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NHTSA People Saving People

Technology Transfer Series

Number 275, June 2002


In 2000, 40 percent of vehicle fatalities were alcohol-related in the United States. Physicians, particularly trauma physicians working in emergency departments (ED) and trauma centers, are in an excellent position to intervene with patients at high risk for crash injury due to their alcohol use. Even when patients are admitted to the ED for reasons other than a motor vehicle crash, many have alcohol abuse or dependence problems. Their time in the ED presents an opportunity when they can be screened for the need for further evaluation and possible treatment.

The Carolinas HealthCare System conducted a study for the National Highway Traffic Safety Administration (NHTSA) to determine whether using an ED screening tool would result in more patients pursuing treatment for their alcohol abuse problems.

Participants in the Study

Participants of this study were patients entering the emergency department between 10 am to 10 pm at two North Carolina Emergency Departments (Carolinas Medical Center and the Pitt County Memorial Hospital) due to injuries caused in a motor vehicle crash. The patients were 18 years and older. Data were collected for one year.


Research assistants approached ED patients and asked whether they would be willing to answer a few questions. If they said yes, participants were asked questions concerning their motor vehicle crash risk, including a set of questions called the TWEAK. The TWEAK is a validated alcohol screening tool that can be administered in a few minutes to identify individuals who may be alcohol dependent.

Those who were scored as positive for alcohol dependence on the screening tool were randomly assigned to either a brief intervention group or the control group.

TWEAK questions to identify individuals who may be alcohol dependent. TWEAK stands for... Tolerance..... Worried..... Eye opener..... Amnesia.....Kut-down

  • How many drinks does it take before you begin to feel the first effects of alcohol?
  • How many drinks does it take before alcohol makes you fall asleep or pass out?
  • Have your friends or relatives worried or complained about your drinking in the past?
  • Do you sometimes take a drink in the morning when you first get up?
  • Are there times when you drink and afterwards you can't remember what you said or did?
  • Do you sometimes feel the need to cut down on your drinking?

Brief Intervention

The brief intervention consisted of an empathic, direct intervention whereby the researcher told the patient that he or she was in a high risk group for alcohol-related problems and there was reason for concern. The researcher then recommended that the subject go for a more complete assessment to determine if treatment would be appropriate. For those who agreed to an assessment, the researcher assisted them with making an appointment.

Attempts were made to contact all subjects three months hence and again six months after their ED visit to see if they had, in fact, attended an assessment session.


During the follow-up interviews, participants were also asked whether they had been in a subsequent motor vehicle crash (either as a driver or otherwise). Seven participants, all from the control group or those who declined the offer of an assessment, had been in a subsequent crash.

The numbers of patients in the final study groups were too small to permit multivariate analyses.


A number of patients who came to the Emergency Departments in this study appeared to be at high risk for alcohol dependence. The number of patients reached with a brief intervention could likely be increased if the intervention were not conducted under research guidelines requiring a standardized script and other controls. Brief interventions by emergency department or other health professionals have the potential to increase the number of high risk individuals who seek assessment and treatment for their alcohol dependence. For those patients in this study who were randomized to the intervention protocol, there was a 5 times greater chance that they would receive a formal evaluation over those patients treated with the current standard of care who receive no ED intervention.

Conducting brief interventions in emergency departments provides a unique opportunity to reach at-risk individuals who might otherwise not be in contact with health professionals.


For a copy of Identification and Referral of Impaired Drivers Through Emergency Department Protocols, write to Research and Traffic Records, NHTSA, NTS-31, 400 Seventh Street, S.W., Washington, DC 20590, or send a fax to (202) 366-7096. Jonathan Walker, Ph.D., and Amy Berning were the contract managers for this study.

U.S. Department
of Transportation
National Highway
Traffic Safety

400 Seventh Street, S.W. NTS-31
Washington, DC 20590

Traffic Tech is a publication to disseminate information about traffic safety programs, including evaluations, innovative programs, and new publications. Feel free to copy it as you wish.

If you would like to receive a copy contact:

Linda Cosgrove, Ph.D., Editor, Evaluation Staff
Traffic Safety Programs
fax (202) 366-7096