Multidisciplinary Approach to Reduce Injury and Alcohol Use

描述（由申请人提供）：需要对处于不同变化阶段的受伤患者进行短暂酒精干预的不同效果进行系统评估。对受伤患者进行了几项短期酒精干预的随机试验（Bazargan-Hejazi等，2005；Gentilello等，1999；Longabaugh等，2001；Monti等，1999；Mello等，2005）。总的来说，这些研究表明，对受伤患者进行短暂的酒精干预可以有效地减少酒精摄入和相关后果，包括伤害再犯。然而，对受伤患者进行单一的短暂干预并不能证明对所有前来治疗酒精相关损伤的患者有效。根据目前的研究，一些受伤患者可能需要加强治疗才能取得积极的治疗效果，而其他患者可能需要转诊进行额外的治疗。不同强度干预的需要可能与来访者的准备程度或变化阶段有关。该建议假设，加强治疗的必要性取决于患者在接受酒精相关损伤治疗时改变饮酒行为的动机。此外，目前提出的研究将扩展目前关于对受伤患者进行短暂干预的研究结果，包括对治疗转诊和减少伤害成分的评估。在酒精依赖和共病（包括药物依赖或抑郁症）患者以及有无家可归等社会心理问题的患者中，后续治疗的利用是一个特别重要的结果。先前对受伤患者进行短暂干预的研究排除了有共病心理社会问题的患者群体，并发现对有严重酒精问题的患者效果有限。因此，对成年受伤患者的研究结果的普遍性可能是有限的，这种方法在更广泛的受伤患者群体中的有效性仍然未知。通过解决上述关键问题，本研究将巩固和扩展我们目前对各种短期干预策略对受伤患者的效用的理解，并将显著提高临床有效性和现有研究结果的可推广性。

DESCRIPTION (provided by applicant): A systematic evaluation of the differential effectiveness of brief alcohol interventions with injured patients at various stages of change is needed. Several randomized trials of brief alcohol interventions have been conducted with injured patients (Bazargan-Hejazi et al, 2005; Gentilello et al.,1999; Longabaugh et al., 2001; Monti et al.,1999, Mello et al, 2005). In general, these studies demonstrate that brief alcohol interventions with injured patients may effectively reduce alcohol intake and related consequences, including injury recidivism. However, a single brief intervention with injured patients has not proven effective with all patient populations presenting for treatment of an alcohol related injury. As suggested by current research, some injured patients may need a booster session to achieve positive treatment outcomes and others may require referral for additional treatment. The need for intervention at different levels of intensity may be associated with the client's readiness or stage of change. This proposal hypothesizes that the necessity of a booster session is dependent upon the patient's motivation to change their drinking behavior at the time they present for treatment of an alcohol related injury. Further, the currently proposed study will extend current findings regarding brief intervention with injured patients to include an evaluation of the treatment referral and harm reduction components. Subsequent treatment utilization is a particularly important outcome of interest among patients with alcohol dependence and comorbid disorders including drug dependence or depression as well as those with psychosocial problems such as homelessness. Prior studies of brief intervention with injured patients have excluded patient groups with comorbid psychosocial problems and found limited effectiveness among patients with severe alcohol problems. As a result, the generalizibility of findings to adult injured patients may be limited and the effectiveness of this approach in the broader population of injured patients remains unknown. By addressing the key issues described above, this study will consolidate and expand our current understanding regarding the utility of various brief intervention strategies with injured patients and will significantly enhance the clinical effectiveness and generalizability of current findings.