How stages of change can predict screening and brief intervention outcome for alcohol problems in young adult emergency department patients

Research Funded by grant from CDC/NCIPC Research Group Presenter: Arshadul Haque MBBS, MPH Luba Leontieva MD, J Helmkamp PhD, K Horn EdD, J Williams MD, P Ehrlich MD, Acknowledgements: W Manley RN, P Furbee MS, M Murray Research Funded by grant from CDC/NCIPC

Objectives To examine beginning stages of change among ED patients. To identify patients with alcohol problems. Provide a brief motivational intervention. Evaluate alcohol problems at a later date. Provide prediction model for decrease in alcohol problems, if any, based on stages of change.

Methods Study Design: quazi-experimental, prospective, convenience sample Participants : patients ages 18 to 29 Setting: university-affiliated ED Timeframe: August 1998 through December 2000 Inclusion Criteria: consumption of alcohol in the previous year Exclusion Criteria: life- or limb-threatening conditions,mentally incompetence, communication deficits, police custody, and over- intoxication

Methods Research Staff: social workers and alcohol counselors with training in motivational interviewing. Stage of Change: assessed by asking patients to selection from five choices (score 1 to 5) – which best described their attitude towards changing their drinking behavior at the time of their baseline screening Intervention: Motivational interviewing described in Miller and Rollnick, 1991 Follow-up: Telephone interview 3-months after initial ED visit

AUDIT- Intake section 1. In the past year, how many drinks containing alcohol do you have on a typical day, when you are drinking? 1 or 2 3 or 4 5 or 6 7 or 9 10 or more 0 1 2 3 4   2. How often do you drink that amount? Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4 3. How often in the past year you had 5 (male)/4 (female) or more drinks on one occasion? 0 1 2 3 4

AUDIT- Dependence section 1. How often during the past year have you found that you were not able to stop drinking once you had started? Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4 2. How often during the past year have you needed a first drink in the morning to get yourself going after a heavy drinking session? 0 1 2 3 4  3. How often during the past year have you had a feeling of guilt or remorse after drinking?  4. How often during the past year have you been unable to remember what happened the night before because you had been drinking? 0 1 2 3 4  

AUDIT- Harm section 1. How often during the past year have you not done what was normally expected from you because of drinking? For example, have you ever missed work or class? Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4 2. Has your drinking contributed to an injury to yourself or anyone else? Never Yes, but not in the last year Yes, during the last year 0 2 4   3. Has a relative, friend, doctor, or other health worker been concerned about your drinking or suggested that you should cut down? 0 2 4

Stages of Change Pre-contemplation stage: I have no thoughts of changing 2. Contemplation Stage: - I need to consider changing some day - I think I should change, but I am not quite ready 3. Preparation Stage: I am thinking about how to change my drinking 4. Action Stage: I am taking action to change, for example, I am cutting down

Methods Outcome Measures: Decrease in scores within the AUDIT domains of intake, harm and dependency Statistical Analysis: Frequency analyses for demographic description of patients Repeated ANOVA for stage of change movement Logistic regression to examine predictive capability of stage of change; pre-contemplators used as the reference group Significance level: p < 0.05

Flowchart of patients in the ED from August 1998 through December 2000

Socio-demographic characteristics of screen-positive patients

Stages of change status for the group of screen-positive patients followed- up at three months*

Logistic Regression Analyses for Predictors of Positive Behavior Outcome§

Average stage of change scores movement of screen-positive patients from baseline to three months follow-up. (p<0.000)

Conclusions Stages of change are predictive for decrease in drinking following a brief intervention As a group, patients moved to more advanced stage of change level at 3-month follow-up Healthcare professionals can use stages of change to tailor intervention procedures

Limitations Relatively young patients ED situated in small, rural, college town with predominately Caucasian population