Emergency Physician Brief Interventions for Alcohol
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/6/2016 |
| Start Date: | May 2002 |
| End Date: | November 2004 |
Patients with hazardous and harmful alcohol consumption are at increased risk for adverse
health consequences and have frequent visits to the Emergency Department(ED). Despite
research that has demonstrated the prevalence of alcohol problems in ED patients, there are
limited data on the effectiveness of brief intervention (BI) strategies for patients in this
setting. The purpose of the current study is to evaluate the effectiveness of a brief
intervention, termed Brief Negotiation Interview (BNI), provided by emergency practitioners
(EPs-emergency physicians and physician assistants), in reducing alcohol consumption in ED
patients with hazardous and harmful drinking. In a controlled randomized clinical trial of
500 patients with hazardous and harmful drinking, BNI will be compared to scripted discharge
instructions (DI). Three hypotheses will be tested: BNI is superior to DI in: 1) reducing
alcohol consumption; 2) reducing the number of binge drinking episodes; and 3) increasing
utilization of primary care or alcohol-related services. Alcohol consumption and utilization
of primary care or alcohol-related services will be measured by self-report at 1,6 and 12
months. An additional benefit to changing patterns of consumption and utilization of health
services may be decreased ED visits and alcohol-related hospitalizations. These will be
assessed utilizing a statewide database. In order to facilitate real-world application of
BNI in the ED, the project will result in a BNI manual for EPs and an adherence and
competence scale. Unique features of the current project as compared to earlier studies
include: 1)use of a credible control condition; 2) enrollment of a heterogeneous population;
3)use of a manual-guided intervention by existing ED staff; 4)systematic assessment of
adherence and competence to ensure quality administration and discriminability of
interventions; 5)monitoring of use of ancillary treatments; and 6)monitoring of repeat ED
visits and alcohol-related hospitalizations.
health consequences and have frequent visits to the Emergency Department(ED). Despite
research that has demonstrated the prevalence of alcohol problems in ED patients, there are
limited data on the effectiveness of brief intervention (BI) strategies for patients in this
setting. The purpose of the current study is to evaluate the effectiveness of a brief
intervention, termed Brief Negotiation Interview (BNI), provided by emergency practitioners
(EPs-emergency physicians and physician assistants), in reducing alcohol consumption in ED
patients with hazardous and harmful drinking. In a controlled randomized clinical trial of
500 patients with hazardous and harmful drinking, BNI will be compared to scripted discharge
instructions (DI). Three hypotheses will be tested: BNI is superior to DI in: 1) reducing
alcohol consumption; 2) reducing the number of binge drinking episodes; and 3) increasing
utilization of primary care or alcohol-related services. Alcohol consumption and utilization
of primary care or alcohol-related services will be measured by self-report at 1,6 and 12
months. An additional benefit to changing patterns of consumption and utilization of health
services may be decreased ED visits and alcohol-related hospitalizations. These will be
assessed utilizing a statewide database. In order to facilitate real-world application of
BNI in the ED, the project will result in a BNI manual for EPs and an adherence and
competence scale. Unique features of the current project as compared to earlier studies
include: 1)use of a credible control condition; 2) enrollment of a heterogeneous population;
3)use of a manual-guided intervention by existing ED staff; 4)systematic assessment of
adherence and competence to ensure quality administration and discriminability of
interventions; 5)monitoring of use of ancillary treatments; and 6)monitoring of repeat ED
visits and alcohol-related hospitalizations.
Inclusion Criteria:
- Patients, 18 years or older who present to the adult ED at Yale-New Haven Hospital
will be screened for the NIAAA criteria for at risk drinking( ) namely:
- Men: > 14 drinks per week or > 4 drinks per occasion
- Women &: > 7 drinks per week or (all >65) > 3 drinks per occasion
- or will be considered to screen positive for harmful drinking, if they exhibit
any current injury or medical condition occurring in the setting of acute
alcohol ingestion as determined by a) self-report; b)serum or breathalyzer test
with a blood alcohol concentration (BAC) > 0.02mg%;( , , ) or c) a history of
any injury or medical condition involving the use of alcohol within the past
year.
Exclusion Criteria:
Patients will be excluded for the following:
- Non-English speaking;
- Pregnancy;
- Alcohol dependence;
- Current enrollment in substance abuse treatment program;
- Current cocaine or illicit opiate use;
- Current ED visit for acute psychiatric complaint;
- History of neuroleptic prescription;
- Hospitalization for psychiatric problem in the past year;
- Condition that precludes interview i.e., life threatening injury/illness;
- In police custody; and
- Inability to provide 2 contact numbers for follow-up.
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