This is a randomized trial to assess the value of an emergency department-based intervention to reduce hazardous alcohol use among older adults. We hypothesize that the intervention will result in a 25% reduction in the prevalence of hazardous alcohol use while the control group will only have a 5% reduction.
The goal of this project is to perform a pilot, randomized, controlled trial of a brief intervention and referral for treatment among older adults in the emergency department (ED) with alcohol misuse. The pilot data would then be used to design a larger study. The intervention for this trial will consist of a Brief Negotiation Interview (BNI) with a stratified referral for further treatment, compared with usual care. The BNI is a standardized, well-described intervention that has been implemented in a broad range of clinical settings but has not been specifically tested in older adults in the ED. Following the BNI, we will provide a referral for further care for the patient that is stratified by severity of alcohol misuse. Patients with hazardous or harmful alcohol use will follow-up with a primary care physician; patients with alcohol abuse or dependence will follow-up with an outpatient alcohol and substance abuse program; those at risk for complicated withdrawal will be recommended for inpatient treatment. In all cases we will contact the referral physician to help transition the patient's care, and ensure the patient receives a consistent message regarding their alcohol use across the different care settings.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
222
As per arm
As per arm (this is the active comparator)
UNC Hospitals Emergency Department
Chapel Hill, North Carolina, United States
Alcohol misuse
Self-reported alcohol misuse is defined as patient self-report of either drinking \>7 drinks per week or \>3 drinks per occasion in the past month.
Time frame: 6 months
Subgroup analysis of patients who met hazardous alcohol use criteria based on time-line follow back method of assessing alcohol consumption
Analysis of rate of hazardous alcohol use in the control and intervention arms within the subgroup of patients who met hazardous drinking criteria of \>7 drinks in the past 7 days, or \>3 drinks per occasion within the last 28 days using the time-line follow back method.
Time frame: 6 months
Alcohol misuse
Alcohol misuse is defined as patient self-report of either drinking \>7 drinks per week or \>3 drinks per day in the past month.
Time frame: 3 months, 12 months
Function
Activities of Daily Living
Time frame: 6,12 months
Alcohol consumption
Average drinks per week and episodes of \>3 drinks in past 3 months
Time frame: 3,6,12 months
Alcohol abuse
AUDIT Score
Time frame: 3,6,12 months
General Health
Mobility, depression, and presence of chronic pain
Time frame: 3,6,12 months
Risk-taking behavior
Driving after drinking
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Time frame: 6,12 months
Trauma
Injuries, falls, and motor vehicle collisions within the last 6 months, alcohol use preceding and medical care following the injury
Time frame: 6,12 months
Healthcare Utilization
Number of primary care, urgent care, and ED visits, and hospitalization days within the last 6 months, and any relation of these visits to alcohol use.
Time frame: 6,12 months