$2.4 Million Grant Funds Alcohol-Related Injury Prevention

It’s late Friday night, and a young man is rushed to the local emergency room with serious injuries suffered in a car wreck – an accident that was in all likelihood related to alcohol.

Craig Field, Ph.D.

This is what Craig Field, Ph.D., calls a “teachable moment” – the right time for someone to talk with the young man about alcohol. The right time for a “brief intervention.”

But is this really the right time? Will the patient respond positively and reduce his drinking? Will the intervention keep him from having another accident?

These are just some of the questions Field, an assistant professor for health promotion and behavioral sciences at the UT School of Public Health Regional Campus in Dallas, hopes to discover as principal investigator of a five-year study set to begin this fall enrolling trauma patients at Parkland Hospital in Dallas.

The project is funded by a $2.4 million grant from the National Institute on Alcohol Abuse and Alcoholism.

Nearly 50 percent of all traumas are related to alcohol misuse, Fields said, and many patients with an alcohol-related injury will be injured again. To reduce the individual, social and financial impacts of such injury, it’s necessary to eliminate the cause: misuse of alcohol.

Thus, the “brief intervention.”

A short – usually less than 30 minutes – one-on-one conversation about alcohol use, the brief intervention is usually provided after the patient has been admitted to the ER or trauma unit or has been hospitalized for an injury. The purpose of this structured, patient-centered intervention is to raise the patient’s awareness about his misuse of alcohol and increase his motivation to reduce involvement in injury-related risk behaviors.

One of the most useful approaches, Field believes is brief motivational intervention which focuses on the person’s perspective of the problem. Instead of confronting the person on the need to change, motivational interventions “elicit ideas from the patient’s perspective about the need to change and present opportunities to capitalize on alcohol-related injury to help motivate changes in the drinking behavior,” he said.

Brief interventions have been shown to be effective sometimes in changing the drinking behaviors, and related consequences, of patients treated in trauma centers. But, Field said, they don’t routinely work with all injured patients. Some patients require more than just a single intervention, and some require referral to treatment. The presence of psychiatric or psychosocial problems also may influence the intervention’s effectiveness.

The effectiveness of certain types of interventions depends upon the person’s readiness to change. “The critical issue in motivational intervention,” he said last year in The Journal of Trauma, Injury, Infection and Critical Care, “is not whether patients are motivated to change but in determining what they are motivated to change and why.”

In the Parkland research study, 1,500 consenting adult trauma patients who have tested positive for an alcohol-related injury will be selected at random for one of two kinds of interventions: a brief intervention alone or a brief intervention with booster. A control group will receive a brief advice session of three to five minutes.

While screening and brief intervention for alcohol problems were recently mandated by the American College of Surgeons Committee on Trauma, there is reluctance on the part of emergency and trauma physicians to use it.

“We know it works,” Field said, “but for whom it works and how is not well understood.”

He hopes this study will demonstrate the intervention’s efficacy in the real-world clinical setting, help refine the screening and identification process, influence the way brief interventions are conducted, and encourage medical personnel at all levels to learn the process.

By Frances Dressman for Institutional Advancement

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