Combination SBIRT for Emergency Department Patients Who Drink and Smoke

• Areas in need of help [ Time Frame: 3 months ]
  Descriptive summary of patient reports of areas in need of help as reported during assessments
  
  
• Barriers and facilitators to accessing care [ Time Frame: 3 months ]
  Descriptive summary of patient reports of barriers and facilitators encountered in trying to access needed alcohol and smoking cessation treatments
  
  
• Counseling satisfaction [ Time Frame: 3 months ]
  Patient reports of satisfaction with counseling modules delivered
  
  

• Treatment utilization [ Time Frame: 3 months ]
  Number of contacts with treatment resources for alcohol and tobacco cessation
  
  
• Reduction of consumption [ Time Frame: 3 months ]
  Patient self reported reductions in smoking and drinking
  
  
• Quit attempts [ Time Frame: 3 months ]
  Number of quit attempts (smoking and drinking)
  
  

Behavioral: Combined BNI
Combination brief negotiated interview (BNI) for patients who smoke and drink

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