This eliminates the negative connotations and resistance that can occur when the patient is asked to quantify their drinking.Ĭherpitel CJ, Ye Y. Another approach is to jump to the CAGE questions for patients who present intoxicated with very high ethanol levels, or when dependence is suspected.
Since the CAGE was originally designed for lifetime prevalence, it may be helpful to specify “during the past 12 months.” Asking Q&F questions, then adding the CAGE questions if the responses exceed moderate levels is one way to use the screens. The CAGE questionnaire is better for identifying dependence with 90% specificity and 76% sensitivity when used in the ED. The Q&F questions can elicit whether the patient is over the recommended levels for moderate drinking and therefore “at risk” for illness and injury. It lists recommendations from the National Institute of Alcohol Abuse and Alcoholism (NIAAA), which advocates the use of Quantity and Frequency (Q&F) questions as well as the CAGE questionnaire for screening for alcohol problems. It provides a framework for screening and intervention taking into account the time and resource limitations of the ED. The American College of Emergency Physicians (ACEP) has produced a resource kit titled Alcohol Screening and Brief Intervention in the ED. ED visits offer practitioners an important opportunity to screen patients for alcohol problems and initiate brief intervention. Based on their research, the authors suggest that screening and brief interventions are feasible and effective in the ED setting. Patients who received an intervention delivered by a computer (n=237) had a 29.1% reduction in alcohol consequences at 6 months.Īn excellent literature review on screening and brief intervention for patients with an alcohol use disorder (AUD) in the ED is available online. Control patients, who received a brochure (n=235), showed 16.4% and 17.7% reductions, respectively. Patients who received a 35-minute intervention in the ED delivered by a therapist (n = 254) demonstrated a 34.3% reduction in peer aggression at 3 months and a 32.2% reduction in alcohol consequences at 6 months. Walton et al found that about a quarter of adolescent ED patients surveyed reported both alcohol (alcohol use, binge drinking, and/or alcohol consequences) and violence (peer aggression and violence and/or violence consequences). Similarly, among urban adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in both behaviors. However, a Cochrane Database of Systematic Reviews article including 11 studies and 2441 patients concluded that evidence of benefit of brief intervention on heavy alcohol users is inconclusive data from 2 of the studies noted that alcohol consumption could be reduced at one-year follow-up, but further studies are needed. The group receiving the brief advice tended to report lower alcohol consumption at 12-month follow-up compared to those who did not receive advice. In one study, injured alcohol-using ED patients (n = 494) were randomly assigned to receive either brief advice or no advice regarding alcohol abuse and completed a 12-month follow-up interview. This concept is sometimes called the "teachable moment".
There are studies that have shown that a brief intervention in the emergency department may be effective for alcohol users. The ED may be the initial or only point of contact with the health care system for these patients.
The emergency physician (EP) should strive to identify patients who might benefit from appropriate referrals for drug and alcohol problems. The initial evaluation may seem routine, yet these patients have multiple physical and emotional issues that should be addressed whenever possible. Data supports the notion that the ED serves an important role in identifying and helping patients with alcohol and substance abuse issues. Physicians in the emergency department (ED) regularly encounter patients seeking treatment for alcohol or substance abuse problems.
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