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The Mixed Evidence for Brief Intervention in Emergency Departments, Trauma Care Centers, and Inpatient Hospital Settings: What Should We Do?

Authors

  • Craig A. Field,

    1. From the Health Behavior Research and Training Institute (CAF), University of Texas, Austin, Texas; Screening and Brief Intervention (CAF), Trauma Services, University Medical Center Brackenridge, Austin, Texas; Injury Prevention Center (JB), Rhode Island Hospital, Alpert School of Medicine Brown University, Providence, Rhode Island; Research and Education (CARE) Unit (RS), Section of General Internal Medicine, Boston Medical Center, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; UT Southwestern School of Health Professions (RC), Regional Dean and Professor, UT School of Public Health, Dallas, Texas; Center for Alcohol and Addiction Studies (PMM), Brown University, Providence, Rhode Island.
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  • Janette Baird,

    1. From the Health Behavior Research and Training Institute (CAF), University of Texas, Austin, Texas; Screening and Brief Intervention (CAF), Trauma Services, University Medical Center Brackenridge, Austin, Texas; Injury Prevention Center (JB), Rhode Island Hospital, Alpert School of Medicine Brown University, Providence, Rhode Island; Research and Education (CARE) Unit (RS), Section of General Internal Medicine, Boston Medical Center, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; UT Southwestern School of Health Professions (RC), Regional Dean and Professor, UT School of Public Health, Dallas, Texas; Center for Alcohol and Addiction Studies (PMM), Brown University, Providence, Rhode Island.
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  • Richard Saitz,

    1. From the Health Behavior Research and Training Institute (CAF), University of Texas, Austin, Texas; Screening and Brief Intervention (CAF), Trauma Services, University Medical Center Brackenridge, Austin, Texas; Injury Prevention Center (JB), Rhode Island Hospital, Alpert School of Medicine Brown University, Providence, Rhode Island; Research and Education (CARE) Unit (RS), Section of General Internal Medicine, Boston Medical Center, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; UT Southwestern School of Health Professions (RC), Regional Dean and Professor, UT School of Public Health, Dallas, Texas; Center for Alcohol and Addiction Studies (PMM), Brown University, Providence, Rhode Island.
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  • Raul Caetano,

    1. From the Health Behavior Research and Training Institute (CAF), University of Texas, Austin, Texas; Screening and Brief Intervention (CAF), Trauma Services, University Medical Center Brackenridge, Austin, Texas; Injury Prevention Center (JB), Rhode Island Hospital, Alpert School of Medicine Brown University, Providence, Rhode Island; Research and Education (CARE) Unit (RS), Section of General Internal Medicine, Boston Medical Center, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; UT Southwestern School of Health Professions (RC), Regional Dean and Professor, UT School of Public Health, Dallas, Texas; Center for Alcohol and Addiction Studies (PMM), Brown University, Providence, Rhode Island.
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  • Peter M. Monti

    1. From the Health Behavior Research and Training Institute (CAF), University of Texas, Austin, Texas; Screening and Brief Intervention (CAF), Trauma Services, University Medical Center Brackenridge, Austin, Texas; Injury Prevention Center (JB), Rhode Island Hospital, Alpert School of Medicine Brown University, Providence, Rhode Island; Research and Education (CARE) Unit (RS), Section of General Internal Medicine, Boston Medical Center, Boston University Schools of Medicine and Public Health, Boston, Massachusetts; UT Southwestern School of Health Professions (RC), Regional Dean and Professor, UT School of Public Health, Dallas, Texas; Center for Alcohol and Addiction Studies (PMM), Brown University, Providence, Rhode Island.
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Reprint requests: Craig Andrew Field, PhD, MPH, University of Texas at Austin, 1717 W 6th Street, Ste 295, Austin, TX 78732; Tel.: +1 512 232 0242; Fax: +1 512 232 0730; E-mail: craig.field@austin.utexas.edu

Abstract

Background:  This qualitative review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism (Baird et al., 2009; Field et al., 2009; Monti et al., 2009; Saitz et al., 2009a). The purpose is to describe the mixed evidence supporting brief interventions in the emergency department, trauma care, and in-patient medical care settings; examine potential moderators of treatment outcome in light of the mixed evidence; and identify methods to move the research and practice of brief interventions beyond their current state.

Methods:  By drawing upon existing reviews and selected individual studies, we provide examples that reflect the current complexity of research in this area and propose steps for advancing the field.

Results:  Emergency departments, inpatient hospital settings, and trauma care settings represent three unique contexts within which brief interventions have been tested. While the general efficacy of brief alcohol interventions in these settings has been recognized, the evidence is increasingly mixed. Recent studies investigating potential moderators of treatment outcomes suggest that a more sophisticated approach to evaluating the effectiveness of brief interventions across varying patient populations is needed to further understand its effectiveness.

Conclusions:  Current dissemination efforts represent a significant advance in broadening the base of treatment for alcohol problems by providing an evidence-based intervention in health care settings and should not be curtailed. However, additional research is required to enhance treatment outcomes, refine current practice guidelines, and continue to bridge the gap between science and practice. Given the current state of research, a multisetting clinical trial is recommended to account for potential contextual differences while controlling for study design.

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