title: Brief alcohol intervention in the emergency department: moderators of effectiveness.
abstract: OBJECTIVE
  Prior research supports the effectiveness of brief interventions for reducing alcohol misuse among patients in the emergency department (ED). However, limited information is available regarding the mechanisms of change, which could assist clinicians in streamlining or amplifying these interventions. This article examines moderators of outcomes among ED patients, ages 19 and older, who participated in a randomized controlled trial of a brief intervention for alcohol misuse.
  
  
  METHODS
  Injured patients (N= 4,476) completed a computerized survey; 575 at-risk drinkers were randomly assigned to one of four brief intervention conditions, and 85% were interviewed again at 3-month and 12-month follow-ups.
  
  
  RESULTS
  Regression models using the generalized estimating equations approach examined interaction effects between intervention condition (advice/no advice) and hypothesized moderator variables (stage of change, self-efficacy, acute alcohol use, attribution of injury to alcohol) on alcohol outcomes over time. Overall, participants who reported higher levels of self-efficacy had lower weekly consumption and consequences, whereas those with higher readiness to change had greater weekly consumption and consequences. Furthermore, individuals who attributed their injury to alcohol and received advice had significantly lower levels of average weekly alcohol consumption and less frequent heavy drinking from baseline to 12-month follow-up compared with those who attributed their injury to alcohol but did not receive advice.
  
  
  CONCLUSIONS
  This study provides novel data regarding attribution for alcohol-related injury as an important moderator of change and suggests that highlighting the alcohol/injury connection in brief, ED-based alcohol interventions can augment their effectiveness.
authors.affiliation: Department of Psychiatry, Rachel Upjohn Building, University of Michigan, 4250 Plymouth Road, Ann Arbor, Michigan 48109, USA. waltonma@umich.edu
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Walton
authors.forename: Abby L
authors.initials: AL
authors.lastname: Goldstein
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chermack
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: McCammon
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Cunningham
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Barry
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000328:Adult; D000368:Aged; D000435:Alcoholic Intoxication / Q000150:complications / Q000517:prevention & control* / Q000523:psychology; D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D003376:Counseling; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008824:Michigan; D008875:Middle Aged; D009042:Motivation; D010174:Pamphlets; D010342:Patient Acceptance of Health Care / Q000523:psychology; D055502:Secondary Prevention; D020377:Self Efficacy; D014947:Wounds and Injuries / Q000517:prevention & control* / Q000523:psychology