Trial Information

Development of a Combined Screening and Intervention Program for Emergency Department Patients Who Both Drink and Smoke

Smoking and drinking are the most common addictions in this country and frequently co-occur.
Among persons who smoke and drink, there appears to be a robust dose-response relationship,
with heavier drinking associated with heavier smoking and vice versa. Additionally, smokers
who are more alcohol dependent often report that smoking is a common way to cope with the
urge to drink.

Research has shown that there is a high prevalence of unmet substance abuse treatment need
among adult Emergency Department (ED) patients. As many as 46% of ED patients have recently
consumed alcohol and a significant number of the 31.6 million ED injury related visits are
alcohol related. The prevalence rate of tobacco use among ED patients is reportedly as high
as 40% and contributes to significant morbidity and mortality.

For many the ED is the only place they can access medical care. Although most
medically-underserved individuals never seek out specialized treatment for smoking or
drinking, each year over 120 million people visit an ED. Since an ED visit may be a
patient's only point of contact with the health care system, it represents an important
opportunity not only to treat their emergent needs, but to screen and provide this
vulnerable population with appropriate alcohol and tobacco use interventions.

The intervention, built upon the Brief Negotiated Interview (BNI) model, aims to help
patients reduce harmful drinking and smoking and will be initiated during an ED visit
followed by 3 follow up COMBINE counseling telephone sessions post ED visit.

The specific aims of the proposed project are to:

Aim 1: To develop an effective brief intervention for smoker- drinkers that is feasible and
acceptable for patients treated in the emergency department

Aim 2: To identify barriers to treatment engagement and factors that facilitate successful
engagement in alcohol and smoking cessation treatment