Identification of heavy drinkers at emergency departments could reduce further alcohol consumption

Referring heavy drinkers for counselling at the time they attend hospital emergency departments for alcohol-related health problems could be an effective way of reducing subsequent alcohol consumption, suggest authors of a UK study published online by THE LANCET. Such intervention could also lead to fewer subsequent hospital visits.

Alcohol misuse is highly prevalent among people attending emergency departments--around a third of patients have consumed alcohol shortly before presentation, increasing to more than two-thirds of patients presenting after midnight. However, the effect of intervention by staff working in these departments is unclear.

Mike Crawford (Imperial College London, UK) and colleagues did a randomised controlled trial to investigate the effects of two types of intervention at the time individuals attended Emergency Departments. Around 600 patients were enrolled in the study; half received an information leaflet, the other half an information leaflet and a future appointment with an alcohol-health worker.

At 6 months, those referred to an alcohol-health worker were consuming an average of 60 units of alcohol per week compared with an average of 83 units for individuals who received only the information leaflet. Patients referred to an alcohol-health worker had on average 0.5 fewer visits to emergency departments over the following year (1.2 visits on average compared with 1.7 visits for the group not given counselling).

Dr Crawford comments: "Screening and referral for brief intervention for alcohol misuse in an emergency department is associated with reduced alcohol consumption and reattendance in the emergency department. Identification and referral of patients attending an emergency department who are misusing alcohol provides an opportunity to help patients develop insight into the consequences of their drinking and promote improved health".

In an accompanying commentary, Daniel W Hungerford (Centers for Disease Control and Prevention, Atlanta, USA) concludes: "They {Crawford and colleagues} highlight the value of the physician's encounter with the patient and show that the ED {emergency department} visit can be used to start a clinical pathway for care of alcohol problems...physicians can take heart that the act of referral itself might motivate patients to reappraise their drinking behaviours".