SBIRT Doesn't Work in EDs

Another study documenting that emergency department Screening, Brief Intervention and Referral to Treatment (SBIRT) doesn't work. Unfortunately, advocates for SBIRT have moved out quite a ways ahead of the evidence. This is not likely to be harmful for patients, obviously, but it may hurt the cause in the long run. It's also a waste of money and time. By the way, the same holds true for hospitalized patients. SBIRT doesn't work because most of the patients identified are dependent drinkers.

MW


Oxford Journals
Medicine
Alcohol and Alcoholism
Volume45, Issue6
Pp. 514-519.

The Impact of Screening, Brief Intervention and Referral for Treatment in Emergency Department Patients’ Alcohol Use: A 3-, 6- and 12-month Follow-up

Academic ED SBIRT Research Collaborative

Corresponding author: Robert H. Aseltine, Jr., Division of Behavioral Sciences and Community Health, MC 3910, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3910, USA. Tel: +1 860 679 3282; Fax: +1 860 679 1342; E-mail: aseltine@uchc.edu

Received October 26, 2009.
Revision received July 30, 2010.
Accepted August 23, 2010.

Abstract

Aims: This study aims to determine the impact of Screening, Brief Intervention and Referral for Treatment (SBIRT) in reducing alcohol consumption in emergency department (ED) patients at 3, 6, and 12 months following exposure to the intervention. Methods: Patients drinking above the low-risk limits (at-risk to dependence), as defined by National Institute of Alcohol Abuse and Alcoholism (NIAAA), were recruited from 14 sites nationwide from April to August 2004. A quasi-experimental comparison group design included sequential recruitment of intervention and control patients at each site. Control patients received a written handout. The Intervention group received the handout and participated in a brief negotiated interview with direct referral for treatment if indicated. Follow-up surveys were conducted at 3, 6, and 12 months by telephone using an Interactive Voice Response (IVR) system. Results: Of the 1132 eligible patients consented and enrolled (581 control, 551 intervention), 699 (63%), 575 (52%) and 433 (38%) completed follow-up surveys via IVR at 3, 6, and 12 months, respectively. Regression analysis adjusting for the clustered sampling design and using multiple imputation procedures to account for subject attrition revealed that those receiving SBIRT reported roughly three drinks less per week than controls (B = −3.00, SE = 1.06, P < 0.05) and the level of maximum drinks per occasion was approximately three-fourths of a drink less than controls (B = -0.76, SE = 0.29, P < 0.05) at 3 months. At 6 and 12 months post-intervention, these effects had weakened considerably and were no longer statistically or substantively significant. Conclusion: SBIRT delivered by ED providers appears to have short-term effectiveness in reducing at-risk drinking, but multi-contact interventions or booster programs may be necessary to maintain long-term reductions in risky drinking.