TY - JOUR
T1 - Alcohol, tobacco, and other drugs
T2 - Future directions for screening and intervention in the emergency department
AU - Cunningham, Rebecca M.
AU - Bernstein, Steven L.
AU - Walton, Maureen
AU - Broderick, Kerry
AU - Vaca, Federico E.
AU - Woolard, Robert
AU - Bernstein, Edward
AU - Blow, Fred
AU - D'Onofrio, Gail
PY - 2009/11
Y1 - 2009/11
N2 - This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening - develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention - conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups - conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies - a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and followup; and d) examine alternatives to specialized treatment referral. 5) Translation-conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.
AB - This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening - develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention - conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups - conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies - a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and followup; and d) examine alternatives to specialized treatment referral. 5) Translation-conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.
KW - Emergency department
KW - Intervention
KW - Public health
KW - Screening
KW - Substance abuse
UR - http://www.scopus.com/inward/record.url?scp=73249132168&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=73249132168&partnerID=8YFLogxK
U2 - 10.1111/j.1553-2712.2009.00552.x
DO - 10.1111/j.1553-2712.2009.00552.x
M3 - Article
C2 - 20053226
AN - SCOPUS:73249132168
SN - 1069-6563
VL - 16
SP - 1078
EP - 1088
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 11
ER -