The aims of the proposed project are to: 1) test standard screening instruments and develop new measures which would be sensitive, specific and efficient for identifying harmful drinking and alcohol dependence among injured and non-injured in the emergency room (ER) setting, 2) compare an abbreviated set of consequences of drinking and of dependency experiences (which have also been used in previous ER studies and in the general population) with screening measures and with a standard diagnostic instrument, 3) determine the comparability of associations of demographic and drinking characteristics with consequences of drinking and dependency experiences from this ER study to similar data from ER studies already carried out in the California Bay Area and from the general population of the region where these new data will be collected. Given a high rate of frequent heavy drinking and alcohol-related problems among both injured and non-injured in the ER, the development of a simple screening instrument specifically designed for use in the ER setting to identify those who would likely benefit from a brief intervention or from a referral for treatment for alcohol problems is especially important. This project is an extension of a project already funded under the Alcohol Research Group's Center grant and would provide for the inclusion of standard screening instruments for harmful drinking and dependence (CAGE, brief MAST, AUDIT, TWEAK, History of Trauma Scale) and a diagnostic instrument (the alcohol section of the CIDI, which is based on ICD-10 criteria for harmful drinking and dependence). The sample size would be doubled (to include the non-injured along with the injured) and the length of data collection doubled from that in the original project. A probability sample of all patients over the age of 18 seeking care in the ER at the University of Mississippi Medical Center during a six-month period will be selected to be interviewed and to be breathalyzed as an estimate of blood alcohol level at the time of admission to the ER. This will yield a sample of 1500 completed interviews (assuming a 75% completion rate as obtained in our prior ER studies). Patients will be interviewed regarding the injury or illness, whether alcohol was a factor in the event, usual drinking patterns, times of higher consumption and alcohol-related problems in the last year, and be given the screening and diagnostic instruments for harmful drinking and dependence. The performance of each of the screening instruments as well as breathalyzer reading, drinking prior to the event, quantity and frequency of drinking, consequences of drinking and dependency experiences (as asked in our prior studies) will be evaluated, separately for harmful drinking and dependence, against CIDI criteria in age, sex and race categories to determine the best set of predictors for use in the ER. Data from this ER study will be compared to those from other ER studies (urban trauma center, suburban county and community hospitals and HMO's) and to data from the general population of the region to determine, in part, the generalizability of findings from this study.
