A significant gap exists in the United States between people who need treatment services for alcohol abuse and those who actually receive it. In 2001, an estimated 13.4 million Americans aged 12 or older (5.9 percent of the total U.S. population) abused or were dependent on alcohol during the past year, while only 2.2 million received treatment. Furthermore, alcohol use-related intentional and non-intentional injuries are a serious public health problem in the U.S. Prevalence rates of alcohol use/abuse/intoxication among injured patients in the Emergency Department (ED) and in trauma units range from 15% to 55%. Alcohol use is implicated in nearly 50% of all motor-vehicle crash (MVC) deaths, suicides and homicides. There is good evidence that patients who abuse alcohol and present with injuries in the ED do not receive needed services to access assessment and treatment. Given the potential of the ED as a """"""""window of opportunity"""""""" for identification and early intervention for injured individuals who abuse alcohol, it is important to determine which intervention, of varying intensities and types, is most effective in linking these out-of-treatment individuals to assessment and facilitating treatment entry. The proposed study will compare three alternative interventions in the ED to promote substance abuse assessment, referral, and treatment entry: 1) a 5-session Strengths-Based Case Management (SBCM) model; 2) a 2-session Motivational Enhancement Therapy (MET), or 3) a one-time Brief Informational Feedback (BIF) session. Patients who present to a large inner-city ED with injuries will be screened using a structured survey about alcohol use and consequences. Eligible subjects will receive a brief baseline assessment and, using stratified randomization by gender, assigned to one of the three study conditions. Three- and 6-month outcomes will be assessed. The primary outcome variables for this trial include follow-through on receiving an assessment and referral, treatment engagement, degree of treatment completion, alcohol-related measures, health services utilization, health status changes, and psychosocial factors. This study will provide critically important information on how to best facilitate linkage and engagement for out-of-treatment alcohol abusers, and will inform public health measures to facilitate treatment seeking for the nation's substance abusing population.
