TOPLINE:

Among emergency department (ED) patients with alcohol use disorder, higher readiness-to-change scores were associated with increased treatment enrollment, with 47.1% enrolled within 30 days. Each one-point increase in the score raised the odds of enrollment by 15.7%, underscoring the integration of such assessments in ED workflows to improve interventions and referrals.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional analysis of 2648 ED visits from 2022 to 2023 and analyzed patients with moderate or severe alcohol use disorder (mean age, 53.94 years; 71.1% men; 67.9% Medicaid users; 67.7% White individuals).
• Before receiving any referral, patients completed a Brief Negotiation Interview as part of a long-standing ED-based alcohol intervention program led by Health Promotion Advocates. During the session, they rated their readiness to change alcohol use on a scale of 1-10 (1 indicated "not ready" and 10 indicated "very ready").
• Based on clinical severity, insurance type, and patient preference, referrals were categorized as direct (same-day placement, 42.4% of visits), indirect (resources without placement, 57.6% of visits), or declined, with 30-day follow-ups conducted to confirm treatment enrollment.
• The primary outcome was treatment enrollment within 30 days. Other analyses included a comparison of readiness-to-change scores across referral types.

TAKEAWAY:

• Overall, 47.1% of patients enrolled in treatment within 30 days.
• Direct referrals had the highest readiness-to-change scores (mean, 8.32; 95% CI, 8.20-8.44), followed by indirect (mean, 6.50; 95% CI, 6.33-6.67) and declined (mean, 5.14; 95% CI, 4.81-5.47) referrals.
• Each one-point increase in the readiness-to-change score was associated with 15.7% higher odds of 30-day treatment enrollment (adjusted odds ratio, 1.157; 95% CI, 1.093-1.220).
• The predicted probability of 30-day treatment enrollment increased from 75% at a readiness-to-change score of 6 to 81% at a score of 8.

IN PRACTICE:

"Higher readiness-to-change scores among ED patients with alcohol use disorder were associated with treatment enrollment within 30 days. Patients with higher scores were more likely to enroll in treatment programs. The findings demonstrate the value of integrating readiness-to-change assessments into routine ED workflows to guide intervention strategies and optimize referrals," the authors wrote.

SOURCE:

The study was led by Caitlin R. Ryus, MD, MPH, Yale School of Medicine, New Haven, Connecticut. It was published online on October 24, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

The study was limited by its observational design, reliance on self-reported readiness-to-change measures, potential selection bias due to limited program operating hours, and unmeasured confounders such as psychiatric comorbidities and social support.

DISCLOSURES:

The study was funded by the National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and Substance Abuse and Mental Health Services Administration. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.