title: Severity of acute illness is associated with baseline readiness to change in medical intensive care unit patients with unhealthy alcohol use.
abstract: BACKGROUND
  Unhealthy alcohol use predisposes to multiple conditions that frequently result in critical illness and is present in up to one-third of patients admitted to a medical intensive care unit (ICU). We sought to determine the baseline readiness to change in medical ICU patients with unhealthy alcohol use and hypothesized that the severity of acute illness would be independently associated with higher scores on readiness to change scales. We further sought to determine whether this effect is modified by the severity of unhealthy alcohol use.
  
  
  METHODS
  We performed a cross-sectional observational study of current regular drinkers in 3 medical ICUs. The Alcohol Use Disorders Identification Test was used to differentiate low-risk and unhealthy alcohol use and further categorize patients into risky alcohol use or an alcohol use disorder. The severity of a patient's acute illness was assessed by calculating the Acute Physiologic and Chronic Health Evaluation II (APACHE II) score at the time of admission to the medical ICU. Readiness to change was assessed using standardized questionnaires.
  
  
  RESULTS
  Of 101 medical ICU patients who were enrolled, 65 met the criteria for unhealthy alcohol use. The association between the severity of acute illness and readiness to change depended on the instrument used. A higher severity of illness measured by APACHE II score was an independent predictor of readiness to change as assessed by the Stages of Change Readiness and Treatment Eagerness Scale (Taking Action scale; p < 0.01). When a visual analog scale was used to assess readiness to change, there was a significant association with severity of acute illness (p < 0.01) that was modified by the severity of unhealthy alcohol use (p = 0.04 for interaction term).
  
  
  CONCLUSIONS
  Medical ICU patients represent a population where brief interventions require further study. Studies of brief intervention should account for the severity of acute illness and the severity of unhealthy alcohol use as potential effect modifiers.
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, Colorado 80045, USA. brendan.clark@ucdenver.edu
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Clark
authors.forename: Alexandra
authors.initials: A
authors.lastname: Smart
authors.forename: Robert
authors.initials: R
authors.lastname: House
authors.forename: Ivor
authors.initials: I
authors.lastname: Douglas
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Burnham
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D018806:APACHE; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*