Readiness to Change and the Role of Inpatient Counseling for Alcohol/Substance Abusing Youth With Major Trauma

Yonas, Michael A.; Baker, Deborah; Cornwell, Edward E.; Chang, David C.; Phillips, J.; Paradise, Jane; Paradise, Michael; Sutton, Erica; Elihu, Arvand

doi:10.1097/01.ta.0000175087.64842.d1

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…Some trauma centers have implemented screening and intervention programs for heavy alcohol use, [16][17][18][19][20] and initial successes have been demonstrated. 16,[18][19][20][21][22] The finding that patients with repeat trauma were more likely to use tobacco and recreational drugs and were more likely to use drugs on the day of injury calls into question the responsibility these patients have in managing their health and behavior. Further, in addition to the patients identified in the current study, it is important to consider potential injury to others (eg, bystanders).…”

Section: Discussionmentioning

confidence: 99%

Frequency of Recidivism in Patients With Orthopedic Trauma

Koleszar¹,

Childs²,

Vallier³

2016

Orthopedics

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The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, P<.0001). Recidivists were also more likely to be uninsured (33.5% vs 17.8%, P<.0001) or to have Medicaid coverage (33.5% vs 23.2%, P<.0001). Recidivists were more likely to have used alcohol (47.2% vs 32.0%, P=.0007) or to be intoxicated (32.4% vs 21.2%, P=.005) and to use tobacco (66.2% vs 50.2%, P=.0003) or recreational drugs (59.1% vs 43.2%, P=.0004) at baseline. The rate of documented mental illness was also higher in repeat patients than in nonrepeat patients (28.1% vs 20.0%, P=.03). These findings showed that recidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.].

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Section: Discussionmentioning

confidence: 99%

Frequency of Recidivism in Patients With Orthopedic Trauma

Koleszar¹,

Childs²,

Vallier³

2016

Orthopedics

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“…Although some studies find that the SOCRATES does predict treatment entry, 36 others do not. 37 For example, Yonas and colleagues, found that although 85% of trauma patients with positive drug screens were in the contemplative or action-oriented stages with regard to their substance abuse, 0% initiated substance abuse treatment postdischarge. 37 However, it is possible that this measure may be useful as a starting place for brief motivational interventions to encourage treatment linkage.…”

Section: Discussionmentioning

confidence: 99%

“…37 For example, Yonas and colleagues, found that although 85% of trauma patients with positive drug screens were in the contemplative or action-oriented stages with regard to their substance abuse, 0% initiated substance abuse treatment postdischarge. 37 However, it is possible that this measure may be useful as a starting place for brief motivational interventions to encourage treatment linkage. Our finding that pre-baseline use of formal treatment services was not a significant predictor of service use in the follow-up period is not consistent with the findings from prior studies conducted in the general population.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Substance Abuse Treatment Seeking Following Cocaine-Related Emergency Department Visits

Fortney

Tripathi

Walton

et al. 2010

J Behav Health Serv Res

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Chest pain is the most common medical complaint among cocaine-using emergency department (ED) patients. Correlates of substance abuse treatment seeking were examined using 3-month post-discharge surveys from 170 ED patients admitted with cocaine-related chest pain. Four treatment categories were specified as the dependent variable in an ordered logistic regression: no treatment (74.7%), informal treatment only (7.1%) formal treatment only (5.9%) both formal an informal treatment (12.4%). The following variables were found to be positively associated with a higher treatment category: frequency of cocaine use (OR=1.07; CI95=1.01-1.15, p=0.03), global severity index (OR=2.26, CI95=1.04-4.90; p=0.04) number of endorsed stigma barriers (OR=4.40; CI95=1.41-13.78; p=0.01), interpersonal consequences (OR=1.41; CI95=1.01- 1.88; p=0.02), and pre-baseline informal treatment (OR=6.69; CI95=1.58-28.36, p=0.01). Physical consequences were found to be negatively associated with a higher treatment category (OR=0.63, CI95=0.47-0.85; p<0.01). ED visits for cocaine-related chest pain represent missed opportunities to link patients to substance abuse treatment and interventions are needed to motivate patients to seek care.

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“…While the literature on classifying patients into stages of change is not entirely consistent (Carey, Purnine, Maisto, & Carey, 1999), prior studies have suggested that patients often fit into one of three ordinal categories: Precontemplation (not even considering decreasing substance use), Contemplation (considering decreasing substance use), and Action (taking steps to decrease substance use). The literature on readiness to change has primarily focused on adults, and the available studies on adolescents have largely included hospitalized and/or incarcerated youths with severe substance-related difficulties (Barnett et al, 2002; Slavet et al, 2006; Yonas et al, 2005). Therefore, little research has been completed using this three-stage framework with a primary care system’s teenage population, which consists of youths typically engaging in less serious forms of substance use.…”

Section: Introductionmentioning

confidence: 99%

Readiness to Change in Adolescents Screening Positive for Substance Use in Urban Primary Care Clinics

Stevens

McGeehan

Kelleher

2010

Journal of Child & Adolescent Substance Abuse

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Primary care physicians often perceive patients as unlikely to decrease their substance use and suggest this reluctance to change diminishes their willingness to screen and intervene. The literature on readiness to change has primarily focused on adults, and the available studies on adolescents have largely included hospitalized and/or incarcerated youths with severe substance-related difficulties. The present study focused on an urban primary care system’s teenage population, which consists of youths typically engaging in less serious forms of substance use. One hundred sixty-eight of these youths ages 11–20 screened positive for substance use on a self-report questionnaire. These youths then completed the Readiness to Change Questionnaire. Nearly 60% of these positive screens were in the Action Stage, with another 16% in the Contemplation Stage. Depressive symptoms and suicidal ideation were positively associated with later stages of change. Implications for screening, prevention, and early intervention programs for adolescent substance use are discussed.

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Readiness to Change and the Role of Inpatient Counseling for Alcohol/Substance Abusing Youth With Major Trauma

Cited by 10 publications

References 9 publications

Frequency of Recidivism in Patients With Orthopedic Trauma

Frequency of Recidivism in Patients With Orthopedic Trauma

Patterns of Substance Abuse Treatment Seeking Following Cocaine-Related Emergency Department Visits

Readiness to Change in Adolescents Screening Positive for Substance Use in Urban Primary Care Clinics

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