Drug and Alcohol Dependence 77 (2005) 205–208
The half-life of the ‘teachable moment’ for alcohol misusing
patients in the emergency department
, Adrian Brown
, Robert Patton
, Michael J. Crawford
, Robin Touquet
Department of Accident and Emergency Medicine, St Mary’s Hospital, Praed Street, London W2 1NY, UK
Central and North West Thames Mental Health Trust, Paterson Centre, 20, South Wharf Road, London W2 1PD, UK
Department of Psychological Medicine, Faculty of Medicine, Imperial College London, Paterson Centre, 20, South Wharf Road, London W2 1PD, UK
Received 5 March 2004; accepted 23 July 2004
Background: To determine whether the length of time between alcohol-related attendance in the emergency department (ED) and follow-up
appointment with an alcohol health worker (AHW) alters attendance rate at the AHW clinic.
Methods: We examined paper and computerized records made by AHWs over a 4-year period, collecting data on the length of time between
identiﬁcation of alcohol misuse and the appointment with the AHW, and whether the appointment was kept.
Results: There is an inverse relationship between the length of time between identiﬁcation of alcohol misuse and AHW appointment and the
subsequent likelihood of keeping that appointment.
Conclusions: To maximiseattendanceratesatAHWclinics, the delay between the identiﬁcation and interventionfor alcohol misusing patients
must be kept to a minimum, preferably giving an appointment on the same day as the attendance in the ED.
© 2004 Elsevier Ireland Ltd. All rights reserved.
Keywords: Alcohol misuse; Emergency departments; Screening; Brief intervention; Teachable moment
Excessive alcohol consumption has well-documented ad-
verse effects on health and is commonly associated with pre-
sentation to emergency departments (EDs) (Cabinet Ofﬁce,
Prime Minister’s Strategy Unit, U.K., 2004).
Initial detection of alcohol misuse followed by briefinter-
ing alcohol intake and lowering levels of ED re-attendance
1999; Longabaugh et al., 2001); howeverthe initial detection
and subsequent BI were carried out by research workers, as
opposedto by ED staffthemselves.Practical problems incar-
rying out opportunistic screening in EDs (Peters et al., 1998)
can be mitigated by audit, education and feedback (Huntley
et al., 2001), and by the use of a robust pragmatic focused
Corresponding author. Tel.: +44 20 7886 1200; fax: +44 20 7886 6366.
E-mail address: email@example.com (R. Touquet).
screening tool, e.g. the Paddington Alcohol Test (PAT), used
by ED staff themselves (Patton et al., 2004a; Crawford et
al., in press). Other brief questionnaires designed for use in
EDs include the FAST (Hodgson et al., 2003) and RAPS4
(Cherpitel, 2000); however, their use was by research work-
ers and has not been combined with reviewing attendance
rates for subsequent BI.
Since 1994, we in the ED of St Mary’s Hospital, London,
have used the PAT (Smith et al., 1996; Huntley et al., 2001;
Patton et al., 2004a,b) to screen patients for hazardous lev-
els of alcohol misuse. Patients who screen positive are told
gently that they are drinking alcohol at a level that may be
harmful to their health and are offered an appointment with
an alcohol health worker (AHW) (Patton et al., 2003). Of
those who keep the appointment, our pilot data showed that
two-thirds reported reducing their level of alcohol consump-
tion(Wrightet al., 1998), the AHW attendingdailyandbeing
routinely involved in education and feedback. However, the
issue of timing of BI following attendance at the ED and its
0376-8716/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved.