Enhanced MI with Alcohol Positive Trauma Patients

描述（由申请人提供）：酒精阳性创伤患者比酒精阴性创伤患者更有可能重新入院或死于随后的伤害。尽管他们的风险增加，但很少有可用于这一人群的药物支持治疗。进入创伤病房可能代表着一个“可教导的时刻”，病人特别愿意讨论他们的酒精使用情况。因此，在创伤病房进行的干预可能特别有效。动机性面试（MI），一个简短的，指令性的，非对抗性的干预，已经证明了一些承诺，在这种情况下。此外，在长期强化酒精治疗中纳入重要他人（SO）似乎可以改善治疗保留和疗效。虽然有人建议在管理信息中列入一个SO，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在内的动机访谈是否能更有效地减少和维持创伤病房出院后6个月和12个月的酒精使用和酒精相关问题的减少，而不是个别患者或仅评估条件的MI。2个MI组将分别接受2次定时在医院进行的干预治疗，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。这项提案将使我们能够解决我们的研究计划的下一阶段，旨在为这些高风险人群在医疗环境中开发易于传播的治疗方法。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。还将讨论干预措施的成本效益问题。因此，这项研究将解决一个重大的公共卫生问题，并提供有关MI机制的重要信息，这些机制可能与更广泛的成瘾治疗社区有关。

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.