title: Integrating Project ASSERT: a screening, intervention, and referral to treatment program for unhealthy alcohol and drug use into an urban emergency department.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. gail.donofrio@yale.edu
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
authors.forename: Linda C
authors.initials: LC
authors.lastname: Degutis
mesh_terms: 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