EDs and trauma centers are ideal settings for the
“teachable moment” that is thought to be one of
the key components of the positive impact of a
brief intervention.^131 Most individuals who
experience substance-related accidents and
injuries do not meet clinical criteria for
addiction^132 but are excellent candidates for brief
interventions. One study of young adults
admitted to a hospital emergency department
found that those who were alcohol-involved*
and who received a brief motivational
intervention followed by two telephone booster
sessions showed greater reductions in alcohol
use than those who just received one to three
minutes of feedback, in which they were
provided information about how much they
drink, what happens when they drink and how
their alcohol intake compares to their peers (a
reduction of up to 53 percent vs. 18 percent).^133
ED and trauma physicians were some of the first
to recommend the adoption of screening and
brief interventions;^134 their focus to date has
been on excessive alcohol use which is the
leading risk factor for injury:^135
The American College of Emergency
Physicians recommends screening and brief
interventions for alcohol use.^136
The American College of Surgeons
Committee on Trauma requires that Level I
and Level II trauma centers have a
mechanism in place to identify patients who
- Screened positive for alcohol use, reported drinking
in the six hours before their accident or had a history
of risky drinking (as determined by their AUDIT
score).
engage in risky alcohol use and Level I
Centers must have a mechanism in place to
intervene with these patients.† 137An important point of access to the health care
system for adolescents is through the ED;
approximately 12.7 percent of substance-related
ED visits are made by individuals ages 12 to 20
years old (5.7 percent by those ages 12 to 17 and
7.0 percent by those ages 18 to 20).^138
Interventions conducted in the ED may reach
adolescents who do not attend school regularly
or who do not have a primary care physician.^139Health Care for Pregnant Women‡
Given the considerable impact of substance use
on reproductive health and pregnancy, women
(especially those who are pregnant or of
reproductive age) are an ideal target for
screening and brief intervention services.^141
Because there is no universally safe level of
substance use during pregnancy, any use should
be screened for and addressed. The American
College of Obstetricians and Gynecologists
recommends that because of these risks, all
women--regardless of present pregnancy status--
should be screened for alcohol use at least yearly
and provided with intervention and referral
services if necessary.^142One study found that pregnant smokers who
received brief counseling and behavioral
interventions in a public maternity hospital had a
higher rate of smoking abstinence (33.3 percent)
than pregnant smokers who received usual care
(8.3 percent).^143 Another study found that
pregnant smokers in community health centers
who received brief interventions were more
likely to be abstinent by the end of their
pregnancy than women receiving usual prenatal
care (past-month abstinence rate of 26 percent
vs. 12 percent). However, in this study, the
higher rates of smoking abstinence following a† The focus in this area primarily has been on alcohol
rather than tobacco or other drugs.
‡ Research on screening and brief interventions for
pregnant women focuses primarily on tobacco and
alcohol use. No studies of the use of such services in
pregnant women who use other drugs were found.Research [related to screening and brief
intervention] began in the ED. The earliest
study--conducted in 1957--was a controlled trial
with 200 dependent drinkers at Massachusetts
General Hospital. Patients who had a
nonjudgmental, respectful conversation inviting
them to attend an outpatient program were more
likely than other patients to complete one
appointment (65.0 percent vs. 5.4 percent) and
five appointments (42.0 percent vs. 1.1
percent).^140