Among Americans greater than or equal to 18 years, 5% are dependent drinkers, 20% million are at-risk drinkers, and more than 107,000 alcohol related deaths are reported yearly. Alcohol abuse is associated with injury, chronic illness, absenteeism from work, and enormous economic costs to individuals and society. Emergency departments (EDs) offer a """"""""teachable moment"""""""" to screen, perform a brief intervention and refer to treatment (SBIRT). The overall aim of this study is to translate motivational interventions to the ED setting by implementing SBIRT to reduce hazardous drinking among ED patients.
Specific aims are: 1) to reduce levels of hazardous drinking among ED patients through use of SBIRT; and 2) to use publicity generated by National Alcohol Screening Day (NASD) to enhance adoption of SBIRT by ED health care providers (HCPs). The study will be conducted from 1/1/04 to 12/31/04 at LAC+USC Medical Center, a Level 1 Trauma Center and the largest county hospital in Los Angeles, with a daily census of 400. The patient population consists of an inner city population, 55% Hispanic. ED HCPs consist of 190 physicians, physician assistants and nurses. The final methodology will be determined by the investigators of the R25 and R21 grants. 30 HCPs will be trained in SBIRT through workshops and a videoconference. Their alcohol knowledge, beliefs and practices will be surveyed before training. Following education, their adoption of SBIRT will be measured over a 2 week period using patient exit interviews. Their changes in perceived barriers to SBIRT, impact for education and ED providers' satisfaction with and adoption of SBIRT will be measured by a questionnaire 3 months post-training. Patients who screen positive for hazardous drinking will be offered participation in the study. During a 2 week period before NASD, 40 controls with at risk drinking will be provided with written referral to alcohol treatment programs. After HCP training, 40 at-risk drinkers will receive SBIRT. Their access of resources and decrease in drinking will be measured at 3 and 6 months. It is expected that subjects receiving SBIRT will have decreased alcohol use, and increased access of referrals compared to controls. Further, training and the experience of applying SBIRT will result in enhanced use of SBIRT by HCPs.
