Evaluation of screening and brief intervention for hazardous alcohol use integrated into clinical practice in an inner-city Emergency Department.

INTRODUCTION: In small studies, Screening, Brief Intervention and Referral to Treatment (SBIRT) in Emergency Departments (EDs) is effective in reducing hazardous alcohol use. OBJECTIVE: To examine the effectiveness of SBIRT at an inner-city ED in routine clinical practice. METHODS: Of the 41 900 consecutive ED patients aged 18 years and older, 22 537 (53.8%) were screened using the Alcohol Use Disorders Identification Test (AUDIT-C). Patients with positive AUDIT-C scores (men≥5 and women≥4) received educational leaflets. Brief interventions were performed by ED personnel trained in motivational interviewing. At 3 months, patients were contacted by telephone and recent drinking pattern was assessed. RESULTS: Out of 22 537 patients, 2209 (9.8%) had an elevated AUDIT-C score. Male sex, alcohol-related reason for ED visit, alcohol or other intoxication at ED visit, head injury, stomach or intestinal bleeding and wounds were significant predictors of hazardous alcohol use in both univariate and multivariate analysis (all P<0.001). Out of 2209 patients, 894 (40.5%) AUDIT-C-positive patients received an intervention: of these 894 patients, 70% received educational material and 30% received motivational intervention and educational material. In the subset of patients available for follow-up, 34.9% either reduced or stopped alcohol use. CONCLUSION: Our study shows that in a large inner-city ED, SBIRT can be implemented in daily care. Screening uncovered large numbers of patients with hazardous alcohol use and identified several risk factors. Moreover, screening and intervention appeared to be effective in reducing alcohol intake.

Obsessions in normality and psychopathology.

BACKGROUND: This study examines the presence of obsessions in the general population and in various psychiatric disorders. Second, the impact of obsessions is studied in terms of general functioning and quality of life in the general population. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the Dutch population (n = 7,076). Diagnostic criteria were assessed by the Composite International Diagnostic Interview (CIDI). The association of quality of life and obsessions on each subject was assessed by using Short Form 36 Health Survey (SF-36) and General Health Questionnaire (GHQ). RESULTS: Obsessions occurred frequently in the general population: the lifetime prevalence of obsessions was 5.3% and the 12-month prevalence was 1.7%. Subjects with obsessions scored significantly worse (P<.0001) on all eight dimensions of the SF-36 as well as on the GHQ. When controlling for the presence of any mental disorder, the negative association of obsessions and low general health and well-being remained significantly intact. In patients with a psychiatric disorder, obsessions had a lifetime prevalence of 10.3% and a 12-month prevalence of 6.8%. CONCLUSIONS: Obsessions are common phenomena in the general population and are associated with decreased functioning in several areas of health and well-being. Furthermore, they occur frequently in the presence of various psychiatric disorders. Obsessions should be perceived, similar to delusions, as a distinct dimension across psychiatric disorders rather than a mere symptom of OCD.