The burden of disease on human life due to alcohol is staggering. Alcohol misuse pervasively erodes the quality of life for individual drinkers and has negative and cumulative consequences on communities. U.S. Latinos are disproportionately affected by alcohol misuse and dependence which is of particular concern given that Latinos comprise 56% of U.S. population growth in the past decade. Simultaneously, the number of U.S. residents that speak Spanish at home grew from 17 million to over 35 million. Language barriers, among other unique challenges in the busy emergency department (ED) setting, have limited wide adoption of ED alcohol screening, brief intervention and referral to treatment (SBIRT). Use of Automated Bilingual-Computerized Alcohol Screening and Intervention (AB-CASI) for Latino Drinkers in the ED holds strong early compelling evidence that it can surmount barriers and increase alcohol treatment in vulnerable ED populations. Objective: To conduct a randomized controlled trial that enrolls both English and Spanish speaking adult Latino ED patients to compare the efficacy of AB-CASI to Standard Care (SC) in reducing alcohol consumption and consequences for all levels of unhealthy drinking ranging from at-risk to dependence.
Aims : Our seasoned multidisciplinary team will: (1) compare the efficacy of AB-CASI to SC in the reduction of alcohol consumption in unhealthy drinkers, (2) compare the efficacy of AB-CASI to SC in the reduction of alcohol-related negative health behaviors and consequences, (3) compare the efficacy of AB-CASI to SC in 30-day engagement in treatment, and (4) explore variation of AB-CASI on alcohol consumption, alcohol-related negative health behaviors and consequences and 30-day treatment engagement across Latino subpopulations and other potential modifiers. Our hypotheses are: (1) at 12 months, AB-CASI will be superior to SC in reducing the number of binge drinking episodes and the mean number of weekly drinks over the last 28-days, (2) at 12 months, AB-CASI will be superior to SC in reducing alcohol-related negative health behaviors and consequences (episodes of impaired driving, riding with an impaired driver, injuries, arrests, tardiness and days absent from work/school), and (3) AB-CASI will be superior to SC in increasing 30-day treatment engagement. Methods: Adult Latino English and Spanish speaking ED patients who drink over the NIAAA low-risk limits (at-risk to dependence) will be randomized to AB-CASI or SC. Baseline, 30-day, 6 and 12-month assessments will be used to evaluate efficacy of AB-CASI. Significance: The rapid U.S. Latino population growth and increasing diversity of ED populations has major implications for alcohol-related health disparities research and prevention activities. Unique features: Nearly all ED-SBIRT research has excluded Spanish speaking populations. Empirically testing AB-CASI will add indispensable value and unique knowledge to move the field of alcohol research forward. Expected results: AB-CASI efficacy will improve the health of millions of vulnerable Americans with unhealthy alcohol use by transcending barriers.

Public Health Relevance

Alcohol-related health disparity gaps are widening in the face of a rapidly growing U.S. Latino population that is disproportionately affected by unhealthy alcohol use. Emergency Department (ED) based alcohol Screening, Brief Intervention, and Referral to Treatment (ED-SBIRT) can broaden the base of alcohol use disorders identification and treatment initiation among vulnerable ED populations. While barriers to wide adoption and implementation of ED-SBIRT persist, Automated Bilingual Computerized Alcohol Screening and Intervention (AB-CASI) will overcome these barriers and improve the health of millions of vulnerable Americans with unhealthy alcohol use.

Agency
National Institute of Health (NIH)
Type
Research Project (R01)
Project #
1R01AA022083-01A1
Application #
8628302
Study Section
Biomedical Research Review Subcommittee (AA)
Program Officer
Ryan, Megan
Project Start
Project End
Budget Start
Budget End
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Yale University
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
City
New Haven
State
CT
Country
United States
Zip Code
06510