The impact of screening, brief intervention, and referral for treatment on emergency department patients' alcohol use.
OBJECTIVE
We determine the impact of a screening, brief intervention, and referral for treatment (SBIRT) program in reducing alcohol consumption among emergency department (ED) patients.


METHODS
Patients drinking above National Institute of Alcohol Abuse and Alcoholism low-risk guidelines were recruited from 14 sites nationwide from April to August 2004. A quasiexperimental comparison group design was used in which control and intervention patients were recruited sequentially at each site. Control patients received a written handout. The intervention group received the handout and a brief intervention, the Brief Negotiated Interview, to reduce unhealthy alcohol use. Follow-up surveys were conducted at 3 months by telephone using an interactive voice response system.


RESULTS
Of 7,751 patients screened, 2,051 (26%) exceeded the low-risk limits set by National Institute of Alcohol Abuse and Alcoholism; 1,132 (55%) of eligible patients consented and were enrolled (581 control, 551 intervention). Six hundred ninety-nine (62%) completed a 3-month follow-up survey, using the interactive voice response system. At follow-up, patients receiving a Brief Negotiated Interview reported consuming 3.25 fewer drinks per week than controls (coefficient [B] -3.25; 95% confidence interval [CI] -5.76 to -0.75), and the maximum number of drinks per occasion among those receiving Brief Negotiated Interview was almost three quarters of a drink less than controls (B -0.72; 95% CI -1.42 to -0.02). At-risk drinkers (CAGE <2) appeared to benefit more from a Brief Negotiated Interview than dependent drinkers (CAGE >2). At 3-month follow-up, 37.2% of patients with CAGE less than 2 in the intervention group no longer exceeded National Institute of Alcohol Abuse and Alcoholism low-risk limits compared with 18.6% in the control group (delta 18.6%; 95% CI 11.5% to 25.6%).


CONCLUSIONS
SBIRT appears effective in the ED setting for reducing unhealthy drinking at 3 months.
D000328:Adult; D017677:Age Distribution; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000517:prevention & control*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology