The Emergency Care Setting for Screening and Intervention for Alcohol Use Problems Among Injured and High-Risk Drivers: A Review

Abstract

Each year thousands of people are treated in emergency departments and trauma centers for alcohol-related injuries, including those sustained in drinking driving crashes. Emergency departments and trauma centers provide an opportunity to screen for alcohol use problems and intervene with injured or high-risk drivers to reduce future alcohol-related traffic and injury risk. Recently physicians have expressed interest in exploring screening and intervention for alcohol use problems in these venues as a means of improving clinical care. This article reviews the literature that has examined screening and brief interventions in acute care settings to reduce future alcohol consumption and alcohol-related injury. The methodological and practical issues inherent in conducting these studies as well as in actual practice are discussed. The chaotic environment of acute care, the large numbers of patients required to be screened to obtain an adequate study sample, and high attrition rates make study in these settings difficult at best and are methodological problems that should be addressed in future research. A basic question that has not been adequately answered by research to date is whether reduction in alcohol consumption will translate to reduced alcohol-related harm, such as driving while impaired, or injurious or fatal crashes. Long-term studies that assess records-based outcomes in addition to alcohol-consumption levels are needed.

Keywords:

• Drinking-Driving
• DUI
• High-Risk Drivers
• Alcohol Use Problems
• Brief Interventions
• Emergency Settings

ACKNOWLEDGMENTS

Dr. Dill's and Dr. Wells-Parker's contributions were supported in part by the Mississippi Alcohol Safety Education Program and by grant 4 DIA RH 00005-01-01 from the Office of Rural Health Policy of the Department of Health and Human Services through the Rural Health Safety and Security Institute, Social Science Research Center, Mississippi State University. This article's contents are the sole responsibility of the authors and do not necessarily represent the official views of the Office of Rural Health Policy. Dr. Soderstrom's contribution was supported in part by grant NIAAA 2 RO1 AA09050-04A2 and his work was done as adjunct faculty of the University of Maryland School of Medicine, National Study Center for Trauma and EMS.

Notes

^a Measured in grams of absolute alcohol.

^b Intoxication defined as ≥1.05 g of alcohol per kg body weight (men), ≥0.90 g (women).

^c Frequency of any alcohol, average daily amount, sober days, frequency of intoxication, peak amount, weekly consumption.

^d Measured in standard alcohol units (4 oz wine = 12 oz beer or 1 oz distilled spirits).

^e Revised to include new items to measure alcohol involvement during injuries.

^f Defined as days in which ≥6 drinks consumed.

^g ADI = Adolescent Drinking Index (Monti et al., 1999), YADDQ = Young Adult Drinking Driving Questionnaire (Donovan, 1993), AIC = Adolescent Injury Checklist (Jelalian et al., 1997), ADQ = Adolescent Drinking Questionnaire (Jessor et al., 1989).

^h Department of Motor Vehicle Records for licensed drivers.

ⁱ TWEAK Screen for Alcohol Dependency (reviewed in Cherpitel, 1995).

^j Reported N of those who met criteria and consented to participate instead of total N screened positive on alcohol screen.

^k NIAAA defined as ≤14 drinks/week (men); ≤7 drinks/week (women) in terms of standard drinks, ^d without binges; for study outcome, defined as number of weeks per month patient drank at or below NIAAA defined level.

^a Specific counseling approaches NR.

^b Details of workbook not provided.

^c Contained feedback of current health behaviors, review of prevalence of problem drinking, list of A-R adverse effects; worksheet of drinking cues, drinking agreement in form of prescription, drinking diary cards; general health booklet.

^d Contained prevention messages on seat belt use, exercise, nutrition, smoking, alcohol, drugs, immunizations, & sex.

^e See Table 1 for definition.

^f Modifications NR.

^g Full menu NR but included list of treatment resources Self-help (12-step) groups in community.

^h Underlying principles of MI (empathy, warmth, lack of confrontation, reflective listening, affirmations, brief summaries, elicited self-motivational statements).

ⁱ Elicit response; Direct; Data; Identify options; Recommend action; Elicit response; Confirm Clarify; Telephone referral: Adaptation of FRAMES (Feedback; Responsibility; Advice; Menu; Empathy; Self-efficacy) methodology (Miller & Sanchez, 1993).

^j (See Table 1 ^k ).