Nearly 50% of patients admitted to trauma centers have an alcohol related injury, yet trauma centers currently treat the injury and ignore the underlying alcohol problem. The purpose of this study is to determine if incorporating a program of screening, intervention and referral in a trauma center reduces future alcohol related injuries and other morbidities. All patients admitted to a Level 1 Regional Trauma Center will be screened for alcohol problems using blood alcohol levels, biochemical markers, and brief screening questionnaire. Patients who screen positive will be randomized into an intervention or control group. The intervention group will receive feedback about their drinking status and brief motivational enhancement, and patients with moderate to high levels of alcohol dependence will receive in addition a referral to community-based alcohol treatment programs that are matched in their intensity to the assessed level of alcohol dependence. The control group will receive traditional trauma care; no discussion regarding alcohol dependence will be initiated by the study staff. An intake assessment will be obtained on intervention group patients in order to determine patient characteristics that predict a positive response to the intervention and successful behavioral change. A subset of control group patients will undergo the intake assessment, however, the majority will receive follow-up only. This will enable us to determine the reactivity of the assessment process while maintaining a pure control condition. The study assesses the appropriate role of the trauma center, screening, identification and triaging of patients with alcohol problems. We will evaluate the effect of the intervention at inducing treatment entry and completion, and perform long-term follow-up by using a statewide computerized tracking system to identify study patients subsequently admitted to any hospital in Washington State for trauma/non-trauma problems. Statewide computerized databases will also be used to assess subsequent health care costs, mortality, motor vehicle crashes and DWI violations. Patients will also be interviewed at six months and one year to assess other outcomes such as utilization of formal and self help services, drinking quantity and frequency, social consequences of drinking, and other behavioral outcomes. The study will enroll 1200 patients over 18 months, and will have the power to detect a 50% reduction in the trauma recidivism rate, and change as small as 20% in other follow up batteries. The project builds upon our recently completed study on the effect of alcohol on trauma management and outcome, as well as our pilot studies. If effective, the proposed intervention may provide an impetus for trauma centers to address alcohol problems as a routine component of care for the injured patient.
