safe alcohol use, but may affect problem drinkers' motivation to change their adverse drinking behavior. Both comparison and intervention groups exhibited slightly decreased days of hazardous drinking and slightly increased knowledge of safe alcohol use at 1 month. A recent study conducted in Sweden found very similar results.
Conclusions
Use of ACEP's brief alcohol use intervention brochure does not seem to affect the primary outcome of number of days of ED patients' hazardous drinking or knowledge of safe alcohol use. However, it does seem that the brochure may prompt the motivation to change hazardous drinking behavior in our study population. However, motivation to change and actually changing behavior are two different things; simply handing out a brochure in the ED is not enough. Additional referral, counseling, and
References (33)
- et al.
Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial
Lancet
(2004) - et al.
The Fifth Edition of the Addiction Severity Index
J Subst Abuse Treat
(1992) - et al.
A brief readiness to change drinking algorithm: concurrent validity in female VA primary care patients
Addict Behav
(2005) 10th Special Report to the U.S. Congress on Alcohol and Health
(June 2000)Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey
J Stud Alcohol
(1997)Broadening the base of treatment for alcohol problems
(1990)- et al.
Impact of normative feedback on problem drinkers: a small-area population study
J Stud Alcohol
(2001) - et al.
Alcohol expectancies as a mediator of the relationship between injury and readiness to change drinking behavior
Psychol Addict Behav
(2000) - et al.
US emergency department visits for alcohol-related diseases and injuries between 1992–2000
Arch Intern Med
(2004) - et al.
Preventive care in the emergency department, part I: clinical preventive services—are they relevant to emergency medicine?
Acad Emerg Med
(2000)
Preventive care in the emergency department, part II: clinical preventive services—an emergency medicine evidence-based review
Acad Emerg Med
Alcohol and violence-related injuries: an emergency room study
Addiction
Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers
J Gen Intern Med
Brief physician advice for problem alcohol drinkersA randomized controlled trial in community-based primary care practices
JAMA
Brief physician advice for alcohol problems in older adults: a randomized community-based trial
J Fam Pract
Treatment of problem alcohol use in women of childbearing age: results of a brief intervention trial
Alcohol Clin Exp Res
Cited by (9)
Variance in the Efficacy of Brief Interventions to Reduce Hazardous and Harmful Alcohol Consumption Between Injury and Noninjury Patients in Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
2017, Annals of Emergency MedicineCitation Excerpt :The statistical analysis was performed with Review Manager (version 5.3).30 The trials below were excluded from meta-analysis on the following bases: it was not a parallel-group randomized controlled trial44; reduction in alcohol consumption in percentage of patients by treatment condition without corresponding SD or any useable standard outcomes was reported36,45-51; it did not include a minimal intervention control group15,52; alcohol-related negative consequences were reported as primary outcomes and reduction in alcohol consumption was not reported53,54; brief intervention occurred outside of the ED setting55,56; and the sample included a high proportion of dependent drinkers.57 Twenty-three trials16,33-38,58-73 were identified as eligible and included in the meta-analysis (see Table E2, available online at http://www.annemergmed.com, for characteristics of the studies).
What makes emergency department patients reduce their alcohol consumption? - A computer-based intervention study in Sweden
2013, International Emergency NursingCitation Excerpt :However, there are many difficulties in delivering alcohol interventions in this setting, which tends to be busy and overcrowded. There are also barriers in the form of negative attitudes to alcohol prevention and insufficient knowledge about alcohol-related issues among ED staff (Wang et al., 2010; Nilsen et al., 2007; Charalambous, 2002). The use of computer technology has been suggested as a feasible option to overcome some of the obstacles to delivering brief interventions in the ED (Blow et al., 2006; Neumann et al., 2004, 2006; Nilsen et al., 2009; Vaca et al., 2010).
Effectiveness of SBIRT for alcohol use disorders in the emergency department: A systematic review
2017, Western Journal of Emergency MedicineReview article: Effectiveness of ultra-brief interventions in the emergency department to reduce alcohol consumption: A systematic review
2016, EMA - Emergency Medicine Australasia
Dr. Wang is currently with the John H. Stroger, Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois.
This study was supported by an Excellence in Academic Medicine grant from the State of Illinois Department of Public Aid and Northwestern Memorial Hospital.