Research Funded by grant from CDC/NCIPC

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

2. Research Group Presenter: Arshadul Haque MBBS, MPHLuba 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

3. 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.

4. 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

5. 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

6. 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? Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4

7. 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? Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4  3. How often during the past year have you had a feeling of guilt or remorse after drinking? Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4  4. How often during the past year have you been unable to remember what happened the night before because you had been drinking? Never <Monthly Monthly Weekly Daily/almost daily 0 1 2 3 4

8. 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? Never Yes, but not in the last year Yes, during the last year 0 2 4

9. 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

10. 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

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

12. Socio-demographic characteristics of screen-positive patients

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

14. Logistic Regression Analyses for Predictors of Positive Behavior Outcome§

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

16. 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

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