The qualities of a "teachable moment" are complicated, said Emily C. Williams, research project director at the VA Puget Sound Health Care System and corresponding author for the study. "On one hand, it may be the first time that a patient realizes that their drinking is responsible for a very serious illness or event requiring acute hospital care," she said. "On the other hand, there are people who continue to drink heavily despite knowing the consequences associated with it. For the former group, hospitalization may serve as a strong impetus of change whereas, for the latter group, hospitalization may be met with a neutral attitude (or worse) toward change."

This is an important issue to address because of the large number of patients and substantial healthcare resources that are involved, added Daniel Kivlahan, director of the Center of Excellence in Substance Abuse Treatment and Education at the VA Puget Sound Health Care System, and associate professor in the department of psychiatry and behavioral sciences at the University of Washington.

"Most providers in inpatient medical settings will see patients similar to those sampled for this study, and we need more evidence about better ways to recognize and address the clinical needs of this diverse group of patients," said Kivlahan. "Hospitalizations need to be considered part of the continuum of integrated healthcare with implications for post-hospital follow-up, rather than isolated events."

Researchers recruited 341 adult medical inpatients from a university medical center (242 men, 99 women) — who self-reported "risky drinking" during the previous month — based on their initial hospital screening. Participants were then enrolled in a randomized trial of brief alcohol counseling, and interviews were conducted at enrollment as well as three months after hospitalization. Information on five measures of physical health was gathered, and compared to two outcomes: abstinence and number of heavy drinking days three months later.

"We found that among inpatients with unhealthy alcohol use whose drinking is less severe — those not dependent on alcohol and those reporting low levels of problem perception — alcohol-attributable illness may serve as a strong catalyst of changes in drinking," said Williams. "As such, alcohol-attributable illnesses could become a focus of hospital-based brief counseling interventions.

"This study provides an important alert to providers that they should not assume that patients recognize a link between their alcohol use and their alcohol-related medical diagnoses," said Kivlahan. "Although most patients may be aware of this link that is typically obvious to providers, a small subset of patients may benefit from having it addressed directly during the hospitalization."

Both Williams and Kivlahan noted the relevance of these findings for helping providers recognize a need for conversation about ways to improve hospital-based brief interventions for patients with unhealthy alcohol use.

"This study offers suggestions regarding the content of hospital-based brief interventions," said Williams. "If physical health is important to the patient, and they see the connection between physical health and their drinking, counseling interventions that make sure to include covering such topics could make the interventions more effective. Also, if the patient links his/her drinking with his/her physical health, they may be willing to follow-up with care in settings where medical and alcohol care are integrated, which could lead to improved outcomes."

"For clinicians, it is worth noting that most of these patients at risk due to unhealthy alcohol use did not have alcohol-attributable medical diagnoses, and only 15 percent had such a diagnosis listed as the primary reason for admission," said Kivlahan.

"Further, even though more than one in five reported abstinence at a three-month follow-up, this was not reliably associated with self-reported worse health after other explanatory variables were considered. Thus, we can see that medical hospitalization is not a sufficient factor to eliminate heavy drinking for many patients. We need to replicate these results under circumstances more similar to clinical practice and with larger samples in the subgroups of interest."

Science Daily reports that in the first evaluation of its kind, the study published in Addiction found that problem drinkers provided access to the online screener www.CheckYourDrinking.net reduced their alcohol consumption by 30% (six to seven drinks weekly), rates that are comparable to face-to-face interventions. This result was sustained in both the three- and six-month follow-up.

Problem drinking is a major cause of preventable deaths in Canada as well as morbidity, trauma and violence, yet many of those who struggle with problem alcohol use will never seek treatment. A recent general population survey indicated that 81% of problem drinkers in Canada have Internet access, and about a third indicated that they would be willing to seek intervention via the web.

Brief Internet-based interventions for problem drinkers are promising, and fill a gap in the services available to problem drinkers, according to principal investigator, Dr. John Cunningham Senior Scientist with the Social and Community Factors in Prevention Research Section, CAMH.

"An unfortunate reality is that many problem drinkers do not seek treatment. While getting help from a health care professional is ideal, there are barriers to access such as concerns about stigma, a desire to handle problems on one’s own, or simply because treatment is not readily available—online interventions can help reduce these barriers by allowing people to seek help in their own homes,” Dr. Cunningham said.

By analyzing self-report data, the website provides problem drinkers with a report that compares their alcohol intake to the national average and informs them of the physical and health risks associated with their drinking patterns. The report also calculates the amount of money spent on alcohol annually and how much of their time is spent under the influence each year. Safer drinking guidelines are also provided to website users.

"The Check Your Drinking online screener provides participants with a wealth of information about their drinking, its consequences, and how they compare to others," said Dr. Cunningham. "When presented these facts in a non-judgmental manner, participants are able to re-evaluate their drinking and may be motivated to reduce their alcohol consumption."

A comparison of the effects of two interventions on DWI recidivists with alcohol problems found that one—Brief Motivational Interviewing (BMI)—was more effective. Results will be published in the February 2010 issue of Alcoholism: Clinical & Experimental Research.

"Traffic crashes contribute more to morbidity in teenagers and young adults than any other cause, and DWI contributes to about a third of the overall toll," explained Thomas G. Brown, assistant professor in the department of psychiatry at McGill University and principal investigator for the study.

"In dollar terms on a yearly basis, total estimated loss due to DWI is estimated at five percent of the gross national product of Canada. This is a staggering figure, associated with a huge amount of personal suffering and loss, and is all the more tragic given that DWI is preventable,” Brown said.

Sandra C. Lapham, senior scientist and director of the Behavioral Health Research Center of the Southwest in Albuquerque, New Mexico, said the problem is equally huge in the United States.

"Approximately 1.5 million people are arrested in the U.S. each year for this crime," she said. "About one in three to one in five convicted offenders will repeat the offense, and repeat offenders are more likely than other drivers to cause alcohol-related crashes."

"While probably the majority of drivers who are arrested and ultimately convicted for DWI will take appropriate measures to not drive again after recent use of alcohol and drugs, so-called DWI recidivists contribute to a disproportionate amount of the carnage occurring on our roads," said Brown.

"As well, many recidivists do not participate in the DWI evaluation and remedial programs that are an obligatory part of regaining their licenses in most jurisdictions. Unfortunately, there is relatively little research about these individuals’ characteristics and the measures that could be taken to reduce their risk, as most research is conducted with drivers who are participating in intervention programs."

Brown and his colleagues divided 184 male and female recidivists with drinking problems and not currently engaged in DWI intervention into two groups: 92 (86 men, 6 women) received a 30-minute BMI session, a brief but powerful psychosocial intervention where the client was encouraged to review personal reasons for change; 92 (79 men, 13 women) received a 30-minute "control" intervention, where the client received information about the hazards of excessive drinking related to health and DWI. Outcomes measured at six- and 12-month follow-ups included percent of risky drinking days in the preceding 6 months, biomarkers of alcohol abuse, and alcohol abuse-related behaviors.

"The drivers we studied may be among the most dangerous drivers, what some authorities call ‘hardcore drunk drivers,’" said Brown. "We figured that an intervention tailored to their specifications would have to be very brief, something that could be applied opportunistically, say at the time of a court appearance. Our results indicated that BMI, compared to the control procedure, was superior in reducing by around 30 percent the number of risky drinking days for up to a year after receiving the intervention. A risky drinking day is when an individual drank enough on a given day that he or she would probably be impaired if they were to drive shortly after."

As for why the BMI intervention was more effective than the control intervention, Lapham responded: "We all have inner conflicts, but these conflicts between how we act and how we would like to be are sometimes not obvious to us. BMI techniques expose these conflicts and allow the person to be more aware of how their harmful alcohol use is at odds with their self image; in other words, how their behavior sabotages their own personal goals for the future. Some interventions try to lead the person into setting goals developed by the therapist, whereas BMI allows the person to fashion his or her own agenda: uncover their own reasons, and motivations, for changing, and set their own goals."

"What is new here is that this may be the first published report of a beneficial effect of a very brief version of MI with individuals who are not in a clinical setting, not particularly motivated to reconsider their drinking (as an individual in an emergency room following an injury might be), and who are generally considered to be hardcore drunk drivers. Nonetheless, the results underscore how, in the right hands, even very brief psychosocial interventions can have important and enduring effects in individuals who are often seen as impervious to change,” said Brown.

He added that encouraging the DWI offenders to participate was rather easy: offering a monetary incentive of about $70, which not only illustrated the power of "immediate positive rewards" but also seemed like a reasonable investment in the name of public safety.

"We need to remember that these repeat offenders reported…drinking 23 to 24 drinks per week, indicating a need to cut down on drinking for both health and public safety reasons," said Lapham.

"The take-home message here is that brief interventions—which can be administered in a health-care provider’s office during a routine visit, and in a variety of other settings—can be very effective tools for helping people change their harmful drinking patterns, changes that can persist for long periods. That said, the most important comparison has not been done yet. The authors are following up to determine what changes, if any, occur in the drinking and driving arrest statistics over time, and whether re-arrest rates will differ between the two groups."

Singer Janet Jackson reportedly tried to stage an intervention for her brother Michael in 2007, two sources close to the Jackson family told CNN. Britney Spears’ family intervened in 2008 through the court after a judge in her custody case cited her for “habitual, frequent, and continuous use of controlled substances and alcohol.” Her father, Jamie Spears, was granted temporary conservatorship over her.

An article in CNN suggests several ways to intervene, noting that interventions can take many forms. Experts say that simply suggesting that a drug addict make an appointment for professional help may work.

Patrick Hart, an intervention specialist in Seattle, Washington, said that speaking openly in a compassionate tone and without judgment is an effective way to approach an intervention. He said that the addiction or other problem should be viewed as an illness that deserves professional care.

“Do not expect an addicted loved one to simply stop within their own right,” Hart said. “Offer specified help.”

Another form of intervention is a more formal, direct approach involving family members and close friends. It’s best to hire a professional interventionist for these meetings. Before the meeting, the interventionist meets with family members and friends to get a history of what has happened.

Loved ones will often explain in writing that they are involved in the intervention because they love the addict, and then detail the ways the addict’s behavior has hurt them or concerned them. For example, if the person is married, his or her spouse may not permit him or her back into the home. If the person is living with family, the relatives may warn that he or she won’t be welcome back.

Before the intervention, the interventionist will help the family create specific consequences if the addict does not agree to go into treatment, and the interventionist will talk with the family about the possibility of the addict running away.

Dr. Bankole Johnson, chairman of psychiatric medicine at the University of Virginia, said it’s best to treat the addiction as a medical problem and stress the physical consequences of it. According to him, simply telling a person that he or she has a problem with alcohol or drugs is often not as effective as saying, “You seem to be having difficulties with your sleeping, or you seem to be having difficulties with your breathing.”

In most states, treatment for addiction cannot be forced by family members of friends—that’s where the legal system comes in. However, it is very difficult to prove in court that a person is not able to manage his or her life because of an addiction.

Different states have different laws, but a conservatorship—when someone takes legal charge of another person’s decisions—is only granted if a person is a threat to other people or to themselves, Johnson said. Generally, he said, the person has to commit a crime such as driving while intoxicated before the legal system gets involved in ordering treatment.

But sometimes the very threat of police intervention is enough to prompt an addict to treatment, said Dr. Marvin Seppala, chief medical officer at Hazelden Foundation.

Experts stressed that family members and friends should not wait until the person they’re concerned about “hits rock bottom” before attempting to get help from a professional.

“Very rarely does someone wake up in the morning and say, ‘I want to change,’” said Mike Loverde, who was addicted to prescription painkillers eight years ago and now is the director of program services at the Intervention Services Inc. branch outside Chicago.

1.) Hire a professional interventionist. Evidence shows that a successful intervention should be directed by an intervention specialist who has been trained in drug abuse intervention techniques and has a track record of intervention success.

2.) Base the intervention around a “happening” in the life of your loved one. This could be an instance when he or she was caught stealing something or lying, a big fight regarding substance abuse with family members, or perhaps if he or she was arrested for driving under the influence. Evidence shows that immediately following events like these, the individual is usually more willing to admit needing help.

3.) Make sure your loved one is not using during the intervention. If possible, choose a time and place where you are certain he or she cannot obtain drugs or alcohol. If there are any signs of recent drug or alcohol use, you may need to reschedule the intervention.

4.) Be extremely patient. Your loved one will most likely yell, scream, argue, and deny everything that’s being said during the intervention. Remain patient and know that the interventionist will handle any conflicts that arise.

Studies show an intervention success rate of 90 to 95 percent, but this depends on the interventionist and the commitment of family and friends to confront the addict.

You may experience resentment from your loved one after the intervention, even if he or she agrees to enter into treatment. If this happens, try to remain positive and keep thinking of the ultimate goal: your loved one’s recovery.

Also keep in mind that an intervention is only the first step in your loved one’s recovery, as he or she must now go through detox and therapy and change their lives in order to remain sober.

It’s imperative for you and other close friends and family members to attend support group meetings and group therapy with your loved one. Family counseling and support groups such as Al-Anon can help keep you strong while your loved one starts his or her journey to recovery.

The most common reasons for an alcohol intervention are:

• The alcoholic is in denial and needs to hear how his or her behavior is affecting others
• The family would like a professional interventionist help them find the right treatment choice
• The alcoholic is hostile toward family members and would be more likely to listen to an unbiased outsider
• The family lives far away and wants someone to help them intervene and get a loved one into treatment

Many times an alcohol intervention is done because the alcoholic is unwilling to admit he or she has a problem. The intervention is no guarantee the alcoholic will admit this, but by having a professional address the behavior in a controlled environment, it is often the first time the alcoholic sees through the haze of their denial.

It is strongly advised that you choose an alcohol interventionist with many years of experience and who is aboard registered Interventionist.