Alcohol Screening and Brief Intervention. A role in injury prevention?
Mike Rotondo
Outline Alcohol Screening and
Brief Intervention:
A Role in Injury Prevention?
Michael F. Rotondo MD FACS
Professor and Chairman, Department of Surgery
Brody School of Medicine, East Carolina University
Director, Center of Excellence for Trauma and Surgical Critical Care
Pitt County Memorial Hospital
University Health Systems of Eastern Carolina
Chairman, Committee on Trauma
American College of Surgeons
Introduction
* Magnitude of the Problem
* Why do this?
* What is a brief intervention and how to administer it?
* Detecting patients who have alcohol related injuries
* Does it work?
The Magnitude of the Problem
Alcohol-Related Deaths Worldwide
Alcohol and Trauma
Why do it?
Public Health Paradigm
* The primary goals of alcohol screening and brief intervention are to:
* Reduce alcohol use to low-risk levels
* Encourage abstinence in persons who are alcohol dependent.
Why Should Health Care Providers, Systems, and Purchasers Care?
* Reduce risk
(e.g., motor vehicle accidents)
* Reduce alcohol-related problems
(e.g., depression, suicide, hypertension, strokes)
* Reduce alcohol-medication interactions (e.g., Xanax. Prozac, Coumadin,
Tylenol)
Why Should Health Care Providers, Systems, and Purchasers Care?
* Reduce alcohol-related family violence and family stress
* Reduce workplace problems (e.g., accidents, performance)
* Save money
* Reduce liability risks
What to do?
FEASIBILITY
Is it feasible to:
Integrate SBIR services as part of the health care institutional culture?
Implementation
* Screening
* BAC levels on everyone
* Screening
* Intervene
* Train healthcare team member in Brief Intervention
* Monitor
* Evaluate program
Biological Markers
* Blood Alcohol Level (BAL)
* Gamma-Glutamyl Transferase (GGT)
* Mean Corpuscular Volume (MCV)
* Carbohydrate-Deficient Transferrin (CDT)
Alcohol Screening: To Detect At-Risk and Problem Drinkers
* Single question test
* Consumption Questions
* Quantity, frequency, binge
* CAGE family of questionnaires
* CAGE, T-ACE, TWEAK, CAGE-AID
* Alcohol Use Disorders Inventory Test (AUDIT)
Alcohol Assessment Tools
(Self-Administered, Pencil and Paper)
* Alcohol Dependence Scale (ADS)
* Michigan Alcoholism Screening Test (MAST)
* Self-Administered Alcohol Screening Test (SAAST)
Brief Intervention or Talk Therapy
* Commonly used by clinicians to talk to patients about chronic health problems
or medications.
* Not unique to the alcohol field.
* Helps move people along the readiness to change continuum
Components of Brief Intervention
* Assessment and direct feedback
* Negotiation and goal setting
* Behavioral modification techniques
* Self-directed bibliotherapy
* Follow-up and reinforcement
Does it work?
Hypothesis
Alcohol Interventions in a Trauma Center
* Study design
* Harborview Medical Center, Seattle
* NIH/NIAAA sponsored RCT
* patients screened with blood alcohol and questionnaire
* screen positive patients randomized
* 15 - 30 minute intervention plus follow-up letter
* standard trauma care
Follow-up
* Objective
* Harborview ED records for one year after discharge
* statewide database of all trauma admissions
* police department records
* Department of Licensing records (motor vehicle)
* Self-report
* 6 and 12 month patient interviews
* corroboration interviews with family members
Baseline Characteristics
What We Know About Brief Intervention
* Can decrease alcohol use for 12 months
* The effect size is similar for men and women
* No difference in effect by age
What We Know About Brief Intervention
* Can decrease emergency department visits
* Can reduce hospital days
* Can reduce accidents and injuries
* Can reduce costs
What We Don't Know About Brief Intervention
* Does brief intervention:
* work for special populations?
* work for more than 12 months?
* reduce morbidity and mortality?
* work in different health care settings?
* work better when combined with pharmacotherapy?
Does Alcohol Screening Have a Role in Injury Prevention?
Yes!
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Ministry of Health
