Health Explorer - Optimizing Alcohol Brief Interventions
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 21 - 65 |
| Updated: | 4/21/2016 |
| Start Date: | January 2012 |
| End Date: | December 2015 |
Optimizing Alcohol Brief Interventions in the ED: Computer vs. Clinician Delivery
The aims of the study are to develop and refine tailored motivational brief interventions
that are parallel in structure but have varied delivery modalities (computer vs. therapist)
for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled
trial comparing the efficacy of these BI approaches (CBI, TBI, control) on subsequent
alcohol consumption and alcohol consequences, including alcohol-related injury, mental and
physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit.
that are parallel in structure but have varied delivery modalities (computer vs. therapist)
for patients with at-risk or problematic alcohol use, and to conduct a randomized controlled
trial comparing the efficacy of these BI approaches (CBI, TBI, control) on subsequent
alcohol consumption and alcohol consequences, including alcohol-related injury, mental and
physical-health functioning, and HIV risk behaviors at 3-, 6-, and 12-months post-ED visit.
Although a high proportion of patients seen in Emergency Departments (EDs) have at-risk or
problem alcohol use, few are screened and receive services such as brief interventions (BI)
designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps
due to feasibility challenges such as training of staff, monitoring fidelity, and
maintaining a system to ensure longer-term implementation. Alcohol BIs have been found to be
efficacious and effective in a variety of health care settings. However, the evidence for
their use in the ED has been mixed. There is a pressing need to develop efficacious
strategies to screen and optimally deliver alcohol BIs in this fast-paced and widely-used
setting. Existing clinician-delivered BI strategies need to be modified so that they can be
standardized and administered with high fidelity and minimal demands on ED staff time and
resources. Computer-delivered BIs are one method to address the challenges inherent in
delivering interventions in this and other healthcare settings. The proposed study will use
computerized screening via touch-screen computer tablets with audio to recruit inner-city ED
patients screening positive for at-risk or problem alcohol use. Participants age 21-65 will
be randomized to one of three conditions: 1) Computer-delivered brief intervention (CBI); 2)
Therapist-delivered brief intervention (TBI); or 3) Enhanced usual care (EUC). All
participants will receive written information regarding community resources; individuals who
meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals.
Stratified random assignment [by gender; meeting criteria for an alcohol use disorder] will
take place at baseline for all conditions. The rigorous examination of the efficacy of
therapist- vs. computer-delivered BIs, including potential moderators and mediators, will
address the key limitations raised by previous trials and will determine the optimal
modality for wide implementation of brief alcohol interventions in this venue. Because the
ED is such an important portal for entry into the medical care system, particularly for
inner-city patients, the delivery of efficacious alcohol BIs that emphasize key motivational
interviewing components and minimize staff resources could have a major public health
impact.
problem alcohol use, few are screened and receive services such as brief interventions (BI)
designed to help them cut-back or stop drinking. EDs do not routinely provide BIs, perhaps
due to feasibility challenges such as training of staff, monitoring fidelity, and
maintaining a system to ensure longer-term implementation. Alcohol BIs have been found to be
efficacious and effective in a variety of health care settings. However, the evidence for
their use in the ED has been mixed. There is a pressing need to develop efficacious
strategies to screen and optimally deliver alcohol BIs in this fast-paced and widely-used
setting. Existing clinician-delivered BI strategies need to be modified so that they can be
standardized and administered with high fidelity and minimal demands on ED staff time and
resources. Computer-delivered BIs are one method to address the challenges inherent in
delivering interventions in this and other healthcare settings. The proposed study will use
computerized screening via touch-screen computer tablets with audio to recruit inner-city ED
patients screening positive for at-risk or problem alcohol use. Participants age 21-65 will
be randomized to one of three conditions: 1) Computer-delivered brief intervention (CBI); 2)
Therapist-delivered brief intervention (TBI); or 3) Enhanced usual care (EUC). All
participants will receive written information regarding community resources; individuals who
meet alcohol abuse/dependence criteria will also receive alcohol treatment referrals.
Stratified random assignment [by gender; meeting criteria for an alcohol use disorder] will
take place at baseline for all conditions. The rigorous examination of the efficacy of
therapist- vs. computer-delivered BIs, including potential moderators and mediators, will
address the key limitations raised by previous trials and will determine the optimal
modality for wide implementation of brief alcohol interventions in this venue. Because the
ED is such an important portal for entry into the medical care system, particularly for
inner-city patients, the delivery of efficacious alcohol BIs that emphasize key motivational
interviewing components and minimize staff resources could have a major public health
impact.
Inclusion Criteria:
- patients age 21-65 years presenting to the ED for medical care (except exclusions as
noted below)
- ability to provide informed consent
- Additional criteria for intervention: past 3-month at-risk alcohol use
Exclusion Criteria:
- patients who do not understand English
- prisoners
- patients classified by medical staff as "Level 1 trauma" (e.g., unconscious,
intubated on respirators, in need of immediate lifesaving procedures such as surgery)
- patients deemed unable to provide informed consent as stated above (e.g.,
intoxication, mental incompetence)
- patients treated in the ED for suicide attempts or sexual assault
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