FROM JAMA

A brief motivational intervention was unsuccessful for reducing heavy drinking or intimate partner violence in women seeking emergency department (ED) treatment for related injuries, according to a report published online in JAMA.

The hope was that encouraging women to both reduce their drinking and redirect their aggression toward their partners would decrease episodes of alcohol- and violence-related injury, said Dr. Karin V. Rhodes of the Center for Emergency Care Policy and Research and the School of Social Policy and Practice, University of Pennsylvania, Philadelphia, and her associates. The intervention entailed a face-to-face, manual-based discussion conducted in a secure ED location, followed by a telephone “booster” discussion 10 days later.

The intervention relied on reflective feedback, avoidance of confrontation, respect, empathy, and empowerment techniques to elicit the patient’s self-identified reasons for change and personal goals. The discussions centered on identifying links between drinking and violence, resolving any patient ambivalence about changing her behaviors, and supporting the patient’s autonomy and personal choice.

Such brief motivational interventions – 20- to 30-minute interactions with trained clinicians – have proved effective in the ED setting at reducing alcohol consumption and alcohol-related injuries in men who abuse alcohol.

“We did find that over time, reports of experiencing and perpetrating [intimate partner violence] and days of heavy drinking decreased significantly within the intervention and the control groups alike. However, there was no evidence that these outcomes were influenced by the intervention, the researchers said. At both 3-month and 12-month follow-ups, patient reports of episodes of heavy drinking and intimate-partner violence declined in all three study groups.

During a 2-year period, 592 women who sought treatment at two urban academic EDs agreed to participate in the study. The participants’ mean age was 32 years, and 43% disclosed a history of child sexual abuse, 40% screened positive for PTSD, and 85% screened positive for depression.

The women were randomly assigned to the brief intervention (239 patients), a control group that didn’t receive the intervention but did undergo periodic assessments of drinking and violence episodes (232 “assessed” controls), or a no-contact control group who were assessed only once at 3 months to determine if their drinking/violence episodes had improved (121 no-contact controls). All the women received usual care and a standard list of social services resources at the index ED visit.

At baseline, 51% of the intervention group and 46% of the assessed control group reported heavy drinking during the preceding week, which decreased to 43% and 41% at 3 months. Similarly, at baseline 57% of the intervention group and 63% of the assessed control group reported intimate partner violence during the preceding week, which decreased to 43% and 41% at 3 months, the investigators said. ( JAMA. 2015 Aug 4. doi: 10.1001/jama.2015.8369. )

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