A Multisite Randomized Controlled Trial of Brief Intervention to Reduce Drinking in the Trauma Care Setting

Abstract

Objective Determine the efficacy of three brief intervention strategies that address heavy drinking among injured patients. Summary of Background Data The content or structure of brief interventions most effective at reducing alcohol misuse following traumatic injury is not known. Methods Injured patients from three trauma centers were screened for heavy drinking and randomly assigned to brief advice or BA (n=200), brief motivational intervention or BMI (n=203), or brief motivational intervention plus a telephone booster using personalized feedback or BMI+B (n=193). Among those randomly assigned, 57% met criteria for moderate to severe alcohol problems. The primary drinking outcomes were assessed at 3, 6, and 12 months. Results Compared with BA and BMI, BMI+B showed significant reductions in the number of standard drinks consumed per week at 3 (Δ adjusted means=-1.22, 95% C.I.=-.99 ∼ -1.49, p=.01) and 6 months (Δ adjusted means=-1.42, 95% C.I.=-1.14 ∼ -1.76, p=.02), percent days of heavy drinking at 6 months (Δ adjusted means=-5.90, 95% C.I.=-11.40 ∼ -0.40, p=.04), maximum number of standard drinks consumed in one day at 3 (Δ adjusted means=-1.38, 95% C.I.=-1.18 ∼ -1.62, p=.003) and 12 months (Δ adjusted means=-1.71, 95% C.I.=-1.47 ∼ -1.99, p=.02), and number of standard drinks consumed per drinking day at 3 (Δ adjusted means=-1.49, 95% C.I.=-1.35∼-1.65, p=.002) and 6 months (Δ adjusted means=-1.28,, 95% C.I.=-1.17 ∼ -1.40, p=.01). Conclusion Brief interventions based on motivational interviewing with a telephone booster using personalized feedback were most effective at achieving reductions in alcohol intake across the three trauma centers.

A Randomized Evaluation of Motivational Interviewing Training for Mandated Implementation of Alcohol Screening and Brief Intervention in Trauma Centers

“…Brief interventions using MI appear to be generally effective in trauma center, emergency department, medical inpatient, and primary care general medical settings, although treatment effects vary across settings and patient populations (Bertholet, Palfai, Gaume, Daeppen, & Saitz, 2014; Bray, Cowell, & Hinde, 2011; Cunningham et al, 2009; D’Onofrio et al, 2012; D’Onofrio et al, 2010; Field, Baird, Saitz, Caetano, & Monti, 2010; Havard, Shakeshaft, & Sanson-Fisher, 2008; Jonas et al, 2012; Madras et al, 2009; Nilsen et al, 2008; Vasilaki, Hosier, & Cox, 2006; Whitlock, Polen, Green, Orleans, & Klein, 2004). More specifically, with injured patients admitted to trauma centers, brief interventions using MI have been shown to improve alcohol use problems (Field et al, 2014; Field, Caetano, Harris, Frankowski, & Roudsari, 2010; Gentilello et al, 1999; Schermer, Moyers, Miller, & Bloomfield, 2006). …”

Effects of brief intervention on subgroups of injured patients who drink at risk levels

“…Screening methods, patient recruitment, study design and intervention, and rates of follow-up have been reported in detail previously 19. Patients who agreed to participate completed a baseline (BL) assessment that captured socio-demographics, alcohol use severity and injury-related risk behaviour.…”

“…Eight indicators were selected from the Short Inventory of Problems+6 (SIP+6)19 23 based on their previously demonstrated relationship with individuals seeking emergency and trauma care3 6 24 and our previous work of identifying injured patient profiles associated with alcohol use 17 18. These items include (1) having driven a motor vehicle after having three or more drinks; (2) having taken foolish risks while drinking; (3) having gotten into a physical fight while drinking; (4) having been arrested for driving under the influence of alcohol; (5) having had trouble with the law (other than driving while intoxicated) because of drinking; (6) having had an accident while drinking or intoxicated; (7) having been physically hurt, injured or burned while drinking or intoxicated; and (8) having injured someone else while drinking or intoxicated.…”

Increasing Follow-up Outcomes of At-Risk Alcohol Patients Using Motivational Interviewing

“…Korcha, Cherpitel, Moskalewicz, Bond, and Ma (2012) found brief interventions motivate patients to decrease alcohol consumption and realize the connection of drinking and the occurrence of physical or social problems. Brief interventions have been proven to be more effective if a follow-up contact is made to reinforce changes in alcohol intake ( Field et al, 2014 ). Success in getting patients to agree to follow-up is contingent on the manner in which the brief intervention is performed.…”