Original contribution
Effects of an Intervention Brochure on Emergency Department Patients' Safe Alcohol Use and Knowledge

https://doi.org/10.1016/j.jemermed.2008.03.003Get rights and content

Abstract

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. The objective of this study was to evaluate the effects of the American College of Emergency Physician's brief alcohol use intervention brochure on patients' hazardous drinking behavior and knowledge of safe alcohol use. We conducted a controlled trial comparing Emergency Department (ED) subjects receiving the alcohol use intervention brochure vs. receiving no brochure. One-month outcome measures included the following: 1) change in days of hazardous drinking; 2) change in knowledge of safe alcohol use; and 3) movement along a readiness-to-change continuum for excessive alcohol use. Of 277 subjects, 252 (91.0%) agreed to participate, and 188 of these (74.6%) were successfully contacted for 1-month follow-up assessment. We did not find any significant decreases in days of hazardous drinking or increases in knowledge of safe drinking limits for either the intervention or comparison groups. However, among the subgroup of excessive alcohol users (n = 100), we found that significantly more intervention subjects had advanced along the readiness-to-change continuum than comparison subjects (p < 0.01). This effect was even greater among the intervention group subjects who stated that they read the brochure (p < 0.001). A brief alcohol use intervention brochure does not affect ED patients' hazardous drinking behavior or knowledge of safe alcohol use. The brochure, however, may affect certain patients' motivation to change their drinking behavior. Changing drinking behavior requires more than simply handing out a brochure in the ED; referral to community resources for those motivated to change is likely an important component to successful management of this problem.

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

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      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).

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    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.

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