A large randomized clinical trial of an emergency department (ED)-based program aimed at reducing incidents of excessive drinking and partner violence in women did not result in significant improvements in either risk factor, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania. Contrary to previous studies which found brief interventions in the ED setting to be effective for reducing alcohol consumption to safe levels and preventing subsequent injury among patients with hazardous drinking, the new study did not find a positive result among women drinkers involved in abusive relationships. Results are available in the August 4th issue of JAMA.
"Concerns have been raised that brief motivational interventions for heavy drinking are less effective in women and in victims of violence; our results support those concerns," said lead author Karin Rhodes, MD, director of the Center of Emergency Care Policy & Research in the department of Emergency Medicine at Penn. "Hopefully our results will serve as a catalyst for further testing to see if a more intensive version of the intervention, provided in a different setting, for a longer period of time might be effective. Relationship violence and heavy drinking are two risk factors that commonly occur together, and have highly negative consequences for individuals, as well as their families and communities. We have to keep working on solutions to these problems."
For the program to be assessed as having had a positive effect, those who participated in the intervention would have achieved statistically better results on the variables being measured than those who did not receive the intervention. However, similar to other research with women who are involved in violent and abusive relationships, the new study -- which involved 20-30 minute motivational intervention sessions, delivered by master's-level therapists with a follow-up phone call -- found that both excessive drinking (defined as greater than or equal to four drinks per day) and incidents of partner violence (as either a victim or perpetrator) declined in both the intervention group that received the program and a control group whose members just received referrals to social service resources.
Specifically, twelve weeks after the intervention, the number of women with any episodes of past-week partner violence declined from 57 percent to 43 percent in the intervention group, and from 63 percent to 41 percent in the control group. Past-week heavy drinking decreased from 51 percent to 43 percent in the intervention group, and from 46 percent to 41 percent in the control group.
The study also found that over time, both victimization and perpetration of partner violence and days of heavy drinking decreased significantly across intervention and control groups alike. At 12 months after the enrolling in the study, over 45 percent of women reported no incidents of partner violence in the previous three months and 22 percent had reduced their alcohol consumption to safe drinking levels. However, there was no evidence that these outcomes were influenced by the intervention. Nor was there any evidence that frequent assessments served as an intervention compared to baseline screening and referral alone.
The all-Penn team of researchers found that 86 percent of study participants were also assessed as clinically depressed, the majority lived at or below the poverty level, 43 percent had histories of childhood sexual abuse, and 40 percent had post-traumatic stress disorder. "Clearly the population we studied had a very difficult set of psychosocial problems," said Rhodes. "Broadening the intervention to address multiple co-occurring risk factors in the context of violence exposure may require a more in-depth and longer approach than can be feasibly provided in an ED setting."
Materials provided by Perelman School of Medicine at the University of Pennsylvania. Note: Content may be edited for style and length.
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