Reducing death and disability caused by alcohol-related intentional and unintentional injuries is a national health status goal. Acute alcohol intoxication is implicated in up to 50 percent of all injuries. The goal of this research is to test the effectiveness of an innovative, tailored brief intervention system using new technologies to reduce alcohol use and alcohol-related problems among injured hazardous drinkers treated in the Emergency Department (ED). It is critical to intervene with hazardous drinkers in the ED, whether or not they are admiited to the hospital, because they are at risk for further injuries due to their drinking patterns, and their drinking patterns are often not addressed in other health care settings. Ongoing ED brief intervention studies have used untailored messages that provide generic feedback and advice, and focus on patients admitted to the hospital from the ED. To be most effective, assessment and interventions need to be tailored to individual patient experiences and characteristics, and directed both to admitted and released ED patients. In other health areas, such as smoking cessation and breast cancer screening, tailored messages have been shown to have a significantly greater impact than generic messages. This study will be the first to use tailored messages to intervene with injured hazardous drinkers in the ED. This randomized controlled four group design will include: 1) tailored alcohol messages with brief advice; 2) tailored alcohol messages with no brief advice; 3) generic alcohol messages with brief advice; and 4) generic alcohol messages with no brief advice. The trial includes the following steps: a) alcohol screening using hand-held personal digital assistants (Newtons); b) random assignment to the four cells based on a positive alcohol screen; c) interventions based on group assignment; and d) 6-and 12-month follow-up interviews. A total of 500 subjects will be randomized to each of the four groups (n=125/cell). Outcome measures include drinking variables, health status, and psychosocial factors. This study has wide-ranging implications for addressing the clinical care of hazardous drinkers in health care settings. With health care reform and the increased focus on health care allocation, the use of computerized tailored messages to augment and/or replace the need for more extensive clinical intervention with injured hazardous drinkers in the Emergency Department where there is limited time to effect health behavior changes, can provide an effective, efficient method to address a serious public health problem.
