Year 2021
October 2021


Abstract Title
Assertive Community Treatment for Alcohol-Related Frequent Attenders; reducing Emergency Department Misuse and Alcohol-Related Problem Severity



Institute of Mental Health1, Khoo Teck Puat Hospital2

Background & Hypothesis

Alcohol-Related Frequent Attenders (ARFAs) are patients with severe Alcohol Use Disorder (AUD) who present frequently to Emergency Departments (EDs). ARFAs engage poorly with traditional addiction treatment services. Assertive Community Treatment (ACT) may be more appropriate, involving community visits with focus on holistic care and harm-reduction.


This is a prospective, multicentre, real-world, interventional, before-and-after trial.

ARFAs were recruited from IMH (pilot phase) and KTPH (main phase).  Patients were provided ACT for 6 months each.  ED attendances and Christo Inventory for Substance-misuse Services (CISS) scores were collected. The CISS provides a measure of alcohol-related problem severity. The Wilcoxon Signed-Rank Test was performed.


A total of 26 patients were recruited (14 from IMH and 12 from KTPH).  These patients had a mean age of 55.58 (SD 7.90) and were mostly male (96.2%).

For the pilot phase, significant 45.3% reduction (Z=-2.244, p=0.025) in average alcohol-related ED attendances was achieved. CISS scores improved significantly (p=0.001) with reduction in median scores indicating a drop from high problem severity to an average level.

Similar results were seen in the next phase. 59.2% reduction in overall ED visits (Z=-3.247, p <0.001) was achieved.  Median CISS scores showed a reduction from high problem severity to average level (p= 0.072).

Discussion & Conclusion

Both phases of this study suggest that ACT leads to reduction in alcohol-related ED attendances and alcohol-related problem severity. The multicentre phase (across four hospitals in Singapore) is currently underway, with at least 200 more patients to be recruited.