This paper reviews the effectiveness of brief interventions in an emergency department setting. It presents an analysis of five systematic reviews and 16 randomised controlled trials. Most of these studies focused on alcohol-related cases or on cases of alcohol and drug use, with four studies specifically targeting illicit drug use. Brief interventions are psychosocial interventions designed to help recipients recognise harmful patterns of substance use, and to motivate and support them to address that use. Brief interventions typically use the collaborative conversation style of motivational interviewing and, as the name suggests, take only a short time, ranging from 5 to 30 minutes. Brief interventions are delivered by a range of professionals, including physicians, nurses and other healthcare workers; one common structure for brief intervention delivery employs the '5As' approach: ask, advise, assess, assist and arrange. Many studies on brief interventions in an emergency department setting stress that this context offers an important 'window of opportunity' in which to engage with people with substance use problems who might otherwise never receive any form of assessment, referral or intervention. Brief interventions have become increasingly popular because they can be delivered in a variety of settings, by a range of workers (after training) and in a short time frame; all three of these factors combine to keep costs relatively low. This review found that there are potential benefits of brief interventions, especially in relation to behavioural outcomes. However, a definitive statement about effectiveness cannot be made, as the results of the studies reviewed may not be generalisable to other age groups, to patients with different levels of substance use, or, given that the focus of many of the studies was on alcohol, to those using illicit drugs. However, the feasibility of brief interventions delivered by emergency department personnel, the absence of reported adverse effects and the potential cost-effectiveness all suggest that brief interventions could be considered as integral to the training of emergency department healthcare staff.
