Text-message-based drinking assessments and brief interventions for young adults discharged from the emergency department.
Suffoletto B., Callaway C., Kristan J. et al. Alcoholism: Clinical and Experimental Research: 2012, 36(3), p. 552–560.

For the first time this US study tried mobile phone text messaging as a way to moderate the hazardous drinking of young adults screened at emergency departments. Compared to merely monitoring, text-based advice did cut drinking – but why did the monitoring-only patients actually start to drink more?

Summary
Though recommended for US emergency departments, few have implemented formal screening to identify risky drinkers and even fewer then offer brief interventions in the form of short sessions of advice or counselling to reduce risk. Conducting brief intervention via a standardised mobile phone text messaging procedure could help overcome resistance from clinical staff who feel they have neither the time nor the expertise to discuss substance use with patients, and permit low-cost, large-scale implementation. For young adults in particular, text messaging may be preferable to face-to-face counselling.

This pilot study aimed to test the feasibility of brief text-message interventions for young adults identified as risky drinkers in emergency departments, and to gauge the impact to help guide the design of a larger study. It was conducted at three US emergency departments and trauma centres in Western Pennsylvania, where in 2010 research assistants asked 109 (all but three agreed) 18–24-year-old patients to complete a computerised screening assessment of their drinking over the past three months based on the Alcohol Use Disorders Identification Test-Consumption Questions (AUDIT-C). This assessment consist solely of questions about drinking, not about its consequences which may not yet be evident among young people.

About half (52) the 106 respondents screened positive for hazardous drinking, of whom 45 met criteria for the study, agreed to join it, and completed further baseline assessments of (inter alia) their drinking and related problems. Nearly two thirds were women and just 15% were unemployed. Their screening responses indicated that most drank at least twice a week and nearly half drank at least six standard US drinks on a single occasion at least once a month. All were advised they could have significant problems related to their drinking and encouraged to talk to their doctors, and were sent and encouraged to read an alcohol advice booklet after discharge.

All further intervention occurred via text messaging over the 12 weeks after the patients had been discharged. The 45 participants were randomly allocated to three groups of 15. One set (the control group) were simply texted reminders about the final assessment to be e-mailed to them 12 weeks after they had been recruited to the study. Another 15 (the assessment-only group) were weekly texted two questions, one about how often they had drunk over the past week, the other about their maximum single occasion consumption.

The final 15 (the intervention group) were sent the same questions, but an automated process then responded with texts depending on their answers. Those who had not drunk were congratulated, while those who had drunk moderately were told they were not drinking at a dangerous level and offered brief information about the risks of drinking. Full intervention was reserved for the (on different weeks) roughly 10–50% whose text responses indicated heavy single-occasion drinking over the past week. They were texted a message expressing concern over their drinking and asked if they would be willing to aim this week to drink moderately. Those who were willing were texted a reinforcing message followed by computer-selected strategies for cutting down, such as keeping track of their drinking, setting goals, pacing and spacing, eating at the same time, finding alternatives, avoiding 'triggers', planning ways to handle 'urges', and refusing drinks. Those unwilling to aim to drink moderately were prompted to reflect on their decision by texts such as: "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."