The Teachable Moment: Screening and Brief Intervention for Admitted Trauma Patients (TM)

The American College of Surgeons now requires screening for alcohol use in trauma centers. The purpose of this research study is to provide information about the best screening and treatment methods. The investigators hope the findings will provide information that will improve healthcare by reducing problems related to risky alcohol use. The trauma team is conducting a comparison of two different ways of talking about alcohol use. Participants will be randomized into one of the two study groups.

The goal of this study is to guide further policy development regarding effective alcohol screening by: (a) comparing the effectiveness of two new, shorter screening tools for risky drinking patterns with the longer screening tool in current use; (b) assessing the outcomes of two different brief counseling interventions (BIs) with trauma patients screened to have risky drinking behaviors; and (c) examining the impact of the implementation of this new policy in a Level I Trauma Center. The Specific Aims will be accomplished by: Screening patients who are admitted to the Trauma Center, and conducting BIs for all who screen positive; Collecting formative qualitative data regarding participants' perceptions of benefits of drunken states, their individual risks, and perceived healthier alternatives; Collecting quantitative data (injury severity score and hospital length of stay) and correlating these data with patient demographics and responses on the different screening methods; Collecting follow-up data by telephone on self-reported alcohol use and trauma recidivism, using an interviewer-administered assessment; Collecting data on trauma recidivism from ED data, publicly available records, and patient self-report at 6-month telephone follow-up; Surveying trauma staff and physicians at three intervals regarding the process of implementing the new ACS policy, any perceived difficulties, and the perceived impact

The quantitative intervention involves emphasis on tracking and measuring the number of drinks on a weekly basis.

Trauma recidivism after discharge as measured by a review of computerized ED records,NC Trauma database,the Forsyth County EMS registry,NC EMS registry and self-reports at a 6-month telephone follow-up of alcohol-related injuries and changes in alcohol

Patient satisfaction ratings of the BI,the response to the BI as rated by the interviewer,reported citations for driving under the influence(to be obtained from the NC State Department of Motor Vehicles) and 3 surveys of trauma service staff

Inclusion Criteria: Inpatient on trauma service 18 years or older Speaks either English or Spanish One or more of the following: Patient answered yes to either admission screening question Patient has a positive BAL of less than or equal to 79 and also has a positive Audit score (men greater than or equal to 8; women greater than or equal to 4) Patient has a BAL of 80 or higher patient has no record of a BAL on file and they have a positive Audit score Exclusion Criteria: Patient unable or unwilling to provide informed consent Patient refusal contact at six months Patient has a positive BAL of less than or equal to 79 and negative AUDIT score Patient deemed unable to complete a BI

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