All US trauma centers verified by the American College of Surgeons are required to have programs for identifying patients who may have alcohol problems and for providing brief intervention (BI) and referral to therapy. Typically they use a standard interview tool (or the fact that patient blood alcohol exceeded a certain limit) to determine if brief intervention is indicated. If so, a trained professional (social worker, nurse, psychiatrist) sits down with the patient for a counseling session that may last 30 minutes, give or take. The idea is that the intervention has more impact in the face of the recent traumatic event, and the patient will be less likely to offend again. A number of studies have shown that alcohol consumption and risk-taking behavior decrease, at least in the short term, for patients who are taken to an emergency department and receive BI.
But does brief intervention really work for people who have been arrested for driving under the influence (DUI) but not injured? Researchers at UC Davis looked at 200 first-time arrestees for DUI in a county jail during a 1 month period. They randomized them for BI or no BI, and 181 of the 200 enrollees actually finished a 90-day followup, which is very good. AUDIT was used to measure the degree of problematic drinking (scale 0-40, higher means worse).
Here are the interesting factoids:
- Mean blood alcohol was 0.14 mg/dl, which is a bit on the low side
- Average initial AUDIT score was about 8 in both control and brief intervention groups
- AUDIT score decreased by 3.4 in controls and 4.7 in BI subjects (not significantly different)
- The likelihood of binge drinking, abstinence, alcohol-related injury, and seeking treatment was no different between the groups at 90 days.
Bottom line: Adding a brief intervention session to the routine after someone has been jailed for DUI does not appear to work. Although the study numbers are small, the number needed to show a difference appears to be pretty large, so the result is probably real. What this means is that jail does change behavior in first-time offenders, and brief intervention doesn’t add that much. I’ve always marveled at the fact that we try to modify behavior with just one counseling session. Much of the substance abuse literature indicates that ongoing counseling and support is needed for real problem users, and patients with alcohol related injuries don’t appear to be an exception.
- Brief interventions as a means to reduce problematic drinking behavior among first-time DUI arrestees: a randomized trial. AAST 2013, paper 6.
- The alcohol use disorders identification test (AUDIT)