Enhanced MI with Alcohol Positive Trauma Patients

描述（由申请人提供）：酒精阳性的创伤患者比酒精阴性的创伤患者更有可能再次进入创伤中心或死于随后的损伤。尽管他们的风险增加，但很少有经验支持的治疗方法可用于这一人群。进入创伤病房可能是一个“教育时刻”，病人特别愿意讨论他们的酒精使用情况。因此，在创伤病房进行干预可能特别有效。动机访谈（MI）是一种简短的、指导性的、非对抗性的干预，在这种情况下表现出了一些希望。此外，在长期、强化的酒精治疗中纳入重要的他者（SO）似乎可以改善治疗的保留性和疗效。虽然有人建议将SO纳入MI，但很少有数据支持这一认可。因此，本研究（N=300）将探讨包括创伤患者和SO在内的动机性访谈是否比针对单个患者或仅针对评估条件的MI更有效地减少并保持出院后6个月和12个月酒精使用和酒精相关问题的减少。两个MI组将分别接受2次在医院进行的干预，以及1次在出院后1个月进行的加强治疗。在仅评估条件下，患者将仅接受基线饮酒评估。这项提议将使我们能够着手研究计划的下一阶段，该计划旨在为医疗环境中的这些高危人群开发易于推广的治疗方法。本研究还将探讨潜在的中介因素（改变酒精使用的动机、自我效能、酒精治疗出勤率和戒酒的社会支持）和MI效应的调节因素。还将讨论干预的成本效益问题。因此，这项研究将解决一个重要的公共卫生问题，并提供可能与更广泛的成瘾治疗社区相关的心肌梗死机制的重要信息。

DESCRIPTION (provided by applicant): Alcohol-positive trauma patients are more likely to be readmitted to a trauma center or die from a subsequent injury than are alcohol-negative trauma patients. Despite their increased risk, there are few empirically-supported treatments available for this population. Admission to a trauma unit may represent a "teachable moment", where patients are particularly willing to discuss their alcohol use. Therefore, interventions delivered in the trauma unit may be particularly effective. Motivational Interviewing (MI), a brief, directive, non-confrontational intervention, has demonstrated some promise in this setting. Further, inclusion of a significant other (SO) in prolonged, intensive alcohol treatment appears to improve treatment retention and efficacy. Although inclusion of an SO in MI has been suggested, there are few data to support this endorsement. Accordingly, this study (N=300) will address whether motivational interviewing including both the trauma patient and an SO can more effectively decrease and maintain reductions in alcohol use and alcohol-related problems 6 and 12 months following discharge from the trauma unit than MI with the individual patient or an assessment-only condition. The 2 MI groups will each receive 2 intervention sessions timed to occur in the hospital, and 1 booster session, occurring 1 month following discharge. In the assessment-only condition, patients will receive only assessment of their drinking at baseline. This proposal will allow us to address the next phase of our program of research designed to develop easily disseminable treatments for these high-risk populations in medical settings. This study will also address potential mediators (motivation to change alcohol use, self-efficacy, alcohol treatment attendance, and social support for abstinence) and moderators of MI effects. The cost-effectiveness of the intervention will also be addressed. Thus, this study will address both a significant public health problem and provide important information about MI mechanisms that may be relevant to the broader addiction treatment community.