ObjectiveAlcoholism is the leading risk factor for injury. The authors hypothesized that providing brief alcohol interventions as a routine component of trauma care would significantly reduce alcohol consumption and would decrease the rate of trauma recidivism. MethodsThis study was a randomized, prospective controlled trial in a level 1 trauma center. Patients were screened using a blood alcohol concentration, gamma glutamyl transpeptidase level, and short Michigan Alcoholism Screening Test (SMAST). Those with positive results were randomized to a brief intervention or control group. Reinjury was detected by a computerized search of emergency department and statewide hospital discharge records, and 6-and 12-month interviews were conducted to assess alcohol use. ResultsA total of 2524 patients were screened; 1153 screened positive (46%). Three hundred sixty-six were randomized to the intervention group, and 396 to controls. At 12 months, the intervention group decreased alcohol consumption by 21.8 Ϯ 3.7 drinks per week; in the control group, the decrease was 6.7 Ϯ 5.8 (p ϭ 0.03). The reduction was most apparent in patients with mild to moderate alcohol problems (SMAST score 3 to 8); they had 21.6 Ϯ 4.2 fewer drinks per week, compared to an increase of 2.3 Ϯ 8.3 drinks per week in controls (p Ͻ 0.01). There was a 47% reduction in injuries requiring either emergency department or trauma center admission (hazard ratio 0.53, 95% confidence interval 0.26 to 1.07, p ϭ 0.07) and a 48% reduction in injuries requiring hospital admission (3 years follow-up). ConclusionAlcohol interventions are associated with a reduction in alcohol intake and a reduced risk of trauma recidivism. Given the prevalence of alcohol problems in trauma centers, screening, intervention, and counseling for alcohol problems should be routine.Regional trauma centers were developed 25 years ago in response to studies showing that 40% of deaths from injuries in the United States could have been prevented if the patient had been treated in a facility with special expertise in treating injuries.1 With the advent of regional trauma systems, the preventable death rate has now been reduced to Ͻ2% to 3%; therefore, future decreases in the trauma death rate are not likely to occur as a result of improvements in the delivery of care.2 Nearly half of all trauma deaths occur at the scene; these also are not responsive to improvements in care.3,4 Future significant decreases in the death rate for injuries, therefore, depend primarily on progress in injury prevention.By far the most common underlying causes of injuries in the United States are alcohol abuse and dependence. 5,6 Studies repeatedly demonstrate that approximately 50% of patients admitted to a trauma center are under the influence of alcohol, and the mean blood alcohol concentration of such patients is 187 mg/dl, nearly twice the legal level for

The high prevalence of both acute intoxication and chronic alcoholism in trauma patients indicates the need to diagnose and appropriately treat this pervasive problem in trauma victims.

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Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.