Am Fam Physician. 2005 Sep 1;72(5):914-916.
Alcohol abuse is prevalent in patients presenting to the emergency department. Approximately one in three patients has consumed alcohol immediately before admittance to an emergency department. This number increases to more than two thirds for patients admitted after midnight. Research suggests that brief interventions to address alcohol abuse are effective, but no scientific studies have examined how they affect alcohol use, quality of life, and readmittance to the emergency department. Crawford and colleagues studied emergency department patients in a central London hospital to evaluate the effectiveness of alcohol-related screening and a brief intervention program.
In the single-blind, pragmatic, randomized controlled study, patients were screened using the Paddington alcohol test (PAT), which takes less than one minute to complete and has high sensitivity and specificity for alcohol abuse. Patients who were suspected of consuming excessive amounts of alcohol, and patients with any of nine preselected complaints (e.g., falls, head injury, trauma, acute psychiatric symptoms) were selected for screening. Patients with known alcohol problems and language difficulties were excluded. Patients with a positive PAT screening and who accepted a brief intervention were randomly assigned to experimental or control groups. The control group received an information packet, including contact information for help lines and local support agencies. The intervention group received the information packet and an appointment with an experienced counselor. The 30-minute appointment focused on resolving ambivalence about alcohol use and developing a practical individualized intervention strategy. At six and 12 months, follow-up assessments on alcohol use and general health were performed using standardized questionnaires. The 12-month follow-up also included an assessment of health-related quality of life. Emergency department visits were tracked throughout the study.
The 287 patients in the intervention group were similar in age and amount of alcohol consumption to the 312 patients in the control group. Nearly 80 percent of participants were men, and the mean age was about 44 years. About two thirds of participants in each group completed follow-up. Only 29 percent of the intervention group attended the appointment. However, at six months, patients in the intervention group reported drinking an average of 59.7 units of alcohol per week compared with 70.8 in the control group. At 12 months, the control group decreased its alcohol consumption and the differences between the groups were no longer significant. Female sex and lower baseline consumption were the two factors associated with reduced alcohol consumption at 12 months. Patients in the intervention group made fewer emergency department visits at 12 months compared with patients in the control group, but no significant differences were noted in general health or quality of life. The authors performed a subanalysis of participants who attended or did not attend the appointments. Attendees reported drinking 14 fewer units of alcohol per week at six months than the nonattendees, but no significant difference was detected at 12 months.
The authors concluded that offering alcohol counseling is associated with at least a six-month reduction in alcohol use and emergency department visits. The effect of attending an appointment with a counselor is unclear. The authors speculate that patients who are offered an appointment perceive a more explicit message from the emergency department staff that they should reduce their alcohol consumption.
Crawford MJ, et al. Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet. October 9, 2004;364:1334–9.
Copyright © 2005 by the American Academy of Family Physicians.
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