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A Single Conversation for Change

It seems a single conversation can go a long way in changing harmful behavior.  As reported in the Annals of Emergency Medicine this past August.  Patients presenting to emergency departments identified as hazardous drinkers (men drinking more than 14 drinks weekly, women more than 7 and anyone over the age of 65).  Individuals were identified through standard screening in the emergency department.  The prospective study included 889 individuals.  Those who were identified as alcohol dependent were excluded from the study.  Patients were divided into intervention groups and standard of care.  One year follow up showed little change in drinking patterns in the standard of care group and at least a 1/3 reduction in drinking in the intervention group. 

The intervention was a brief negotiation interview.  This standardized instrument was conducted by one of the hospital staff.  Elements of the interview reviewed current drinking patterns, readiness for change and resources for change.  Patients were also engaged in a prescription or contract for change.

I feel it is too easy to forget how much a single visit or conversation can impact someone’s life at the right time.  Perhaps it is because they were engaged in the ER and some were there because of their drinking that it seems there was a cardinal moment for change.  I believe that even in the context of a standard office visit this is possible.  This could potentially be useful for other harmful behaviors.  It is critical to screen for all harmful behavior at the office visit and address them at the moment.

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