title: Physical health and drinking among medical inpatients with unhealthy alcohol use: a prospective study.
abstract: OBJECTIVE
  Unhealthy alcohol use is common in medical inpatients, and hospitalization has been hypothesized to serve as a "teachable moment" that could motivate patients to decrease drinking, but studies of hospital-based brief interventions have often not found decreases. Evaluating associations between physical health and subsequent drinking among medical inpatients with unhealthy alcohol use could inform refinement of hospital-based brief interventions by identifying an important foundation on which to build them. We tested associations between poor physical health and drinking after hospitalization and whether associations varied by alcohol dependence status and readiness to change.
  
  
  METHODS
  Participants were medical inpatients who screened positive for unhealthy alcohol use and consented to participate in a randomized trial of brief intervention (n = 341). Five measures of physical health were independent variables. Outcomes were abstinence and the number of heavy drinking days (HDDs) reported in the 30 days prior to interviews 3 months after hospitalization. Separate regression models were fit to evaluate each independent variable controlling for age, gender, randomization group, and baseline alcohol use. Interactions between each independent variable and alcohol dependence and readiness to change were tested. Stratified models were fit when significant interactions were identified.
  
  
  RESULTS
  Among all participants, measures of physical health were not significantly associated with either abstinence or number of HDDs at 3 months. Having an alcohol-attributable principal admitting diagnosis was significantly associated with fewer HDDs in patients who were nondependent [adjusted incidence rate ratio (aIRR) 0.10, 95% CI 0.03-0.32] or who had low alcohol problem perception (aIRR 0.36, 95% CI 0.13-0.99) at hospital admission. No significant association between alcohol-attributable principal admitting diagnosis and number of HDDs was identified for participants with alcohol dependence or high problem perception.
  
  
  CONCLUSIONS
  Among medical inpatients with nondependent unhealthy alcohol use and those who do not view their drinking as problematic, alcohol-attributable illness may catalyze decreased drinking. Brief interventions that highlight alcohol-related illness might be more successful.
authors.affiliation: VA Health Services Research & Development, Seattle, WA, USA. emily.williams3@va.gov
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Tibor
authors.initials: T
authors.lastname: Palfai
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Wickizer
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology* / Q000628:therapy*; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies