Use of a Brief Negotiation Interview in the emergency department to reduce high-risk alcohol use among older adults: A randomized trial

Abstract

Objective: To determine whether a Brief Negotiation Interview (BNI) performed in the emergency department (ED) can reduce future rates of alcohol use among older adults who are high-risk drinkers. Methods: Adults aged 65 years and older in a single academic ED were screened for high-risk alcohol use based on the National Institute for Alcohol Abuse and Alcoholism definition of >7 drinks per week or >3 drinks per occasion. Eligible individuals who were high-risk drinkers who passed a cognitive impairment screener and who consented to enrollment were randomly assigned to receive the BNI versus usual care. Outcomes were assessed at 3, 6, and 12 months. The primary outcome was the rate of high-risk alcohol use at 6 months. Results: Of 2250 ED patients who were screened, 183 (8%) met the criteria for high-risk alcohol use. Of those, 98 (53%) patients met full criteria and consented to participation. Of the participants, 67% were men and 83% were non-Hispanic White. There was no significant difference in the primary outcome of high-risk alcohol use at 6 months between the BNI at 59.1% (95% confidence interval [CI], 45.5%–76.8%) and the control at 49.1% (95% CI, 36.9%–65.2%). However, there was a significant time-effect reduction in alcohol consumption and rates of high-risk alcohol use for both groups. Conclusion: Among older adults who met the criteria for high-risk alcohol use, the BNI in the ED did not result in a reduction in high-risk alcohol use at 6 months, although both groups showed significant reductions after their ED visit. Further work is needed to determine the optimal setting and time to use the BNI to impact high-risk alcohol use in this population.