Hazardous or harmful alcohol use in emergency care : Early detection, motivation to change and brief intervention

Sammanfattning: Alcohol often leads to accidents, assaults, poor health in the family and is associated with psychiatric and somatic diseases. Binge drinking, in particular, has been shown to be a central factor in alcohol related problems. Adding alcohol detection and intervention to routine emergency care, where one out of five patients is reported to have hazardous or harmful alcohol habits, should make surgical care more effective and have a beneficial impact on the public health problem that alcohol constitutes. The aim of this thesis has been to increase knowledge about detection, motivation to change, and brief intervention of hazardous and harmful alcohol habits among emergency patients. Two study samples were used. At the emergency ward at St Göran Hospital, 1909 patients were randomised for routine care or alcohol screening tests. With the use of tests at least twice as many risk consumers were indicated compared to notes in the medical records of the routine care group and among young women, in particular, the proportion was manifold. Thus, screening is important for young women, in particular. At the Danderyd emergency intake ward, 697 patients were approached. In a sub-sample of 234 patients, the validity of the psychological tests Malmö modified MAST (Mm-MAST), CAGE, Trauma-scale, and the biological tests carbohydrate deficient transferrin (CDT) and gamma glutamyl transferase (GGT) were examined separately and in combination in relation to binge drinking. Mm- MAST alone and CAGE and CDT combined were sensitive to binge drinking among 30-73 year old men. Mm-MAST, CAGE, Trauma Scale, CDT, and GGT did not identify binge drinking among young women. Thus, these alcohol markers should be combined with questions about binge drinking, when used among young women. Binge drinking proved to be a prevalent risk behavior and most prevalent among young women. Out of 697 emergency patients, 165 were assessed to have hazardous or harmful alcohol habits, and they responded to the Swedish Readiness to Change Questionnaire (RTCQ). In order to get an index of the patients' motivational status, the psychometric properties of the test were examined. The RTCQ factor structure was consistent with Prochaska and DiClements stages of change model, and that the test is reliable. Both the Quick Method to allocate a stage of change and a readiness to change score has modest construct validity. Thus, the Swedish RTCQ seems to get an index of the patients motivational status. The 165 patients with hazardous or harmful alcohol habits were randomized to a modified Drinkers Check Up (DCU) or brief assessment with a short feedback. There was the same outcome with the two interventions at the six and twelve month follow-up. There were reductions in alcohol outcome measures and patients moved to a stage more ready to change. Furthermore, the surgical staff was comparable to specialists in the alcohol field when conducting the brief assessment with feedback. Thus, screening and intervention could be done at an emergency ward and may have a preventive effect on the patients' alcohol use. Opportunistic alcohol intervention might cause negative feelings as a result of the alcohol issue being raised. However, less than 4% of the patients who bad alcohol screening had a negative response to the intervention. This is promising considering that 56% of the patients with hazardous or harmful alcohol use had not thought of their alcohol habits as a problem and 24% more were ambivalent whether it was a problem. However, alcohol screening tests and interventions should be adapted to the patients' low level of motivation. Patients with hazardous or harmful alcohol habits and a trauma diagnosis were more ready to change than risk patients with e.g. appendicitis, which is not alcohol-related. Thus, an alcohol-related diagnosis might be a motivational window for changed alcohol habits.