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Brief ED intervention cuts alcohol consumption in risky drinkers

NEW YORK (Reuters Health) – A brief intervention performed by emergency department staff reduced alcohol consumption and episodes of impaired driving in problem drinkers over the next six to 12 months in a randomized study conducted at Yale New Haven Hospital in Connecticut.

Contrary to the investigators’ hypothesis, a follow-up “booster” phone call made one month after the ED intervention offered no added benefit over the one-time intervention in the ED setting.

“This intervention uses motivational interviewing techniques to change behavior,” Dr. Gail D’Onofrio of the department of emergency medicine, Yale University School of Medicine in New Haven, Connecticut, told Reuters Health.

The “Brief Negotiation Interview,” taught during a two-hour training program, includes raising the subject of alcohol use with the ED patient, asking about changing his or her drinking behavior, negotiating a drinking goal with the patient, and asking them to sign a drinking agreement. The whole intervention takes about seven minutes to complete.

The US Preventive Services Task Force recommends screening and brief intervention for at-risk drinkers, but studies in ED settings have been inconclusive, Dr. D’Onofrio and colleagues point out in a report online March 30 in the Annals of Emergency Medicine.

The investigators enrolled in their study 889 adults who presented to the ED and were identified as hazardous and harmful drinkers based on questions embedded in a 17-item general health questionnaire.

They randomly allocated 297 of them to the Brief Negotiation Interview, 295 to the Brief Negotiation Interview with booster phone call one month later, 148 to standard care, and 149 to a standard care-no assessment group (control), which was used to study the impact of research assessments on drinking outcomes. Participants received $20 at the index visit and the 6- and 12-month assessments.

The researchers report that the two intervention groups and the standard care group decreased their alcohol consumption over time. However, reductions from baseline to 12 months in mean number of drinks consumed per week were greater in the Brief Negotiation Interview with booster and the Brief Negotiation Interview groups (7.4 and 5.5, respectively) compared with the standard care group (3.3).

There were also greater reductions in the number of monthly binge episodes in the two intervention groups (2.8 and 2.1, respectively) compared with the standard care group (1.4).

At 12 months, the reductions in rates of driving after drinking more than three drinks were also greater with Brief Negotiation Interview alone (dropping from 38% at baseline to 20% at one year) and with the booster (dropping from 39% to 31%) relative to standard care (dropping 43% to 42%).

As mentioned, the booster phone call offered no significant benefit over the one-time ED intervention alone.

The researchers also report that the intervention worked best in participants older than 26 years, whereas drinking and binge episodes in younger individuals showed a “strong rebounding trend” toward baseline at 12 months. This suggests that additional modifications to the intervention in either content or intensity may be needed for this group.

The researchers note that the study was conducted at a single teaching hospital associated with an academic institution. On the other hand, they say, they trained a large number of emergency practitioners with a variety of training and experience.

Dr. D’Onofrio told Reuters Health that this brief intervention is now being used in many EDs and primary care settings. “We continue to incorporate it into our daily practice. As part of a SAMHSA (Substance Abuse and Mental Health Services Administration) grant, I have trained over 400 residents at Yale New Haven Hospital in the technique. This includes medicine, psychiatry, pediatrics, OB/GYN, and emergency medicine,” she said.

A strength of the study, according to its authors, is the use of interactive voice response technology, which allows for the collection of data without patient-staff interaction, which can yield more accurate data.

“We also examined the effect of assessment reactivity by adding the standard care-no assessment group. However, contrary to our original hypothesis, our assessment had no significant effect on drinking reductions, thus supporting the effectiveness of the Brief Negotiation Interview itself,” the authors note.

The current study, they conclude, “adds to the evidence in support of brief interventions for general ED patients.” Such interventions can be used for a variety of purposes, such as “helping patients adhere to medical regimens,” Dr. D’Onofrio said.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism.

SOURCE: http://bit.ly/IzPOr4

Ann Emerg Med 2012.