In findings to be published in the March 2012 issue of Alcoholism: Clinical and Experimental Research and now available online, Brian Suffoletto, M.D., M.S., assistant professor of emergency medicine at Pitt, and his colleagues found that using text messaging to collect drinking data and to offer immediate feedback and support to young adults discharged from emergency rooms reduced the number of drinks they consumed and the number of binge-drinking episodes.
“Each day in the U.S., more than 50,000 adults ages 18 to 24 visit hospital emergency departments, and more than a third of them report current alcohol abuse or dependence,” said Dr. Suffoletto. “If not addressed, hazardous drinking can lead to high rates of avoidable injuries and death.” The emergency department, or ED, provides a unique opportunity to screen young adults for drinking problems and to intervene to reduce future risk, he noted. However, fewer than 15 percent of EDs at trauma centers have formal screening processes, and only 9 percent offer interventions. “That’s often because clinical staff believe they do not have the time or expertise to discuss substance abuse, and patients with acute drinking issues are not necessarily ready to have those discussions immediately,” Dr. Suffoletto added.
To address this problem, Dr. Suffoletto and his colleagues designed a first-of-its-kind trial, funded by the Emergency Medicine Foundation (EMF), to see if mobile phone text messaging—ubiquitous among college students—could be used to effectively collect drinking data, deliver feedback and change drinking behavior in young adults.
They conducted a randomized, 12-week trial of a text messaging-based program involving 45 adults ages 18 to 24 who were discharged from three urban EDs in western Pennsylvania. Surprisingly, the researchers found that almost half of the young adults who were screened indicated hazardous drinking behavior, based on their Alcohol Use Disorders Identification Test-Consumption scores—a rate that was somewhat higher than reported in other studies. Those who reported previous treatment for alcohol dependence or current treatment for any psychiatric condition were ineligible for the trial.
Over the course of the study, participants in the assessment and intervention groups reported that they drank an average of 1.6 days per week and a maximum of 3.8 drinks per drinking day.
Participants in both groups received a series of standard, automated text-message queries each week about the frequency of their drinking and quantity consumed. In the intervention group, men who reported more than five drinks during any 24-hour period and women who reported more than four received a text message expressing concern about those levels and asking if the participant would be willing to set a goal to reduce drinking for the week. Those who said yes then received messages expressing positive reinforcement and strategies for cutting down. Those who refused to set goals received a text message encouraging them to reflect on the decision (for example, “It’s OK to have mixed feelings about reducing your alcohol use. Consider making a list of all the reasons you might want to change.”) The program was based on National Institute on Alcohol Abuse and Alcoholism recommendations for alcohol interventions by a primary care clinician.
At three months, participants who were exposed to the text-message intervention had 3.4 fewer heavy drinking days in the preceding month and 2.1 fewer drinks per drinking day when compared to baseline. The assessment-only group, however, increased drinking over the course of the study, which is inconsistent with prior studies showing a reduction in drinking in patients that undergo assessments, the researchers noted. They speculated that the frequent text messaging might have raised the awareness of alcohol use by the participants and improved the accuracy of their responses.
“Because we used an automated computer system, our intervention has the ability to provide text messaging-based feedback and support at large scale with minimal cost,” said Dr. Suffoletto. “Although larger studies are still needed to verify the efficacy and feasibility of this type of program, this appears to be a promising approach that could save the lives of young adults nationwide.”
The Emergency Medicine Foundation’s research grant to Dr. Suffoletto was funded by the Century Council, a not-for-profit organization supported by distillers dedicated to fighting drunk driving and underage drinking. For more than 35 years, the EMF has funded innovative clinical and laboratory research.
Co-authors of the study are Clifton Callaway, M.D., Ph.D., Jeff Kristan, Kevin Kraemer, M.D., M.S., and Duncan B. Clark, M.D., Ph.D., all of the University of Pittsburgh School of Medicine.