Analysis of Alcohol Use Clusters among Subcritically Injured Emergency Department Patients

Objectives : 1) To cluster patients according to self-reported drinking patterns using cluster analysis; 2) to externally validate clustered groups on variables related to drinking but not used in the cluster analysis; and 3) to use the clustered patients' responses to alcohol consumption questions to develop a brief screening tool emergency physicians can use to identify patients in need of referral or intervention related to potentially hazardous alcohol consumption. Methods : A self-report battery was administered to 95 subcritically injured patients. Patients also were saliva alcohol-tested upon arrival to the ED. Using the patients' self-reported quantity, frequency of alcohol consumption, and frequency of having ≥6 drinks on a drinking occasion, patients were categorized into 3 groups using cluster analysis. The 3 clusters were externally validated using injury-related variables, alcohol-related consequences, and the patients' reported readiness to change drinking. A screening tool was developed using cutoff values reported by the patients' answers to drinking pattern questions. Results : Fifty-nine patients were alcohol-negative, and 36 tested alcohol-positive (i.e., >4 mmol/L [>20 mg/ dL]) or had elevated scores on an alcohol problem screening instrument. Three distinct drinking pattern clusters were found. Clusters were validated using discriminant function analysis and multivariate analyses of variance to confirm cluster classifications. Steady and high-intensity drinkers reported more alcohol-related negative consequences, and high-intensity drinkers indicated they would consider changing their drinking. The screening tool correctly classified 97% of the patient sample into their respective clusters. Conclusions : Using the drinking pattern questions in the clustering procedure was effective for grouping injured patients into clusters that could be differentiated on other drinking-related variables. The resulting screening tool can be used in the ED setting to screen patients for further assessment and intervention. The readiness-to-change results support the assertion that the injury event provides a “teachable moment” for subcritically injured patients whose injury may be related to their alcohol consumption.     

Prevalence of problem drinking and characteristics of a single-question screen

Hazardous drinking and alcohol use disorders (i.e, abuse and dependence) are common in Emergency Departments (EDs). This study examined 1) the prevalence of these conditions among ED patients and 2) characteristics of a single screening question (having consumed at least five drinks for males or four for females during a single day). Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Logistic regression for clustered data was used to estimate the relative risk for past-year ED use associated with hazardous drinking, abuse, and dependence. Contingency tables were analyzed to estimate the sensitivity and specificity of the single-question screen for detecting these conditions. Hazardous drinking was not associated with ED utilization. Alcohol abuse was associated with a relative risk of 1.3 (95% confidence interval [CI] 1.1-1.5) and alcohol dependence with a relative risk of 1.9 (95% CI 1.6-2.2). For current drinkers, the single question screen was 0.96, 0.85, and 0.90 sensitive for hazardous drinking, alcohol abuse, and alcohol dependence, respectively. Individuals with a positive screen in the past year were considered at least hazardous drinkers, and specificity was 0.80, 0.64, and 0.65 for hazardous drinking, abuse, and dependence, respectively. Specificity was modestly increased in women. Most problem drinkers were hazardous drinkers, but only severe alcohol use disorders were particularly prevalent in the ED. The single heavy-drinking-day item appears sensitive for problem drinking. Positive tests must be followed by additional assessment to differentiate hazardous drinking from alcohol use disorders.     

Review article: Effectiveness of ultra‐brief interventions in the emergency department to reduce alcohol consumption: A systematic review

To assess the effectiveness of ultra‐brief interventions (ultra‐BI) or technology‐involved preventive measures in the ED to reduce alcohol harm and risky drinking. Medline, Embase, PsycINFO, CINAHL and EBM reviews were searched for articles published between 1996 and 2015. Randomised controlled trials and quasi‐randomised trials, which compared an ultra‐BI with screening, standard care or minimal intervention for adults and adolescents at risk for alcohol‐related harm presenting to an ED, were included. Outcomes of interest were frequency of alcohol consumption, quantity of alcohol consumed, binge drinking and ED representation. Thirteen studies (nine single centre and four multicentre) were included. Six studies showed a significant reduction in the quantity consumed with intermediate effect size at 3 months (d = ?0.40) and small effect size at 12 months (d = ?0.15). Two studies showed a significant reduction in binge drinking with small effect size at 3 months (d = ?0.12) and 12 months (d = ?0.09). No studies showed an effect on frequency of alcohol consumption or ED representation. Heterogeneity in study design, definition of risky, harmful or hazardous alcohol use, intervention types, outcomes, outcome timeframes and outcome measures prevented the performance of quantitative meta‐analysis. Despite its limited effectiveness in reducing alcohol use in the short‐term, with the large number of people attending EDs with risky drinking, the use of an effective ultra‐BI would have the potential to have a measurable population effect.     

The Verbal Numeric Pain Scale: Effects of Patient Education on Self-reports of Pain

Background: Emergency department (ED) patients are frequently asked to provide a self‐report of the level of pain experienced using a verbal numeric rating scale. Objectives: To determine the effects of patient education regarding the verbal numeric rating scale on self‐reports of pain among ED patients. Methods: In this prospective, interventional study, 310 eligible ED patients with pain, aged 18 years and older, were randomized to view either a novel educational video (n= 155) or a novel print brochure (n= 155) as an educational intervention, both developed to deliver educational information about the verbal numeric pain scale and its use. Participants initially rated their pain on a scale from 0 to 10 and then were administered the educational intervention. Following the educational intervention, participants completed a survey that included demographic information, postinterventional pain score, prior pain experience, and subjective rating of the helpfulness of the educational intervention. Fifty‐five consecutive participants were enrolled as controls and received no educational intervention but gave a self‐reported triage pain score and a second pain score at an equivalent time interval. Clinical significance was defined as a decrease in pain of 2 or more points following the education. Results: Following the educational interventions, there were statistically significant, although not clinically significant, decreases in mean pain scores within each intervention group (video: mean change, 1 point [95% confidence interval [CI] = 0.7 to 1.2]; printed brochure: mean change, 0.6 points [95% CI = 0.4 to 0.8]). For participants in the control group (no intervention), there was no significant change (mean change, 0.2 points [95% CI =?0.2 to 0.5]). A clinically significant decrease in pain was seen in 28% of the video group, 23% of the brochure group, and 5% of controls. Most patients had no change (71% of the video group, 73% of the brochure group, and 89% of controls). Participants rated the helpfulness of the video educational intervention as 7.1 (95% CI = 6.7 to 7.5) and the print educational intervention as 6.7 (95% CI = 6.2 to 7.1) on a scale from 0 (least effective) to 10 (most helpful). Conclusions: Among ED participants with pain, both educational interventions (video and printed brochure) resulted in statistically and clinically significant decreased self‐reported pain scores by 2 or more points in 26% of participants compared with 5% of controls. The educational interventions were rated as helpful by participants, with no appreciable difference between the two intervention groups.     

Alcohol use among young adults presenting to the emergency department

Objectives: To determine the prevalence of young ED patients at risk from hazardous alcohol consumption, to identify high‐risk patient subgroups and evaluate the feasibility of use of the Alcohol Use Disorders Identification Test (AUDIT) in this setting. Methods: We undertook a cross‐sectional survey of 336 ED patients aged 18–30 years, inclusive. All were breathalysed prior to self‐administering the AUDIT. A ‘positive’ AUDIT score (≥8) defined hazardous alcohol consumption. AUDIT scores were correlated with sex and trauma diagnosis. Results: One hundred and thirty‐one (39.0%, 95% confidence interval [CI] 33.8–44.5) patients were classified as AUDIT‐positive. Men were significantly more likely to be AUDIT‐positive (49%vs 23%, P < 0.001) and had significantly higher total AUDIT scores (P < 0.001) than women. Trauma patients were significantly more likely to be AUDIT‐positive (P < 0.001) and had significantly higher AUDIT scores than non‐trauma patients (P < 0.001). Of the six patients who recorded a positive breath alcohol reading, all were AUDIT‐positive. One hundred (76.3%, 95% CI 68.0–83.1) AUDIT‐positive patients did not report others being concerned about their drinking or had not been given advice to cut down. Conclusion: It is feasible to use the AUDIT screening tool in the ED to identify those at risk from hazardous drinking. In our ED there is a high prevalence of hazardous alcohol consumption in young adult patients, many of whom have not previously received advice to cut down on their drinking.     

Alcohol-related problems: emergency physicians' current practice and attitudes

To determine whether emergency physicians' (EPs) attitudes affect their support and practice of brief intervention in the Emergency Department (ED), EPs completed an anonymous survey. EPs were asked about their attitudes toward patients with alcohol problems, current ED screening, use of brief intervention, and barriers to use of brief intervention. Chi-square analysis was used and a step-wise regression model was constructed. Respondents reported a high prevalence of patients with alcohol-related problems: 18% in a typical shift. Eighty-one percent said it is important to advise patients to change behavior; half said using a brief intervention is important. Attending physicians had significantly less alcohol education than residents, but were significantly more likely to support the use of brief intervention. Support was not associated with gender, race, census, hours of education, or personal experience. EPs who felt that brief intervention was an integral part of their job were more likely to use it in their daily practice.     

Psychometric properties of a single-item assessing drunkenness to identify hazardous drinking: a replication study

Background: The Alcohol Use Disorders Identification Test (AUDIT-C) is a commonly used scale to screen for hazardous alcohol use in various settings, including primary and emergency care settings. In such settings, brevity of effective screening tools is needed; therefore, single items have been developed and tested for detecting at-risk alcohol use behaviors.

Purpose: This study replicates previous work validating the ability of a non-quantity-based single item assessing drunkenness to effectively identify signs of hazardous alcohol use.

Methods: During fall 2013, alcohol use data were collected from 781 self-reported current drinkers. Concurrent validity of a drunkenness item to detect hazardous drinking behaviors was assessed against gender-based AUDIT-C thresholds. Convergent validity of the drunkenness item was assessed against biologic BrAC samples.

Results: The single drunkenness item accounted for 0.856 of the area-under-the-received operating characteristics (ROC) curve for hazardous alcohol use (p?<?0.001). Using a specific cut-off of 1, the drunkenness item was 99.8% sensitive in detecting hazardous drinking behavior and was 93.5% specific in identifying non-hazardous drinking behaviors.

Conclusion: In a new sample, initial psychometric findings of the single drunkenness item to accurately detect hazardous alcohol use were replicated, providing additional support for the utility of this item.     

Alcohol Expectancies,Pregaming, Drinking Games,and Hazardous Alcohol Use in a Multiethnic Sample of College Students

Pregaming is a risky drinking behavior that occurs when students drink alcohol before a primary social gathering or event. The paucity of research on pregaming highlights the need for research on the correlates of drinking behaviors, such as alcohol expectancies, that might increase the likelihood of pregaming. Thus, we sought to examine how alcohol expectancies and the valuations (i.e., desirability) of these expectancies are associated with frequency of pregaming, drinking game (DG) participation, and hazardous alcohol use. Students (N = 1327) from nine U.S. colleges and universities completed self-report surveys. Results showed sufficient discriminant validity among pregaming behaviors, DG participation, and hazardous alcohol use. Findings also revealed that pregaming mediated the associations between positive alcohol expectancies and hazardous drinking behaviors. Finally, when we tested for invariance across gender, ethnicity, and legal versus underage alcohol users, we found full invariance across gender and ethnicity, but not for legal versus underage alcohol users. Future research directions and potential implications for prevention efforts are discussed.     

Substance misuse, anxiety and depression and urgency of presentation to a public emergency department in Australia

Objectives: To establish the prevalence and comorbidity of substance‐related problems and anxiety and depression, among ED presentations, and to compare the prevalence of these conditions among more and less urgent presentations. Design and setting: Cross‐sectional survey of ED presentations over a 14 day period (24 h/day) at the Gold Coast Hospital Emergency Department in south‐east Queensland, Australia, in October 2002. Measures: Usual level of alcohol consumption (Alcohol Use Disorders Identification Test), acute alcohol and illicit drug use (during 24 h prior to interview), symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) and triage category (Australasian Triage Scale). Results: Thirty‐one per cent of the sample reported usually consuming alcohol at a hazardous or harmful level. Twenty per cent of participants reported clinically significant levels of anxiety and/or depression, which were in turn significantly associated with hazardous and harmful levels of alcohol use. Hazardous/harmful alcohol consumption was over‐represented among less urgent ED presentations, whereas anxiety and depression were more prevalent among more urgent ED presentations. Conclusions: Emergency departments in Australia are appropriate settings for the detection of both substance use and mental health problems in the wider community. The prevalence of these problems in ED settings is high and there is a need for the development of systematic screening and referral processes. The evidence of a link between urgency of presentation and these problems needs to be further explored.     

Marijuana Use and Prior Injury among Injured Problem Drinkers

OBJECTIVES: The purpose of this paper is to better understand marijuana use among injured problem drinkers in the emergency department (ED). The specific objectives are: 1) to assess the prevalence of marijuana use; 2) to identify factors associated with marijuana use; 3) to determine whether prior injury is associated with marijuana use; and 4) to determine whether marijuana-using problem drinkers want to change behaviors. METHODS: The authors conducted a post-hoc analysis on data obtained prospectively. Subjects had injury and problem drinking: either measurable alcohol level (blood alcohol concentration, BAC), report of drinking, or an Alcohol Use Disorders Identification Test (AUDIT) score of > or =8. The study was conducted on weekend nights; 3,776 injured ED patients were screened, 383 refused, 578 were enrolled, and 433 had complete data. RESULTS: Of the 433 subjects, 48.3% reported using marijuana in the three months prior. Marijuana-using problem drinkers had more hazardous drinking, higher AUDIT scores (14.0 vs. 11.4, p < 0.001), and higher risk-taking scores (12.4 vs. 10.1, p < 0.001). More used other drugs (69.7% vs. 30.3%, p < 0.001). In regression analyses, marijuana use remained an independent predictor of prior injury (OR = 2.16, 95% CI = 1.25 to 3.75), particularly prior alcohol-related (OR = 2.26, 95% CI = 1.45 to 3.53) and motor-vehicle-related (OR = 1.69, 95% CI = 1.03 to 2.79) injury. Readiness-to-change scores were similar (4.14 vs. 4.22, p = 0.21) between users and nonusers. CONCLUSIONS: Marijuana use among injured problem drinkers is prevalent. Their risk of prior injury is increased. Counseling for alcohol and injury should address marijuana use.     

Prevalence and characteristics of patients with risky alcohol consumption presenting to emergency departments in rural Australia

Objective: This study measures the prevalence of problematic alcohol consumption in patients of EDs in rural areas of Australia, relative to the general population in the same rural communities. It also identifies the characteristics associated with risky drinking in rural ED patients. Methods: Surveys containing the Alcohol Use Disorders Identification Test (AUDIT) and questions corresponding to the 2001 Australian Alcohol Guidelines were completed by 1056 patients presenting to five EDs in rural areas of New South Wales, and 756 residents of the same five communities. Results: Relative to the general community, ED patients were statistically significantly more likely to engage in risky alcohol consumption according to the AUDIT (39% vs 20%), alcohol consumption posing a high risk of short‐term harm (26% vs 18%) and alcohol consumption posing a high risk of long‐term harm (7% vs 3%). Although being aged under 40 years of age, being unmarried, not completing school and being assigned less urgent triage categories were associated with risky alcohol use among ED patients, rates of risky consumption were high across all patient subgroups. Conclusions: Risky drinking, across a number of measures, is overrepresented in patients of rural Australian EDs relative to the general community, and this type of consumption is not limited to certain subgroups of patients. There is a need for interventions that address both heavy single occasion drinking and excessive regular consumption in patients of rural Australian EDs, with universal interventions recommended rather than targeted programmes.     

Motivational interviewing with hazardous drinkers

PURPOSES: To test the effectiveness of motivational interviewing in a population of hazardous drinkers utilizing community health care centers in rural southeastern Idaho. DATA SOURCES: This study targeted rural people at risk for alcohol dependence utilizing low-income community health care centers in rural southeastern Idaho. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen interested clients' alcohol use. Clients achieving an AUDIT score indicating hazardous alcohol use were recruited into the study and randomized into a control or treatment group. Twenty-six hazardous drinkers attending five low-income community health centers participated in the study. The experimental group participated in one motivational interviewing session with the investigator, a family nurse practitioner (NP). The comparison group received no treatment. Alcohol use was tracked for 6 weeks after successful recruitment into the program. CONCLUSIONS: Participants in the study significantly decreased their average number of drinks per day. At time 1 (pretreatment), the control group drank 4.37 drinks per day and the treatment group drank 4.65 drinks per day. At time 2 (posttest), the control group drank 3.77 drinks per day and the treatment group drank 1.95 drinks per day. The effects of the motivational interviewing treatment on hazardous drinking also were measured by serum gamma-glutamyltransferase (GGT), a liver function test. There was also a significant decrease in the GGT from pretest to posttest in the treatment group. IMPLICATIONS FOR PRACTICE: The results of this investigation found that motivational interviewing shows promise as an effective intervention for hazardous drinkers attending low-income community clinics. Although other possible explanations could be postulated for the positive changes in sample participants, the data indicate that the motivational interviewing approach was responsible for a significant portion of the positive changes within the current sample. The information collected from the study adds to the literature on hazardous drinking, research, and treatment of this significant problem. Negotiating change in behavior is part of the practice of NPs. People struggling with alcohol use are more likely to encounter NPs, family doctors, or social workers than counselors specializing in alcohol treatment. Motivational interviewing is specifically designed for preparing people for change. Because most people resist being told what to do, that is, "you have to stop drinking," use of motivational interviewing principles can decrease resistance and optimize change. Additionally, identifying and intervening with hazardous drinking in a primary care setting can reduce healthcare costs and reduce the stigma of specialist care. Adding this valuable communication skill to the competencies of NPs is important to both clients and NPs.     

Conjoint Smoking and Drinking: A Case for Dual-substance Intervention among Young Emergency Department Patients

OBJECTIVES: To better understand conjoint smoking and drinking among young adult emergency department (ED) patients, the purposes of this investigation were: 1) to assess the prevalence of conjoint use; 2) to determine the factors associated with conjoint alcohol use and smoking; and 3) to address the implications for future ED-based investigation of dual-substance intervention. METHODS: Data for this investigation were obtained from a battery of questionnaires administered to the routine-care patients during an alcohol screening in the ED, which was part of a larger alcohol intervention study. RESULTS: Study findings revealed that a majority of patients with self-reported alcohol-related problems were smokers. In fact, drinkers who smoked were likely to be pack-a-day smokers. Among the study sample, being female, having low education levels (e.g., high school education or less), having some emotional problems, and currently using marijuana were risk factors for conjoint smoking and drinking. CONCLUSIONS: Conjoint users were identifiable through brief screening. Given the prevalence of conjoint smoking and alcohol use among the ED sample and a specific set of risk factors, tailored intervention for alcohol and nicotine dependence may be an important and opportunistic clinical ED service.     

Usefulness of Computerized Pediatric Motor Vehicle Safety Discharge Instructions

OBJECTIVES: To determine whether providing child motor vehicle safety recommendations on computerized discharge instructions (CDIs) were useful to parents and modified their use of child-restraint devices (CRDs). METHODS: The subjects were guardians of children seen in an urban pediatric emergency department (ED). An intervention group was given computerized ED discharge instructions that included the National Highway Traffic Safety Administration recommendations for motor vehicle CRDs. A control group was given CDIs without the recommendations. All subjects were subsequently called within four days of the ED visit and asked questions about their knowledge and use of CRDs. They also were queried if the recommendations affected their knowledge or changed their behavior. RESULTS: There were 52 subjects in the control group and 58 in the intervention group. Fifty-seven percent of the intervention group remembered reading a safety tip (p < 0.001, 95% confidence interval [CI] = 0.32 to 0.62), and 82% of that subset correctly identified it pertaining to motor vehicle safety. Forty-five percent (n = 33) of those who remembered the safety recommendation in the intervention group supported it being educational (p = 0.067, 95% CI = 0.28 to 0.64). Ten percent of the subjects in the intervention group said the CDIs changed their behavior regarding buckling-up their child, compared with 0% of the control group (p = 0.473, 95% CI = 0.05 to 0.32). CONCLUSIONS: Including CRD information on CDIs is a convenient method of educating guardians of patients about motor vehicle safety in a pediatric ED setting. The data suggest that parents find it educational and a smaller subgroup change their behaviors after receiving them.     

Positive Social Alcohol Outcome Expectancies,Social Anxiety,and Hazardous Drinking in College Students

Although social anxiety and problematic alcohol use co-occur at alarmingly high rates, the mechanism for this co-occurrence is not well understood. The current study examined the mediating role of positive social alcohol expectancies (i.e., beliefs related to the desirable social effects of drinking) in the relationship between social anxiety and hazardous drinking (i.e., heavy drinking and negative consequences) among an ethnically and racially diverse (87% racial and/or ethnic minority) sample of undergraduate volunteers (n = 610; Mage = 19.1; 69% women). The results of structural equation modeling analyses (using AMOS 7.0) indicated that social (but not tension reduction, sexual enhancement, positive cognitive changes, or negative affective changes) alcohol outcome expectancies partially mediated the association between social anxiety and hazardous drinking; however, social anxiety had a negative direct effect on hazardous drinking. Findings implicate social alcohol outcome expectancies as a mechanism to target in treatment and prevention among socially anxious students.     

Alcohol problems among young adult emergency department patients: making predictions using routine sociodemographic information

OBJECTIVES: The study aims were to explore the process of identifying young adult Emergency Department (ED) patients at risk for alcohol problems, examine the sociodemographic predictors of patient alcohol problems, and determine differences between patients who screened positive and those who screened negative for alcohol problems. Implications for ED practice are discussed. METHOD: As part of a larger study, the Alcohol Use Disorders Identification Test was administered to consenting patients ages 18 to 29. A score of greater than 5 (out of 40) was considered a positive screen for alcohol problems. Sociodemographic information was collected from a generic Individual Information Form. RESULTS: Approximately 48% (1855 of 3890) of patients screened positive for alcohol problems. Among screen-positive patients, 91% (1689) had scores that corresponded to mild to moderate alcohol problems. Compared with screen-negative patients, screen-positive patients were almost 3 times more likely to be men (odds ratio [OR] = 2.70); 2.5 times more likely to use tobacco (OR = 2.43); 2 times more likely to be single (OR = 2.03); and 1.5 times more likely to have some college education (OR = 1.41), be an 18- to 20-year-old adult (OR = 1.61), be a college student (OR = 1.60), be unemployed (OR = 1.39), and cohabitate with friends (OR = 1.19). Screen-positive patients also were more likely to have made at least one past attempt to change their drinking behavior (OR = 3.21). CONCLUSION: Routine patient information presented an accurate risk profile for alcohol problems among patients in this study. If ED-based health care professionals routinely screened patients for alcohol problems or could predict potential alcohol problems by using routinely collected information, then intervention or referral for additional services may increase.     

The feasibility of substance misuse screening in referrals from Accident and Emergency to an inner-city fracture clinic: results from a pilot study

Objectives To assess the prevalence of problem drinking, excessive alcohol consumption and illicit drug use among patients referred to a fracture clinic from Accident and Emergency (A&E). Design Prospective self-completion questionnaire study. Setting An inner-city outpatient fracture clinic in South London. Subjects New referrals from an A&E department ( n = 73). Outcome measurements The AUDIT questionnaire was used to assess problem drinking, while the subjects' report of weekly alcohol consumption was used to identify excessive alcohol consumption. Illicit drug use was measured with the substance misuse section of the Maudsley Addiction Profile (MAP). Results Forty-one per cent of the sample scored over 8 (a positive AUDIT result), indicating problem drinking. This was significantly associated with male gender and with not being married. Twenty-three per cent of the sample consumed above recommended weekly limits of alcohol consumption. The only illicit drug that was used by any of the subjects over the month preceding interview was cannabis: 19% of the patients had used cannabis at least weekly over the month preceding interview. Cannabis use was associated with a positive AUDIT result and with belonging to a white non-UK ethnic group. Conclusions The rates of problem drinking resemble those found in the small number of previous fracture clinic studies and in A&E and orthopaedic in-patient population studies. A high incidence of cannabis use was also found in this patient group and this is the first study of drug use among fracture clinic attendees in the UK. Fracture clinics present an under-utilized opportunity to screen, engage and deliver brief interventions for the treatment of drug and alcohol problems.     

Injury as a Motivator to Reduce Drinking

Objectives: To identify predictors of readiness to change drinking behavior by minor-injury patients who had positive saliva alcohol tests (SATs) in the ED. To develop and test a model intended to be prognostic of readiness to change, which included predispositional and injury-event-related variables.
Methods: An on-site survey was conducted of minor-injury ED patients sampled consecutively during predesignated periods. Patients were identified as SAT-positive during their screening evaluations. After giving their consent, they were administered a self-report battery that assessed predispositional and injury-event-related variables as well as readiness to change their drinking. Predictors of readiness to change drinking were tested with regression analyses.
Results: Twenty-four SAT-positive patients participated; there were 18 men and six women (average age 34 years). Preinjury predispositional variables were by themselves unrelated to the patient's readiness to change while in the ED. Aversiveness of the injury and perception of degree of alcohol involvement were injury-event-related variables predictive of readiness to change (p <0.008). Negative consequences attributed to drinking prior to the injury event strengthened the association of injury aversiveness and alcohol involvement with readiness to change (p <0.0075).
Conclusion: Interventions to decrease drinking in this population should focus on increasing patient awareness of the association between drinking, injuries, and other alcohol-related negative consequences.