Hospital-based and health-based interventions for alcohol treatment

Individualized alcohol treatment plans enable people in alcohol recovery to focus on their physical health as it relates to their alcohol consumption.

Individuals who practice unhealthy drinking habits often end up as patients in hospitals – for drinking-related accidents and health problems, among other reasons. This time in the hospital may serve as an eye-opener or “teachable moment” for convincing patients to decrease unhealthy drinking behavior. However, studies of brief hospital-based interventions have shown that such interventions are not always successful. A team of researchers based at the VA Puget Sound Health Care System hypothesized that hospital-based interventions for alcohol treatment might be more successful if they were based on the associations between drinking and poor physical health (Williams et. al., 2010).

Participants in the current study were 341 medical inpatients who screened positive for unhealthy alcohol use and agreed to participate in a randomized trial of hospital-based brief intervention for alcohol treatment. The researchers identified five measures of physical health as independent variables. Outcomes measured in the study were either abstinence or number of heavy drinking days in the 30-day period before the follow-up, which occurred 3 months after hospitalization.

Results showed that measures of physical health were not associated with abstinence or heavy drinking days. Non-dependent patients and patients with a low alcohol problem perception at baseline who had an alcohol-attributable diagnosis as the primary cause of admission had significantly fewer heavy drinking days. However, alcohol dependent individuals and those with a high problem perception did not display an association between alcohol-attributable admitting diagnosis and number of heavy drinking days. The authors conclude that alcohol-attributable illness may catalyze decreased unhealthy drinking among hospital patients who are not dependent on alcohol and who do not see their drinking as problematic. Thus, the authors suggest, interventions that focus on alcohol-related illness might be more successful for these patients.

“On one hand, it may be the first time that a patient realizes that their drinking is responsible for a very serious illness or event requiring acute hospital care,” said lead author Emily C. Williams of the VA Puget Sound Health Care System. “On the other hand, there are people who continue to drink heavily despite knowing the consequences associated with it. For the former group, hospitalization may serve as a strong impetus of change whereas, for the latter group, hospitalization may be met with a neutral attitude (or worse) toward change.”

This study suggests that alcohol treatment providers should not always assume that all patients are aware of the link between alcohol consumption and health problems. Indeed, learning about associated health problems may provide the motivation to change for some individuals.

“This study offers suggestions regarding the content of hospital-based brief interventions,” Williams continues “If physical health is important to the patient, and they see the connection between physical health and their drinking, counseling interventions that make sure to include covering such topics could make the interventions more effective. Also, if the patient links his/her drinking with his/her physical health, they may be willing to follow-up with care in settings where medical and alcohol care are integrated, which could lead to improved outcomes.”

Williams EC, Palfai T, Cheng DM, Samet JH, Bradley KA, Koepsell TD, Wickizer TM, Heagerty PJ, Saitz R. Physical health and drinking among medical inpatients with unhealthy alcohol use: a prospective study. Alcoholism: Clinical and Experimental Research. Early view published online 4 May 2010

http://www3.interscience.wiley.com/journal/123415867/abstract