Multidisciplinary Approach to Reduce Injury and Substance Abuse

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PROJECT SUMMARY/ABSTRACT The American College of Surgeons (ACS) recently established requirements for Level I Trauma Centers to provide screening and brief intervention (SBI) for alcohol problems. The impetus for this mandate was the evidence base supporting the effectiveness of brief alcohol interventions with injured patients on reducing alcohol use and risk of future injury, as well as cost savings. However, there is a lack of evidence regarding the effectiveness of SBI for drug use. In addition, there is little evidence on the effectiveness of drug SBI on HIV risk and other health outcomes strongly associated with drug use. This application proposes a randomized clinical trial evaluating the effectiveness of brief advice (BA), brief motivational intervention with feedback (BMI), and brief motivational intervention with feedback and booster (BMI+B) in injured patients with drug problems. The setting is a trauma center serving a large and diverse patient population. The primary outcome of interest will be subsequent drug use. Other outcomes of interest include: (a) HIV-related risk behaviors, (b) improved health outcomes including injury reduction, (c) increased employment, (d) decreased engagement in illegal behavior (e) increased substance abuse treatment utilization, and (e) enhanced quality of life at three, six, and twelve month follow-ups. This study will also examine the potential moderating and mediating effects of patient readiness to change, use of experiential and behavioral processes of change and decisional balance considerations. In addition, this project will examine implementation factors at the organizational level and the cost effectiveness of BA, BMI, and BMI+B. Funding of the proposed study will increase the knowledge base with regard to the effectiveness of brief intervention among injured patients with drug use problems and, thereby, provide the ACS and the field with the necessary evidence base for screening, brief intervention and referral for treatment for drug use problems in the trauma care setting.