Phone delivered motivational intervention for emergency department patients who report risky drinking

Background/Purpose: Hazardous drinking accounts for as much death and disability globally as tobacco and hypertension. Despite the public health mandate to disseminate early alcohol interventions, few protocols exist. We report on the feasibility of manualized phone-based brief motivational intervention delivered to 351 injured Emergency Department (ED) patients at a Level 1 Trauma Center in the Northeast. Methods: Therapist training: Interventionists were trained in motivational interviewing (MI) and the manualized protocol. The Motivational Interviewing Treatment Integrity (MITI) system and protocol adherence checklist were used to rate taped pilot calls. At least two consecutive calls following protocol had to meet criterion before the interventionist was deemed MI competent (> 3 for all MITI domains). Weekly supervision (MINT trainer) reviewed tapes. Manualized Protocol: The call provided all MI elements directed at participants' alcohol use. Calls 2 and 3 were boosters. Therapists completed treatment fidelity forms after each call and participants completed an assessment regarding the intervention. Results/Outcomes: 67% male, 31 years average age (SD = 11.46, range 18-86), 38% no insurance, 77.9% needed brief intervention (average ASSIST score 20.53, SD = 7.89, range 11-39). Phone contact rate following ED visit: Call 1, 75.4%. Treatment completion rates: Call 2 , 82.2%; Call 3, 72.8%. Range of pilot calls for MI competence: 1-13. 66% of patients received at least one call. Conclusions: Retention rates for phone delivered MI is higher than multi-session in-person delivered MI. Phone-based motivational interviewing is a feasible alternative model for delivery of an alcohol BI with broader potential reach.