U.S. Latino Patients Cut Down Binge Drinking After Receiving AB-CASI

The number of binge drinking episodes was significantly reduced within a year in Latino emergency department patients in the United States who received automated bilingual computerized alcohol screening and intervention (AB-CASI) compared to those who received standard care for unhealthy drinking.

According to a study published in JAMA Network in May, findings suggest that AB-CASI is a viable tool that overcomes known procedural barriers to emergency department screening, brief intervention, referral to treatment and directly addresses alcohol-related health disparities.

In 2019, U.S. emergency departments had more than 150 million visits — more than 26 million being Latino patients. Of the more than 26 million, more than 5.1 million visits were categorized as alcohol misuse, abuse or dependence, according to data from the National Hospital Ambulatory Medical Care Survey.

Alcohol use disorders have a high disease burden among U.S. Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing —leading to high rates of chronic liver disease and cirrhosis-related death.

A recent systematic review and meta-analysis reported that emergency department screening, brief intervention, and referral to treatment (ED-SBIRT) was associated with a small reduction in drinking. While perceived barriers of standard care have included practitioner time burden, personnel cost, and maintenance of intervention fidelity.

On top of that, the inability to deliver the intervention in the patient’s preferred language is crucial to care. Without a meaningful patient to physcician discussion about unhealthy alcohol use and disease prevention, it’s a failed endeavor, authors of the JAMA study said. The inability to provide ED-SBIRT easily and readily in a language other than English limits the reach of prevention efforts.

Authors expressed the need for effective bilingual and culturally adapted brief interventions to identify and reduce disease burden. To do so, researchers in the study compared the effectiveness of an AB-CASI digital health tool with standard care for the reduction of alcohol consumption among U.S. adult Latino emergency department patients with unhealthy drinking.

In the bilingual, unblinded parallel-group, and randomized clinical trial, 840 self-identified adult Latino patients with unhealthy drinking habits were observed from October 29, 2014, to May 1, 2020. Patients were in the emergency department of a large urban community tertiary care center in northeastern U.S. that was verified as a level II trauma center by the American College of Surgeons.

Of the 840 Latino patients, 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. Majority were of Puerto Rican descent (697), according to the study.

At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups.

The effect of AB-CASI was modified by age. After a year, the reduction rate in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years compared with an increase of 40% in participants 25 years or younger.

Dr. Federico Vaca, University of California, Irvine professor of emergency medicine and lead author of the study, said in UCI News that this study is the first bilingual, large-scale, emergency department-based, randomized clinical trial of its kind in the country focused on English- and Spanish-speaking Latino participants.

“Our aim was to overcome well-known barriers to alcohol screening and intervention from the emergency department while addressing the high disease burden and health disparities related to alcohol use disorders in this population,” Vaca said. “This tool offers considerable promise in addressing alcohol-related health disparities and should be considered for routine emergency department screening and intervention, as we know that incremental sustained reductions in alcohol use can benefit both individual and public health.”

Though the intervention shows success, the study does have limitations. First, trial enrollment occurred only at one emergency department in a large urban community. Second, enrolled participants were predominantly of Puerto Rican descent. Consideration of variability in cultural stressors within different U.S. Latino subgroups could be relevant to interpretation of the findings. Lastly, while the participant retention was successful, researchers are not able to comprehensively account for all outcomes among those unavailable for follow-up at some point after the initial baseline assessment.