ALCOHOL ABUSE AND DEPENDENCE IN TRAUMA PATIENTS

这项竞争性更新提案扩展了我们之前NIAAA研究（RO1-AA09050）的工作，该研究记录了超过三分之一的创伤中心患者终身诊断为酒精依赖。对筛选试验的分析表明，CAGE和酒精使用障碍识别测试（AUDIT）中的两个问题可以确定哪些患者需要对酒精使用问题进行医疗管理，哪些饮酒者有未来受伤的风险，哪些没有酒精问题。长期目标是减少创伤中心高危患者的饮酒后果和酒精使用。我们计划进行一项两组随机临床试验，其中创伤患者将被分配到个性化动机干预（PMI）治疗组或信息和建议（IA）对照组。主要目的1是评估PMI是否比IA更好地减少酒精相关后果。该评估基于“SIP+6”问卷（创伤患者改良的DrInC仪器）。主要目的2是根据OASAS（酒精中毒和物质服务办公室）饮酒史问题，评估PMI是否减少了酒精消费。作为次要目标，患者的特征，如变化阶段和决策平衡，将评估其对干预效果的影响。根据临床方案，将筛选约2800名未选择的连续患者。需要医疗管理和没有酒精问题的人将被排除在研究之外。其余36%的患者（n=894）将符合研究条件。筛选者将获得同意。然后，吸入和介入专家（IISs）将管理SIP+6、OASAS问题和评估患者特征的措施，并根据随机化提供PMI或IA。PMI由四个部分组成，其中包括个性化的摄入数据：在创伤中心进行20至30分钟的动机干预，在接触后2周发送个性化反馈信，以及在第3周和第6周进行两次随访电话联系。IA将包括一本介绍过量饮酒风险的小册子，然后由IIS在三周内进行一次电话联系。结果将在6个月和12个月时通过电话访谈进行评估，其中将重复摄入措施，记录新的伤害，并评估治疗服务的依从性和满意度。在临床试验中，随访采访者将对分组分配不知情。据估计，超过80%的患者（n=572+）将完成整个研究方案。自我报告的有效性将通过在干预组和对照组中随机选择100名患者在6个月和12个月时进行访谈来评估。

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.