Integrating Project ASSERT: a screening, intervention, and referral to treatment program for unhealthy alcohol and drug use into an urban emergency department.
OBJECTIVE
The objective was to evaluate the effects of Project Alcohol and Substance Abuse Services Education and Referral to Treatment (ASSERT), an emergency department (ED)-based screening, brief intervention, and referral to treatment program for unhealthy alcohol and other drug use.


METHODS
Health promotion advocates (HPAs) screened ED patients for alcohol and/or drug problems 7 days a week using questions embedded in a general health questionnaire. Patients with unhealthy drinking and/or drug use received a brief negotiation interview (BNI), with the goal of reducing alcohol/drug use and/or accepting a referral to a specialized treatment facility (STF), depending on severity of use. Patients referred to an STF were followed up at 1 month by phone or contact with the STF to determine referral completion and enrollment into the treatment program.


RESULTS
Over a 5-year period (December 1999 through December 2004), 22,534 adult ED patients were screened. A total of 10,246 (45.5%) reported alcohol consumption in the past 30 days, of whom 5,533 (54%) exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Use of at least one illicit drug was reported by 3,530 patients (15.7%). Over one-fourth of screened patients received BNIs (6,266, or 27.8%). Of these, 3,968 (63%) were referred to an STF. Eighty-three percent of patients were followed at 1 month, and 2,159 (65%) had enrolled in a program. Patients who received a direct admission to an STF were 30 times more likely to enroll than those who were indirectly referred (odds ratio = 30.71; 95% confidence interval = 18.48 to 51.04). After 3 years, funding for Project ASSERT was fully incorporated into the ED budget.


CONCLUSIONS
Project ASSERT has been successfully integrated into an urban ED. A direct, facilitated referral for patients with alcohol and other drug problems results in a high rate of enrollment in treatment programs.
D'Onofrio
Gail
G
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. gail.donofrio@yale.edu
Degutis
Linda C
LC
D000328:Adult; D019973:Alcohol-Related Disorders / Q000517:prevention & control / Q000628:therapy*; D003237:Connecticut; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006293:Health Promotion; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D011314:Preventive Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration*; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000628:therapy*; D014505:Urban Population