ALCOHOL ABUSE AND DEPENDENCE IN TRAUMA PATIENTS

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This competitive renewal proposal extends the work of our previous NIAAA study (RO1-AA09050), which documented that over one-third of trauma center patients had a lifetime diagnosis of alcohol dependence. Analysis of screening tests revealed that the CAGE and two questions from the Alcohol Use Disorders Identification Test (AUDIT) can identify which patients require medical management for an alcohol use problem, other drinkers who are at risk of future injury, and those without an alcohol problem. The long-term objectives are to reduce drinking consequences and alcohol use in at-risk trauma center patients. We plan to conduct a two-arm randomized clinical trial in which trauma patients will be assigned to either a Personalized Motivational Intervention (PMI) Treatment Group or an Information and Advice (IA) Control Group. Primary Aim 1 is to assess whether a PMI reduces alcohol-related consequences better than IA. This assessment is based on the "SIP+6" questionnaire (DrInC instrument modified for trauma patients). Primary Aim 2 is to assess whether the PMI reduces alcohol consumption based on OASAS (Office of Alcoholism and Substance Services) Drinking History Questions. As a secondary goal, patient characteristics, such as stages of change and decisional balance, will be assessed regarding their impact on the effectiveness of the intervention. By clinical protocol, approximately 2800 unselected, consecutive patients will be screened. Those requiring medical management and those without alcohol problems will be excluded from study. The remaining 36 percent of patients (n=894) will be eligible for study. The screener will obtain consent. Then, Intake and Interventional Specialists (IISs) will administer the SIP+6, OASAS questions, and measures to assess patient characteristics and will deliver PMI or IA, based on randomization. The PMI consists of four components personalized with intake data: a 20- to 30-minute motivational intervention session in the trauma center, personalized feedback letter sent 2 weeks after contact, and two follow-up telephone contacts at 3 and 6 weeks. IA will consist of a brochure describing the risks of excessive drinking followed by one telephone contact at 3 weeks by the IIS. Outcomes will be assessed at 6 and 12 months via telephone interviews in which intake measures will be repeated, new injuries documented, and compliance and satisfaction with treatment services assessed. The follow-up interviewer will be blinded to group assignment in the clinical trial. It is estimated that more than 80 percent of patients (n=572+) will complete the entire study protocol. The validity of self reports will be assessed by interviewing collaterals from 100 randomly selected patients in each of the intervention and control groups at 6 and 12 months.