Reducing Substance Use by an Emergency Department Intervention
Abstract
Introduction: Substance use and misuse is prevalent in emergency department (ED) patients. We set out to determine substance use reduction rates after a brief ED intervention for patients with tobacco, alcohol, or drug use.
Methods: In this pilot prospective study, we approached a convenience sample of subjects in 2 EDs in PA during scheduled provider nonclinical times. One site was a trauma center while the other was a smaller community hospital. Subjects had to be ≥18 yo, have capacity to answer survey questions and participate in the program interventions, could not be critically ill, and had to be willing to participate. Participating subjects admitted to definitions of unhealthy use of one or more of: tobacco products, alcohol, street drugs, or addictive prescription drugs. Subjects received a structured survey and intervention tool that was previously validated (Project ASSERT), a brief intervention based on motivational interviewing, and referral to treatment, which took on average 5-10 minutes1. The intervention was carried out by a medical student, Emergency Medicine (EM) Resident, or an Addiction Recovery Specialist (a licensed social worker and certified recovery specialist with lived substance use disorder experience). These providers had training in Project ASSERT prior to the study start. Phone follow-up was used to determine current substance use by the patient. Subjects received no financial incentives.
Results: One-hundred ninety-one patients were recruited (105 for tobacco usage, 54 for alcohol, and 32 for drugs). At follow-up, 16/105 tobacco users (15.0%) reported stopping smoking, 51 (48.6%) a decrease in the number of cigarettes per day, and 32 (30.5%) attempting to quit. Of 54 patients in the high-risk alcohol utilization group, 40 (74.1%) reported either a decrease in the number of days per week of drinking, or a decrease in the number of drinks per day. Of the 32 patients who used drugs, 25 (78.1%) reported a decrease in usage.
Conclusion: In this pilot study involving medical students, EM residents and drug counselors at 2 EDs, we found that a brief intervention to patients with unhealthy tobacco, alcohol, and drug use resulted in overall decreased use. A more robust study, with a larger patient sample size is indicated.