The prevalence of alcohol use disorders among people hospitalized for trauma far exceeds that in the general population, making trauma centers a promising venue for brief interventions (Bl) to reduce future alcohol-related harm and related costs. Optimal approaches for such intervention are unclear, but two strategies appear promising: motivational interviewing (Ml) and brief physician advice. Adaptations of Ml have demonstrated effectiveness in medical settings, although the Ml has always been confounded with other intervention components such as assessment feedback and advice. Ml is a general health behavior change counseling method, requiring significant time and training to establish proficiency. A simpler option for Bl in a hospital setting after acute injury is brief advice from the trauma surgeon treating the injured patient. The proposed study will evaluate these two different Bl strategies - specialist Ml counseling and brief physician advice and compare them with standard care at a Level I trauma Center, via a randomized clinical trial with 375 trauma patients. The overall aim of the study is to determine whether these two distinct, readily implemented models of Bl can reduce alcohol use and related harm and costs in trauma patients with alcohol disorders. All sessions will be tape recorded and coded, permitting both fidelity monitoring and theory-testing analyses regarding relationships between process and outcome variables. New knowledge of the effectiveness, benefits and costs of these two Bl approaches would allow surgeons and trauma centers to make informed choices about alcohol interventions in trauma settings.
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