Emergency room intervention for problem drinkers in ten minutes

Emergency room practitioners can be successfully trained in two hours to counsel problem drinkers in a 10-minute intervention, according to a study by Yale researchers in Academic Emergency Medicine.

"The emergency room is an ideal opportunity to identify and treat alcohol-related problems," said Gail D'Onofrio, M.D., acting chief of emergency medicine at Yale-New Haven Hospital and associate professor of surgery at Yale School of Medicine. "Patients with alcohol use disorders, which is estimated to be 20 percent of the population over the age of 12, are more likely to be seen in emergency rooms than in a primary care setting."

D'Onofrio, first author of the study, and colleagues, developed and taught the two-hour brief negotiation intervention to 58 emergency room physicians, residents and physician associates. The counseling is intended for hazardous and harmful drinking. Hazardous is defined as more than 14 drinks per week and four per occasion for men; seven drinks per week or more than three per occasion for women, and seven drinks per week and more than one drink per occasion for persons over age 65. Harmful drinkers are those patients who are in the emergency room directly as a result of their drinking.

The intervention has four components: raise the subject of alcohol consumption with the patient; provide feedback on the patient's drinking levels and effects; enhance motivation to reduce drinking, and negotiate and advise a plan of action. The practitioners were trained to listen carefully to the patient's concerns, help them identify strategies to change their drinking patterns and were encouraged to be nonconfrontational and nonstigmatizing.

More than 90 percent of the emergency practitioners who were trained passed the proficiency exam after the first try. Between March 2002 and August 2003 a total of 250 patients were counseled in the new procedure.

Co-authors are Michael Pantalon, Linda Degutis, David Fiellin, M.D., and Patrick O'Connor, M.D.