Original Research

Using Recovering Alcoholics to Help Hospitalized Patients with Alcohol Problems

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Limitations

Our study has many of the limitations of initial retrospective studies: a nonrandomized design, a study sample limited to a particular type of patient, limited follow-up data, variation in the interval from the time of the intervention to the time of follow-up data collection, reliance on self-report, and treatment groups that were not masked to the follow-up interviewers. The nonrandomized design might suggest that some of the favorable outcomes could be the result of selection bias. However, as indicated in Table 2, the baseline characteristics of the 3 groups were similar, except that women were under-represented in the peer intervention group. This finding is probably because of the limited availability of women peer volunteers during a 6-month period of time during the study. The trend towards a lower BAC in the control group suggests that patients with severe alcohol problems may be over-represented in the experimental groups. If anything, this would have biased the study results against the 2 intervention groups. However, the diagnosis of an alcohol use disorder was made using a chart audit for the control group (which did not always provide enough information to differentiate abuse from dependence), while an unstructured patient interview was used for the intervention group. Limited follow-up is a frequent problem in the patient populations used for alcohol use studies. Response rates of approximately 50% are typical. It is not clear why the follow-up rates for nonwhite patients were lower than for white subjects. We did seem to experience more problems with disconnected telephones in the nonwhite population, suggesting that there may be some economic differences between the 2 groups. We observed a significantly better follow-up rate for those in the peer intervention group. This is probably because we established contacts for follow-up directly from the patient in the intervention groups and could verify telephone numbers, but we had to rely on the medical record for the telephone numbers of the members of the control group. These numbers were not always correct. Also, we had significantly fewer family contacts in the control group. We did not record the exact timing of the follow-up after hospital discharge for each individual patient, and therefore could not compare the mean follow-up intervals between groups. However, for the reasons mentioned in the qualitative part of the results section, we do not believe that this problem would have influenced our results in any material manner. Our study was performed with trauma patients who may not be representative of other patient groups. Painful injuries and court appearances related to driving while intoxicated may be important factors that influence drinking behaviors. However, we have observed some nonsurgical patients who have benefited from peer interventions. We relied on patient self-report for outcomes and found a difference between the control and the 2 intervention groups. Although patients with alcohol use disorders may not accurately report their alcohol consumption, it is unlikely that those in the intervention groups would be more likely to report abstinence or to report initiation of treatment or self-help than those in the control group. We preferentially coded the poorest outcome information we obtained from the patient or the family member. Therefore, the source of the follow-up data had a minimal favorable impact on its accuracy. Although the follow-up interviewers knew to which group an individual patient belonged, they asked the interview questions from a printed script, to reduce observer bias to a minimum. Finally, although we obtained severity of disease data for the intervention groups (ie, abuse vs dependence) this information was not available for the control group.

Conclusions

The significant findings of our study suggest that the methods we employed should be evaluated in a well-funded rigorously designed prospective randomized study with more patients who would be objectively evaluated for the severity of their alcohol use disorder and with mechanisms to confirm and quantify the subjects’ self-reports of alcohol consumption and to ensure higher follow-up rates.

In the meantime, physicians can request that members of AA visit their hospitalized patients who have alcohol use disorders. Interventions by recovering alcoholics are not difficult to arrange, involve no costs, pose little patient risk, and might be of great benefit to some patients. We have continued to observe individual patients who were able to find sobriety following these interventions. These patients have expressed opinions that it was primarily the peers who motivated them to seek help for their problem drinking.

Acknowledgments

This work was supported, in part, by the University of Louisville Summer Research Scholarship Program and the University of Louisville Hospital Trauma Institute. We are indebted to the anonymous alcoholic members of a local self-help organization and to The Healing Place for assistance with locating volunteers to visit with our patients. We thank Karen Newton and Gail Wulfman for their assistance with the training of the volunteers. We thank Phillip Boaz, Janet Wallace, and Lance Hottman for their help with the data collection and Margaret M. Steptoe and Murphy Shields for their assistance in the preparation of this manuscript.

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