A large clinical trial of emergency department motivational interventions for women experiencing alcohol abuse or relationship violence failed to discover a significant improvement over traditional care.
The finding conflicts with previous studies which found brief interventions in the emergency department (ED) setting to be effective for reducing alcohol consumption to safe levels and preventing subsequent injury among patients with hazardous drinking.
Researchers at the Perelman School of Medicine at the University of Pennsylvania found that motivational interventions in the ED with a phone follow-up did not improve care more than traditional referrals to social services among women drinkers involved in abusive relationships.
Study results appear in JAMA.
“Concerns have been raised that brief motivational interventions for heavy drinking are less effective in women and in victims of violence; our results support those concerns,” said lead author Karin Rhodes, M.D., director of the Center of Emergency Care Policy & Research in the department of Emergency Medicine at Penn.
“Hopefully our results will serve as a catalyst for further testing to see if a more intensive version of the intervention, provided in a different setting, for a longer period of time might be effective. Relationship violence and heavy drinking are two risk factors that commonly occur together, and have highly negative consequences for individuals, as well as their families and communities. We have to keep working on solutions to these problems.”
In the study, women seen in the ED for either excessive drinking or for relationship violence, received a 20-30 minute motivational intervention, delivered by master’s-level therapists, in addition to a follow-up phone call. Results from this intervention were compared to traditional care provided to a control group in which women were referred to social service resources.
For the program to be assessed as having had a positive effect, those who participated in the intervention would have achieved statistically better results on the variables being measured than those who did not receive the intervention. In the study, women received benefit from both the motivational intervention and from traditional social services.
Specifically, 12 weeks after the intervention, the number of women with any episodes of past-week partner violence declined from 57 percent to 43 percent in the intervention group, and from 63 percent to 41 percent in the control group. Past-week heavy drinking decreased from 51 percent to 43 percent in the intervention group, and from 46 percent to 41 percent in the control group.
The study also found that over time, both victimization and perpetration of partner violence and days of heavy drinking decreased significantly across intervention and control groups alike. At 12 months after the enrolling in the study, over 45 percent of women reported no incidents of partner violence in the previous three months and 22 percent had reduced their alcohol consumption to safe drinking levels.
However, there was no evidence that these outcomes were influenced by the intervention. Nor was there any evidence that frequent assessments served as an intervention compared to baseline screening and referral alone.
The all-Penn team of researchers found that 86 percent of study participants were also assessed as clinically depressed, the majority lived at or below the poverty level, 43 percent had histories of childhood sexual abuse, and 40 percent had post-traumatic stress disorder.
“Clearly the population we studied had a very difficult set of psychosocial problems,” said Rhodes.
“Broadening the intervention to address multiple co-occurring risk factors in the context of violence exposure may require a more in-depth and longer approach than can be feasibly provided in an ED setting.”
Source: University of Pennsylvania