6 February 2007 | Volume 146 Issue 3 | Pages 167-176Brief Intervention for Medical Inpatients with Unhealthy Alcohol Use
A Randomized, Controlled Trial
Current Author Addresses: Drs. Saitz, Chang, and Samet and Ms. Guerriero: Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118.
Dr. Palfai: Psychology Department, Boston University, 64 Cummington Street, Boston, MA 02215.
Dr. Horton: Department of Mathematics, Smith College, 44 College Lane, Northampton, MA 01063.
Ms. Freedner: ORC Macro, 126 College Street, Burlington, VT 05401.
Dr. Dukes: DM-STAT, Inc., One Salem Street, Suite 300, Malden, MA 02148.
Dr. Kraemer, MD: University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213
Dr. Roberts: University of Pittsburgh School of Medicine, 200 Meyran Street, Suite 200, Pittsburgh, PA 15213.
Abstract
Background: The efficacy of brief intervention in reducing alcohol consumption is well established for selected outpatients but not for medical inpatients.
Objective: To determine whether brief intervention improves alcohol outcomes in medical inpatients who were identified by screening as having unhealthy alcohol use.
Design: Randomized, controlled trial.
Setting: Medical service of an urban hospital.
Patients: 341 medical inpatients who were drinking risky amounts of alcohol (defined for eligibility as >14 drinks/wk or 
5 drinks/occasion for men and >11 drinks/wk or 4 drinks/occasion for women and persons 66 y); 77% had alcohol dependence as determined by the Composite International Diagnostic Interview Alcohol Module.
Intervention: A 30-minute session of motivational counseling given by trained counselors during a patient's hospitalization (n = 172) versus usual care (n = 169).
Measurements: Self-reported primary outcomes were receipt of alcohol assistance (for example, alcohol disorders specialty treatment) by 3 months in dependent drinkers and change in the mean number of drinks per day from enrollment to 12 months in all patients.
Results: The intervention was not significantly associated with receipt of alcohol assistance by 3 months among alcohol-dependent patients (adjusted proportions receiving assistance, 49% for the intervention group and 44% for the control group; intervention–control difference, 5% [95% CI, –8% to 19%]) or with drinks per day at 12 months among all patients (adjusted mean decreases, 1.5 for patients who received the intervention and 3.1 for patients who received usual care; adjusted mean group difference, –1.5 [CI, –3.7 to 0.6]). There was no significant interaction between the intervention and alcohol dependence in statistical models predicting drinks per day (P = 0.24).
Limitations: Baseline imbalances existed between randomized groups. Patients who received usual care were assessed and advised that they could discuss their drinking with their physicians.
Conclusions: Brief intervention is insufficient for linking medical inpatients with treatment for alcohol dependence and for changing alcohol consumption. Medical inpatients with unhealthy alcohol use require more extensive, tailored alcohol interventions.
