From Thrive, Monday Health Section /By Rita Watson
Summertime is synonymous with backyard barbecues and ice cold beer parties at the beach. It is also a dangerous time for binge drinking, especially among students. However, a Yale study, recently published in the Annals of Emergency Medicine, says that seven minutes of emergency room intervention might alleviate the problem.
Researchers randomized 889 adult patients in the emergency department (ED) who had symptoms of hazardous and harmful drinking. Dr. Gail D’Onofrio, Chief of the Emergency Department at Yale-New Haven Hospital, explained a simple intervention, “a conversation to help motivate the patient to change” called a Brief Negotiation Interview (BNI). She said “The first step is a practitioner asking, ‘Would you mind if I talk with you about your alcohol use?’ — then saying, ‘I’m concerned about your risk for illness or injury.’ ”
She added: “We try to make a connection between a health issue and the binge drinking whether hypertension, a sexually transmitted disease, or a car crash.” The goal is to heighten awareness “between their drinking and how it is that they ended up in the ED.”
What happens next is “the hard part.” D’Onofrio said: “The physician tries to motivate the patient to reduce drinking into low risk limits by asking: ‘On a scale from 1 to 10 how ready are you to change your drinking?’
After the patient chooses a number, the next question might be: ‘Why did you not choose a lower number?’ This starts a conversation as to why the patient would want to make a change. After some reflection we try to negotiate a number that the patient can agree to by asking ‘So, how much do you think you can reduce drinking?’ ”
Once the patient agrees to a number they are encouraged to write it down. “In this way it becomes a contract,” she said. “Then we thank them for their time.”
For part of the sample, a nurse will make a booster call one month later in addition to the intervention.
The success rate? The reductions in bingeing episodes per month were 2.8, 2.1 and 1.4 respectively for the BNI with Booster, BNI alone and the standard care group. Reductions in rates of driving after drinking three or more drinks were also greater in the BNI with Booster (38 percent to 29 percent, the BNI alone (39 percent to 31 percent) compared to the standard care group (43 percent to 42 percent).
D’Onofrio noted, “We spend more valuable minutes with ED patients talking about tetanus — which most of us have never seen — than we do screening and intervening with hazardous and harmful drinkers who flood the ED. We need to normalize the process of screening and intervention for alcohol problems. This will be a giant step toward improving the health of the public.”
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Rita Watson, master of public health ( www.ritawatson.com ), is a regular Journal contributor and a relationship columnist for our All About You section.