The Emergency Department as a prevention site: a demographic analysis of substance use among ED patients.

OBJECTIVES: To identify rates of alcohol and drug use among patients presenting to an inner-city Emergency Department (ED) and to describe demographic and health characteristics of patients with high-risk use. METHODS: A cross-sectional study of patients presenting to the ED for any complaint. Patients were administered a brief screening about past 12-months alcohol and drug use. Patients who answered "yes" to any question were approached for a longer survey, the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Based on ASSIST scores patients received a brief intervention, and, when appropriate, a referral for brief outpatient therapy or specialized substance abuse treatment. Patients whose score indicated high-risk or dependent use were also asked demographic and health questions. RESULTS: Over a 20-month period, 19,055 patients were pre-screened. 87.1% of patients were black, 57% were male, with average age 44.8 years. 27.6% of patients pre-screened positive for drug or alcohol use; among these patients 44.2% scored in the low-risk range on the ASSIST, 35.8% moderate risk, 10% high risk and 10% probable dependence. Among patients with high-risk or dependent use, 70% rated their current health as fair/poor, with a mean of 1.7 ED visits in the prior 30 days. 40.7% reported "extreme" stress due to their use. 34.6% reported that they had stable housing and 13.6% were fully employed. CONCLUSION: Among all patients seen in the ED for any complaint, a significant proportion is engaged in alcohol and drug use that increases their risk of health and social consequences.

A randomized trial of motivational interviewing and feedback with heavy drinking college students.

Motivational interviewing (MI) is a brief intervention that has been shown to reduce heavy drinking among college students. Because all college studies of MI to date have included a personalized feedback report, it remains unclear which of the components is necessary to produce behavior change. This study evaluated the separate and collective effects of MI and feedback among 122 "binge" drinking college students. Participants were randomized to: (1) MI with feedback, (2) MI without feedback, (3) Mailed feedback only, (4) MI with mailed feedback, or (5) Assessment only control. At an eight-week follow-up, all groups reduced their consumption, peak BAC, consequences, and dependence symptoms. For females, there were reductions in consequences and dependence symptoms in groups that received feedback, as compared to groups that did not receive feedback. For females, there was an effect of the feedback on consequences and dependence symptoms, but was no overall effect of MI on any outcome measure.