Alcohol Abuse
Conditions
Keywords
alcoholism, dangerous behavior, aged, emergency medicine
Brief summary
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.
Detailed description
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.
Interventions
BEHAVIORALBrief Negotiated Interview
As per arm
BEHAVIORALGeneral Health Information
As per arm (this is the active comparator)
Sponsors
The American Geriatrics Society
National Institute on Aging (NIA)
Society for Academic Emergency Medicine
North Carolina Translational and Clinical Sciences Institute
University of North Carolina, Chapel Hill
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 65 and older * Receiving care in the emergency department * Hazardous alcohol use, defined as reporting drinking more than 7 drinks per week on an average week during the three months prior to the visit, and whether they have consumed more than three drinks on any given occasion.
Exclusion criteria
* Prisoner * psychosis or psychiatric hold * nursing home * life-threatening condition * current hospice care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Alcohol misuse | 6 months | 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. |
| Subgroup analysis of patients who met hazardous alcohol use criteria based on time-line follow back method of assessing alcohol consumption | 6 months | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Alcohol consumption | 3,6,12 months | Average drinks per week and episodes of \>3 drinks in past 3 months |
| Alcohol abuse | 3,6,12 months | AUDIT Score |
| General Health | 3,6,12 months | Mobility, depression, and presence of chronic pain |
| Alcohol misuse | 3 months, 12 months | Alcohol misuse is defined as patient self-report of either drinking \>7 drinks per week or \>3 drinks per day in the past month. |
| Trauma | 6,12 months | Injuries, falls, and motor vehicle collisions within the last 6 months, alcohol use preceding and medical care following the injury |
| Healthcare Utilization | 6,12 months | 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. |
| Risk-taking behavior | 6,12 months | Driving after drinking |
| Function | 6,12 months | Activities of Daily Living |
Countries
United States
Outcome results
None listed