From the critical care literature, looking at whether the ICU admission represents a “teachable moment” for counseling against health-endangering behaviors. It’s a review article asking the question whether interventions at the time of admission to an ICU – i.e., a close brush with death – are effective.
This is relevant to the Emergency Department for those situations where you want to shake your patients and tell them “you did this to yourself, you fool!”
They look at the literature for nicotine cessation and for alcohol cessation. The nicotine cessation literature is rather bleak. They break down the interventions to <15 minutes vs. >15 minutes, and then whether contact after hospital discharge is helpful. Pretty much, unless you have a mechanism for prolonged after-discharge contact and counseling, you won’t get any meaningful results.
As far as alcohol goes – there are good studies that support questionnaires, lab work, or scoring systems to identify individuals at risk for alcohol-related injuries or illness. However, all the studies in their review show regardless of behavioral intervention, no decrease in alcohol consumption at discharge is seen.
So, sadly, almost assuredly, the ED, with the minimal time and follow-up available to us, is unlikely to be a place where impactful counseling is feasible.