Brief alcohol intervention for general hospital inpatients: A randomized controlled trial

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Abstract

Aim

To test the effectiveness of a brief alcohol intervention among non-dependent general hospital inpatients with alcohol problems, delivered by either a specialized liaison service or hospital physicians.

Method

All inpatients of 29 wards from four general hospitals of one region in Germany were screened for alcohol problems (n = 14,332). Of those screening positive, 595 patients were included in a randomized controlled group design using a time-frame. Patients with alcohol dependence were not considered in this study. Patients received Motivational Interviewing based counselling either by a specialized liaison service, by hospital physicians trained under routine conditions or received hospital treatment as usual without additional counselling. One year later, alcohol consumption, motivation and well-being were assessed. Sample survey analyses and generalized estimating equations were conducted.

Results

At baseline, the three groups differed regarding motivation, with higher motivation among the controls. At follow-up, the groups did not differ regarding alcohol consumption, alcohol-related problems and well-being. All groups decreased their alcohol consumption significantly. Regarding motivation, longitudinal analyses revealed significant interaction effects of time and intervention (p < 0.05), indicating a stronger increase of readiness to change drinking and a less profound drop of readiness to seek help among those who received intervention compared to the controls.

Conclusion

The intervention was not effective in reducing alcohol consumption or in increasing well-being 12 months after hospitalization. It had a positive effect on readiness to change drinking and on readiness to seek formal help for alcohol problems. The intervention groups compensated their lag of motivation.

Section snippets

Background

Hospitalization for alcohol-associated injury or disease provides a “teachable moment” due to increased motivation to change drinking (Longabaugh et al., 1995, Rumpf et al., 1999), suggesting that brief alcohol interventions (BAI) might reduce drinking in general hospital patients. However, while BAI are effective in reducing alcohol consumption and alcohol-related problems in outpatient primary care settings (Bien et al., 1993, Ashenden et al., 1997, Bertholet et al., 2005, D’Onofrio and

Recruitment

This paper reports findings of the randomized controlled trial “Implementing early intervention for alcohol misuse in the general hospital” (registered in ClinicalTrials.gov: NCT00423904), conducted by the Research Collaboration on Early Substance Use Intervention (EARLINT) between 28-04-2002 and 30-06-2004. The local ethics committee of the Ernst-Moritz-Arndt-University of Greifswald approved of the study. Data were collected at four general hospitals in Western Pomerania in Northeastern

Sample description

The flow-chart according to the CONSORT statement (Moher et al., 2001) is presented in Fig. 1. A total of 14,332 patients were screened. For 20% (n = 2924) of these, a positive screening result was identified on at least one of the two measures. Of these, 80% (n = 2337) agreed to participate in a diagnostic interview. A total of 1281 patients met criteria for AD, AA, AR or HE in the past year. Individuals with AD (n = 599) were excluded from the following analyses. Of the remaining 682 non-alcohol

Discussion

The study's aim was to investigate the effectiveness of a MI based brief intervention among non-alcohol dependent general hospital inpatients with alcohol problems. Two ways of delivery were tested: motivational counselling by a specialized liaison service or by hospital physicians.

At follow-up no significant differences in alcohol consumption and related problems were found between the intervention groups and the controls, indicating that the intervention had no effect regarding alcohol use.

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Acknowledgements

The authors wish to thank Christine Pockrandt, Birgit Hartmann and Katrin Stegemann for data collection, the medical and nursing staff of the University Hospital Greifswald (Prof. Dr. A. Ekkernkamp, Prof. Dr. S. Felix, Prof. Dr. C.-D. Heidecke, Prof. Dr. W. Hosemann, Prof. Dr. M. Juenger, Prof. Dr. G. Kraatz), of the Hanse Hospital Stralsund (Dr. M. Bartelt, Prof. Dr. T. Ittel, Prof. Dr. J. Kasch, PD Dr. M. Knoop, Dr. G. Langhans), and of the District Hospitals Demmin (Dr. B. Parnitzke, PD Dr.

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