Brief Motivational Intervention for Intimate Partner Violence and Heavy Drinking in the Emergency Department: A Randomized Clinical Trial

Abstract

Importance: Intimate partner violence (IPV) and heavy drinking are co-occurring public health problems, but integrated brief interventions for these conditions have not been tested.

Objective: To determine whether a brief motivational intervention provided at the time of an emergency department (ED) visit reduces IPV and heavy drinking.

Design, setting, and participants: A randomized clinical trial conducted at 2 US academic urban EDs between January 2011 and December 2014 to assess the effectiveness of a motivational intervention for IPV-involved female ED patients (ages: 18-64 years; N = 600) who exceeded sex-specific safe drinking limits. All received social service referrals; 2:2:1 to brief intervention (n = 242), assessed control (n = 237), or no-contact control (n = 121).

Interventions: A 20- to 30-minute manual-guided motivational intervention (recorded and monitored for fidelity) delivered by master's-level therapists with a follow-up telephone booster. The assessed control group received the same number of assessments as the brief intervention group; the no-contact control group was assessed only once at 3 months.

Main outcomes and measures: Incidents of heavy drinking and experiencing IPV measured over prespecified, 12 weekly assessments using an interactive voice response system.

Results: Of 600 participants, 80% were black women with a mean age of 32 years. Retention was 89% for 2 or more interactive voice response system calls. Seventy-eight percent of women completed the 3-month interview, 79% at 6 months, and 71% at 12 months. During the 12-week period following the brief motivational intervention, there were no significant differences between the intervention group and the assessed control group on weekly assessments for experiencing IPV (odds ratio [OR], 1.02; 95% CI, 0.98-1.06) or heavy drinking (OR, 0.99; 95% CI, 0.96-1.03). From baseline to 12 weeks, the number of women with any IPV in the past week decreased from 57% (134 of 237) in the intervention group to 43% (83 of 194) and from 63% (145 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 8%). From baseline to 12 weeks, the number of women with past week heavy drinking decreased from 51% (120 of 236) in the intervention group to 43% (83 of 194) and from 46% (107 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 3%). At 12 months, 43% (71 of 165) of the intervention group and 47% (78 of 165) of the assessed control group reported no IPV during the previous 3 months and 19% (29 of 152) of the intervention group and 24% (37 of 153) of the control group had reduced their alcohol consumption to sex-specific National Institute on Alcohol Abuse and Alcoholism safe drinking levels.

Conclusions and relevance: For women experiencing IPV and heavy drinking, the use of a brief motivational intervention in the ED compared with assessed and no-contact controls did not significantly reduce the days of heavy drinking or incidents of IPV. These findings do not support a brief motivational intervention in this setting.

Trial registration: clinicaltrials.gov Identifer: NCT01207258.

Conflict of interest statement

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Sommers reported receiving book royalties from FA Davis. No other disclosures were reported.

Figures

Figure 1. Flow of Female Patients Approached at Emergency Departments (EDs) to Participate in Study to Assess Effects of Intimate Partner Violence and Heavy Drinking

aOf 592 total participants included in primary analysis. bDefined as failing to complete all enrollment and any follow-up activities.

Figure 2. Participants Experiencing Intimate Partner Violence or Heavy Drinking in Assessed Control and Brief Intervention Groups

aIndicates a response of 1 or more. Using a binary outcome of any overall violence experienced, this graph presents the percentage of participants in each group who reported any experience with intimate partner violence, including any incidence of physical, verbal, emotional, and sexual abuse for the 12-week follow-up period. Experiencing intimate partner violence is defined as answering “yes” to 1 or more of the questions coded as “Victimization” on the Revised Conflict Tactics Scales assessment. bIndicates a response of at least 1 incidence. This graph presents the percentage of participants in each group who reported any heavy drinking days (≥4 drinks) during the past week for the 12-week follow-up period.