Detection and Intervention of Problem Drinkers in the ED - Brief Negotiation Interview (BNI) Screening Tool Flow Chart

Establish Rappaport

Raise the Subject

Do you drink beer, wine or liquor? NO -YES

Ask Permission

Do you mind spending a few minutes talking about your alcohol use? NO - YES

Explore Pros & Cons

What are some of the positive things with your use of alcohol?*

What are some of the negative things with your use of alcohol?

Offer Feedback

Do you see a connection between your ED visit today and your drinking?

Assess Readiness

Summarize pros and cons then ask

Where does this leave you?*


How ready are you to change your drinking behavior?

Not Ready

  1. Express concern
  2. Offer education and information for follow-up, including recommendations, e.g. Do not drink and drive?

Not Ready

  1. What will it take to get you ready?
  2. Offer education, information for follow-up, and recommendations.


  1. Help patient identify resources.
  2. Make an appropriate referral for treatment.

*See reverse side for screening tests and assessment and incorporate findings into BNI where appropriate.

*If patient tests positively or has Hx of alcohol problems, assess for safe discharge with appropriate referrals and instructions.