November 12, 1999
Alcohol counseling for trauma patients halves risk of reinjury
Routine counseling in trauma centers for those injured due to alcohol abuse can significantly reduce further excessive drinking and prevent future injuries, according to a study at Harborview Medical Center, published in the November issue of Annals of Surgery.
Alcohol is often linked to trauma–about 50 percent of patients admitted to trauma centers throughout the United States are intoxicated, and among them approximately 85 percent have a serious problem with alcohol. Trauma centers routinely treat the injuries, but ignore the underlying alcohol problem, says Dr. Larry Gentilello, lead researcher of the study and a University of Washington (UW) associate professor of surgery, based at Harborview.
Between October 1994 and November 1996, blood alcohol levels and questionnaires were used to screen 2,574 trauma patients for alcohol problems after they were taken to the emergency department of Harborview, a level 1 trauma center. Positive results were found in 1,153 patients, or 45 percent. Patients were randomly assigned to receive a brief, 30-minute counseling session on alcohol problems, or received standard trauma center care. Follow-up interviews were conducted at 6 and 12 months.
A total of 336 patients were randomized to the intervention group and 396 were randomized to the control group. The content and structure of the interventions varied according to the severity of the patient?s alcohol problem, but focused on communicating facts about how blood alcohol levels increase the risks of car crashes, boosting awareness of the patient?s responsibility and giving encouragement to help overcome the problem. A month later, the patients received letters summarizing the conversation and offering further support.
To obtain objective information that the intervention had a beneficial effect, researchers used records from every hospital within Washington state to determine if patients in the study were re-admitted to any hospital for treatment of a new injury over the next three years. There was a 48 percent reduction in injuries requiring hospital admission over the next three years.
The patients in the intervention group were found not only to have decreased alcohol use and trauma recurrence, but also a decrease in risk-taking behavior, such as driving while intoxicated arrests, traffic violations, alcohol-related arrests and other types of arrest.
A number of studies have documented that alcohol-related injuries motivate patients to reduce or stop their drinking, most likely because injury has a major impact on the patient that often reduces their drinking for a period of time, says Gentilello. The purpose of the intervention is to capitalize on the motivating effects of the recent, life-threatening injury in order to help patients take the steps needed to obtain counseling, participate in self-help groups, or take advantage of other means to reduce or eliminate their use of alcohol.
“We are not proposing that we have a cure for alcoholism by virtue of a 30-minute counseling session,” says Gentilello. “The intervention capitalized on the motivating effects of the injury, which resulted in a change in outcome when compared to controls, and that appeared to last for the study duration period.
“As with most chronic diseases, many patients will relapse. If an intervention is performed at each relapse event, whether it be in a trauma center, general medical ward, or even a doctor?s office, the overall effect may be a significant reduction in cumulative drinking amounts by the patients over their lifetime.”
Trauma centers are ideal sites for intervention programs because injuries are the leading cause of death for people with alcohol problems, and most alcoholics will injure themselves at one time or another, he adds. Furthermore, since one out of eight hospital beds in the United States are occupied by an injured patient, routine provision of alcohol counseling in trauma centers has the potential to have an enormous impact on public health.