Correlates of readiness to change problem drinking among a sample of problem drinkers receiving care from an inner-city emergency department.

Background: The high rate of alcohol use among emergency department (ED) patients makes the ED setting an obvious target for increased screening and interventions. However, interventions to change alcohol behavior may be applied inappropriately if a patient's motivation to change is not factored in. In this study, we identify correlates of readiness to change problem drinking among a sample of ED patients with problem drinking.

Method: Cross-sectional study of 295 ED patients who scored positive for alcohol problems on the CAGE questionnaire (score > or = 1). Study measures include illicit drug use, exposure to violence, and having a primary care doctor as the main predictor variables and level of readiness to change problem drinking as the outcome measure.

Results: Participants were 64% African American, 30% Latino, and 80% male; 46% had less than a high school diploma; 85% were not married; 72% had no health insurance; and 85% had no primary care provider. Whereas 12% of patients were not ready to change their drinking behaviors, 47% and 41% were unsure and ready, respectively. Multiple linear regression analysis showed that only the use of illicit drugs significantly affected the likelihood of changing one's level of readiness-to-change problem drinking (P < .05). Female and married participants were also more likely to be ready to change their alcohol use behaviors.

Conclusions: Recognizing that approximately half of ED patients with problem drinking are ambivalent to changing their behaviors supports further investigation into specific clinical interventions aimed at motivating such individuals along the continuum of readiness to change. Such interventions should also incorporate strategies for addressing the co-occurrence of illicit substance use.