Using Recovering Alcoholics to Help Hospitalized Patients with Alcohol Problems
The results for the main outcome measures of the 3 groups are shown in Table 3. The data reflect the fact that 7 patients drank for several weeks following hospital discharge but then abstained from drinking. As hypothesized, the success rates were greatest in the peer intervention group, followed by the brief intervention and control groups. All 3 outcomes showed statistically significant differences across groups. In terms of pairwise comparisons, the comparison between the control group and the peer intervention group met the Bonferroni criterion of 0.0167 for both abstinence for 6 months following hospital discharge (P=.013) and abstinence during the sixth month following hospital discharge (P=.007). For initiation of treatment or self-help, the comparisons of the peer group with both the control group and the brief intervention group were significant using the Bonferroni criterion (P <.001 in both cases).
Stratifying by sex yielded results that were not materially different from those presented in the Table (P=.016 for 6 months of abstinence; P=.007 for abstinence at during the sixth month; and P <.001 for initiation of treatment or self-help). Stratifying by BAC also did not affect the P values in any material way (data not shown).
Because of inconsistencies between the data from the 2 parts of the study and because of missing or unrecorded data, we can only make qualitative statements about other outcomes. No patient who was completely abstinent for the entire 6 months following hospital discharge had began drinking again by the time of the telephone interview. Many patients in the intervention groups (approximately a third) drank after hospital discharge and continued to drink up to the time of the follow-up interview, although a few of these patients claimed to have cut down. Only a few patients initially abstained from alcohol but returned to drinking at the time of follow-up. Most of the follow-up information came from the patient, our preferred source for outcome data. No patient who claimed to be abstinent had a family member who contradicted that report. However, several patients admitted to drinking (or using drugs) who had a member of the family who reported that the patient was abstinent. In those cases in which a family member could be located but the patient could not, it was usually because the patient was still drinking, living on the streets, or had no telephone. It was rare that the family member reported a favorable outcome (ie, abstinence), and we could not confirm this directly with the patient.
Several patients in the peer intervention group expressed gratitude for the help they received with their drinking problems while in the hospital and especially for the visits by the peers. Some of these patients dramatically changed their lives. At least 3 patients in the peer intervention group went from being unemployed and homeless to full-time employment and having a permanent residence after they entered a treatment program and became involved in AA. They credited the peer intervention as being the most important factor that motivated them to seek help for their alcohol use disorder. At the time this manuscript was being prepared, one of these individuals was serving as a volunteer making visits to hospitalized patients with drinking problems.
Discussion
Previous studies have shown that brief interventions by professionals appear to help motivate patients to reduce drinking. Our study demonstrates that peers may help motivate patients to initiate treatment or self-help as well as promote abstinence. Brief physician advice followed by a visit with a volunteer from AA shows promise as a simple, practical, inexpensive, and effective intervention that may help to prevent patients from returning to alcohol use. This could lead to reductions in recurrent injuries for patients hospitalized with alcohol-related injuries.
Primary care physicians could use this approach to intervene with any patient hospitalized with alcohol-related problems. At our institution, peer volunteers are often called to visit patients with substance use disorders who are hospitalized by the surgery, medicine, family medicine, and psychiatry services. We used trauma patients, because there is a large volume of such patients at our institution who routinely have had toxicology tests performed on admission. Also, an existing trauma registry database facilitated the collection of patient data.
Many primary care physicians already possess the skills required to give patients brief advice about harmful lifestyles and are familiar with the use of community resources that can help their patients. Most communities that are large enough to have a hospital are large enough to support several AA groups. As part of the AA program, members are expected to carry the message of AA to alcoholics who are still drinking. They consider this Twelfth Step Work an essential part of the program that leads to personal progress in AA. Most physicians can easily identify patients who could benefit from hearing the message of AA. It is often not difficult to link up these 2 groups of individuals.29 The local AA office can be called from the patient’s bedside telephone. After the physician explains the situation to the person who answers the call, the telephone can then be given to the patient. If the patient agrees, a member of AA may come to the hospital for a visit. These visits typically last 30 minutes to an hour. Sometimes the AA member may visit again during the patient’s hospital stay or at the time of discharge to escort the patient to an AA meeting. This service is provided without cost to the patient, the patient’s insurance carrier, or the hospital.
