Brief Intervention for Medical Inpatients with Unhealthy Alcohol Use

A Randomized, Controlled Trial

6 February 2007 | Volume 146 Issue 3 | Pages 167-176

Background: The efficacy of brief intervention in reducing alcohol consumption is well established for selected outpatients but not for medical inpatients.

Objective: To determine whether brief intervention improves alcohol outcomes in medical inpatients who were identified by screening as having unhealthy alcohol use.

Design: Randomized, controlled trial.

Setting: Medical service of an urban hospital.

Patients: 341 medical inpatients who were drinking risky amounts of alcohol (defined for eligibility as >14 drinks/wk or 5 drinks/occasion for men and >11 drinks/wk or 4 drinks/occasion for women and persons 66 y); 77% had alcohol dependence as determined by the Composite International Diagnostic Interview Alcohol Module.

Intervention: A 30-minute session of motivational counseling given by trained counselors during a patient's hospitalization (n = 172) versus usual care (n = 169).

Measurements: Self-reported primary outcomes were receipt of alcohol assistance (for example, alcohol disorders specialty treatment) by 3 months in dependent drinkers and change in the mean number of drinks per day from enrollment to 12 months in all patients.

Results: The intervention was not significantly associated with receipt of alcohol assistance by 3 months among alcohol-dependent patients (adjusted proportions receiving assistance, 49% for the intervention group and 44% for the control group; intervention–control difference, 5% [95% CI, –8% to 19%]) or with drinks per day at 12 months among all patients (adjusted mean decreases, 1.5 for patients who received the intervention and 3.1 for patients who received usual care; adjusted mean group difference, –1.5 [CI, –3.7 to 0.6]). There was no significant interaction between the intervention and alcohol dependence in statistical models predicting drinks per day (P = 0.24).

Limitations: Baseline imbalances existed between randomized groups. Patients who received usual care were assessed and advised that they could discuss their drinking with their physicians.

Conclusions: Brief intervention is insufficient for linking medical inpatients with treatment for alcohol dependence and for changing alcohol consumption. Medical inpatients with unhealthy alcohol use require more extensive, tailored alcohol interventions.

Editors' Notes Context Brief interventions reduce alcohol use in outpatients who drink unhealthy amounts but are not alcohol-dependent. Their effect in medical inpatients is unknown. Contribution The authors screened all adult medical inpatients at an urban teaching hospital and randomly assigned 341 risky drinkers to a 30-minute motivational counseling intervention followed gy treatment planning or to usual care. By 3 months, the same proportion of patients from both groups had received alcohol assistance, and both groups had reduced their drinking to the same degree. Cautions Three quarters of the participants met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for alcohol dependence. Implications In this well-done study, brief intervention did not affect alcohol-related outcomes in persons who drank unhealthy amounts. —The Editors

 

Author and Article Information

From Boston Medical Center and Boston University, Boston, Massachusetts; Smith College, Northampton, Massachusetts; DM-STAT, Malden, Massachusetts; and University of Pittsburgh, Pittsburgh, Pennsylvania.

ClinicalTrials.gov Identifier: NCT00183105.

Acknowledgments: The authors thank the staff and patients of the medical inpatient service and CARE Unit research associates at Boston Medical Center; the staff and house staff of the Boston University Internal Medicine Residency Training Program; and Karen Sullivan, Nicole Tibbetts, Alison Pedley, and other data management staff at DM-STAT, Malden, Massachusetts.

Grant Support: This study was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA RO1 12617) and a General Clinical Research Center grant from the National Center for Research Resources (M01 RR00533).

Potential Financial Conflicts of Interest: Honoraria: R. Saitz (Fusion Medical Education). All authors have received grant support from the National Institute on Alcohol Abuse and Alcoholism.

Requests for Single Reprints: Richard Saitz, MD, MPH, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118; e-mail, rsaitz{at}bu.edu.

Current Author Addresses: Drs. Saitz, Chang, and Samet and Ms. Guerriero: Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118.

Dr. Palfai: Psychology Department, Boston University, 64 Cummington Street, Boston, MA 02215.

Dr. Horton: Department of Mathematics, Smith College, 44 College Lane, Northampton, MA 01063.

Ms. Freedner: ORC Macro, 126 College Street, Burlington, VT 05401.

Dr. Dukes: DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148.

Dr. Kraemer, MD: University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213

Dr. Roberts: University of Pittsburgh School of Medicine, 200 Meyran Street, Suite 200, Pittsburgh, PA 15213.

Author Contributions: Conception and design: R. Saitz, T.P. Palfai, D.M. Cheng, K. Dukes, M.S. Roberts, J.H. Samet.

Analysis and interpretation of the data: R. Saitz, T.P. Palfai, D.M. Cheng, N.J. Horton, N. Freedner, K. Dukes, K.L. Kraemer, M.S. Roberts, J.H. Samet.

Drafting of the article: R. Saitz, T.P. Palfai, D.M. Cheng, N.J. Horton, N. Freedner, K.L. Kraemer, R.T. Guerriero.

Critical revision of the article for important intellectual content: R. Saitz, T.P. Palfai, D.M. Cheng, N. Freedner, K.L. Kraemer, M.S. Roberts, R.T. Guerriero, J.H. Samet.

Final approval of the article: R. Saitz, T.P. Palfai, D.M. Cheng, N. Freedner, N.J. Horton, K. Dukes, K.L. Kraemer, M.S. Roberts, R.T. Guerriero, J.H. Samet.

Provision of study materials or patients: R. Saitz.

Statistical expertise: D.M. Cheng, N.J. Horton, K. Dukes.

Obtaining of funding: R. Saitz.

Administrative, technical, or logistic support: R. Saitz, N. Freedner, R.T. Guerriero.

Collection and assembly of data: R. Saitz, N. Freedner, K. Dukes.

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