A critical need exists to test the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for Emergency Department (ED) populations with problem drinking. A multi-center trial designed as an extension of National Alcohol Screening Day (NASD), provides an ideal opportunity to translate motivational interventions successful in primary care settings to the real-world ED environment. The ED is an ideal setting for SBIRT, as many problem drinkers do not have contact with either alcohol treatment specialists or visit primary care medical practitioners. The purpose of this study is to evaluate the effectiveness of SBIRT performed during the study intervention period, by existing ED staff (attending physicians, residents, physician associates and nurses) as compared to the study control period, when subjects only receive a handout of available resources, without SBIRT. Patients presenting to the Yale New Haven Hospital ED, who screen above NIAAA guidelines for low-risk drinking will be eligible for enrollment during two 2-week study periods. Forty patients will be enrolled during the Control Period, Pre NASD, in February, 2004. An additional 40 patients will be enrolled during the Intervention Period beginning on NASD, in April, 2004. Primary hypotheses to be tested include: (1) among ED patients who drink above NIAAA low-risk guidelines, those who receive SBIRT will report significantly decreased frequency and quantity of alcohol use, reduced alcohol-related health risk factors, and increased completion of referrals, compared to those who receive no intervention; and (2) ED staff training (R25-Bemstein, PI) and positive experiences with SBIRT will translate into increased ED practice. Follow up assessments at 3 and 6 months will be centrally managed by interactive telephone response by the Data Coordinating Center (R21-DCC). Unique features of the proposed project include: (1) use of existing ED staff to provide interventions; (2) enrollment of a heterogeneous ED population; and (3) use of interactive telephone assessments to promote accurate, non biased subject self-reporting; and (4) use of publicity surrounding NASD to increase SBIRT into practice.
