Disseminating alcohol screening and brief intervention at trauma centers: A policy-relevant cluster randomized effectiveness trial

Douglas Zatzick, Dennis M. Donovan, Gregory Jurkovich, Larry Gentilello, Chris Dunn, Joan Russo, Jin Wang, Christopher D. Zatzick, Jeff Love, Collin Mcfadden, Frederick P. Rivara

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Background and Aims: In 2005 the American College of Surgeons passed a mandate requiring that level I trauma centers have mechanisms to identify and intervene with problem drinkers. The aim of this investigation was to determine if a multi-level trauma center intervention targeting both providers and patients would lead to higher-quality alcohol screening and brief intervention (SBI) when compared with trauma center mandate compliance without implementation enhancements. Design: Cluster randomized trial in which intervention site (site n=10, patient n=409) providers received 1-day workshop training on evidence-based motivational interviewing (MI) alcohol interventions and four 30-minute feedback and coaching sessions; control sites (site n=10, patient n=469) implemented the mandate without study team training enhancements. Setting: Trauma centers in the United States of America. Participants: A total of 878 blood alcohol-positive in-patients with and without traumatic brain injury (TBI). Measurements: MI skills of providers were assessed with fidelity coded standardized patient interviews. All patients were interviewed at baseline and 6- and 12-months post-injury with the Alcohol Use Disorders Identification Test (AUDIT). Findings: Intervention site providers consistently demonstrated enhanced MI skills compared with control providers. Intervention patients demonstrated an 8% reduction in AUDIT hazardous drinking relative to controls over the course of the year after injury (relative risk=0.88, 95%, confidence interval=0.79, 0.98). Intervention patients were more likely to demonstrate improvements in alcohol use problems in the absence of traumatic brain injury (TBI) (P=0.002). Conclusion: Trauma center providers can be trained to deliver higher-quality alcohol screening and brief intervention (SBI) than untrained providers, which is associated with modest reductions in alcohol use problems, particularly among patients without TBI.

Original languageEnglish (US)
Pages (from-to)754-765
Number of pages12
JournalAddiction
Volume109
Issue number5
DOIs
StatePublished - May 2014

Keywords

  • Alcohol
  • American College of Surgeons
  • Dissemination and implementation research
  • Motivational interviewing
  • Policy mandate
  • Screening and brief intervention
  • Traumatic brain injury

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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