Reducing Hazardous & Harmful Drinking in ED Patients

Alcohol problems are prevalent in EDs nationwide, often manifesting when individuals seek medical care for acute illnesses and injuries relating to alcohol. Hazardous and harmful drinking has emerged as a major focus of screening, brief intervention, and referral to treatment efforts in various healthcare settings. Hazardous and harmful drinking has been defined as more than 14 drinks a week or more than four drinks per occasion for men. For women, the thresholds have been defined as more than seven drinks a week or more than three per occasion. While some evidence supports the usefulness of brief interventions for alcohol in primary care and inpatient trauma settings, the data from ED settings are less clear. “It is difficult to compare and assess studies of alcohol screening and interventions in the ED because of several factors,” explains Gail D’Onofrio, MD, FACEP. “Screening tools vary and different levels of severity of drinking may have been included, such as hazardous (at-risk) drinking to dependent drinkers. Also, enrollment may have been limited to certain chief complaints (eg, injury), while others screened participants universally. Other analyses may have varied in length and quality.” Examining a Brief Alcohol Intervention In the March 27, 2012 Annals of Emergency Medicine, Dr. D’Onofrio and colleagues had a study published in which they assessed the impact of an emergency practitioner-based intervention on alcohol consumption in 740 patients who were classified as hazardous and harmful drinkers. A brief negotiation interview (BNI)—which takes only about 7 minutes to perform—was administered to 298 patients. The BNI included: 1. Raising the subject of alcohol. 2. Providing feedback by reviewing screening data and connecting alcohol...