Acceptability of emergency department-based screening and brief intervention for alcohol problems

Objectives: To adapt screening and brief intervention for alcohol problems (SBI) to a high-volume emergency department (ED) setting and evaluate its a cceptability to patients. Methods: Patients at a large public-hospital ED w ere screened with the Alcohol Use Disorders Identification Test (AUDIT). Sc reen-positive drinkers (AUDIT score greater than or equal to 6) were provid ed brief, on-site counseling and referral as needed. Three months later, pr oject staff blinded to baseline measures reassessed alcohol intake, alcohol -related harm, alcohol dependence symptoms, and readiness to change. Result s: Of 1,034 patients approached, 78.3% (810) consented to participate (95% CI = 75.5% to 81.2%), and 21.2% (172) screened positive (95% CI = 18.4% to 24.0%). Of 88 patients with complete intervention data, 94.3% (83) accepted an intervention (95% CI = 89.5% to 99.2%), with acceptance rates ranging f rom 93% to 100% across four alcohol-problem-severity levels (p = 0.7). A ma jority (59.0%) set goals to decrease or stop drinking (95% CI = 48.4% to 69 .6%). The group recontacted (n = 23) experienced statistically significant decreases in alcohol intake, alcohol-related harm, and dependence symptoms, with measures decreasing for 68%, 52%, and 61% of the patients. Readiness to change also showed statistically significant improvement, with scores in creasing for 43% of the patients. Moreover, two-thirds of the patients (15/ 23) reported at follow-up that SBI was a helpful part of their ED visit. Co nclusions: High rates of consent and acceptance of counseling for alcohol p roblems by patients across a wide range of problem severity indicate that t his protocol was acceptable to at-risk patients in a public-hospital ED. Im provements in alcohol-related outcome measures at follow-up were strong eno ugh to warrant controlled studies of intervention efficacy.