Binge drinking, sensible drinking, and abstinence after alcohol-related vehicular crashes: the role of intervention versus screening.

Brief interventions have been shown to reduce problem drinking in a variety of populations and settings. The hypothesis for our randomized trial was that individuals injured in alcohol-related crashes who received a more intensive intervention (brief counseling) would have reduced binge drinking as compared to those with a less intensive intervention (simple advice) and controls. Non-alcohol dependent, seriously injured individuals (N = 186) were enrolled in the protocol. At baseline, mean binges/month (b/m) were 5.88 and at 12 months were 2.02 b/m. Although there was no significant difference by condition, at 12 months the brief counseling group had the lowest rate of binge drinking (1.97 b/m). Whether these drinking patterns were a result of the crash, injury, screening for alcohol use, or combination of these factors is difficult to determine.

Validity of self-reported alcohol consumption in nondependent drinkers with unintentional injuries.

BACKGROUND: Self-report has become an anchor for alcohol assessment in the acute and primary care populations. The purpose of the study was to determine the validity of self-reported alcohol consumption after unintentional injuries in hospitalized, nondependent drinkers. METHODS: Non-alcohol-dependent subjects 18 years of age and older with unintentional injuries (n = 209) were enrolled in the study and were interviewed if they had either an admitting blood alcohol concentration (BAC) > or = 10 mg/dl (0.01 g/dl) or a positive screen for a history of problem drinking. The self-reported number of standard drinks, time that drinking commenced, sex, and weight were used to calculate estimated blood alcohol concentration (EBAC), which was then compared to the admission BAC. RESULTS: We had data to calculate the EBAC on 141 of the 209 subjects. Seven men and no women with positive (> or = 10 mg/dl) BAC denied drinking. Of the 134 subjects for whom we had data to calculate EBAC and who acknowledged drinking, mean BAC was 147.06 mg/dl and mean EBAC was 68.66 mg/dl. For women (n = 30), mean BAC was 149.53 mg/dl and mean EBAC was 114.67 mg/dl; for men (n = 104), mean BAC was 146.35 mg/dl and mean EBAC was 55.38 mg/dl. The Spearman's p between laboratory BAC and EBAC was 0.461 (p < 0.001) for all subjects (n = 134), 0.275 (NS) for women (n = 30), and 0.532 (p < 0.001) for men (n = 104). For women and men separately, multiple regression analyses were performed to predict BAC by using weight and reported number of drinks. For women, weight and number of drinks accounted for 3% of the variance in laboratory BAC [r = 0.181, F(2,47) = 0.797,p = NS]. In contrast, for men these same predictors accounted for 34% of the variance [r = 0.585, F(2,135) = 35.203,p < 0.001). CONCLUSIONS: Most nondependent patients with unintentional injury acknowledged drinking before injury. After injury, women and men have different patterns of reporting their drinking, with men more frequently underreporting but reporting more accurately and women more random in their self-reports.

Attribution of injury to alcohol involvement in young adults seriously injured in alcohol-related motor vehicle crashes.

BACKGROUND: Approximately 40% of all traffic fatalities are associated with the use of alcohol. Hospitalization for serious injury after a motor vehicle crash related to use of alcohol may be an opportunity to change drinking behaviors in non-alcohol-dependent drinkers, thereby reducing the risk for future disability and death. OBJECTIVES: To determine the degree to which non-alcohol-dependent adults aged 18 to 45 years with alcohol-related vehicular trauma attributed their injury to use of alcohol. METHODS: During hospitalization, 132 subjects involved in alcohol-related motor vehicle crashes were interviewed. The interviews included the question, "To what extent do you believe your alcohol consumption was responsible for this injury?" Responses were measured on a 7-point scale ranging from 1 (not at all) to 7 (totally). RESULTS: In response to the question about attribution of injury to alcohol, 37.8% of subjects responded "not at all," 24.3 responded "somewhat," and 37.9% responded "mostly" or "totally." Spearman rank correlation between attribution of injury to alcohol involvement and blood alcohol content at admission was r = 0.440 (P < .001). CONCLUSIONS: More than 60% of patients injured in alcohol-related motor vehicle crashes attributed their injury partly or totally to use of alcohol. When alcohol-free, hospitalized patients with higher blood levels of alcohol on admission were more likely than those with lower levels to attribute their injury to alcohol. Hospitalization for a motor vehicle crash related to use of alcohol provides an opportunity for interventions to decrease drinking.

Brief intervention after alcohol-related injuries.

Brief intervention is a clinically-based, cost effective, time efficient intervention designed to counsel nondependent drinkers about strategies to reduce their alcohol consumption. The ultimate goal of brief intervention is to prevent future alcohol-related injury and health problems. This focused and time limited intervention is designed for use by health care providers in their ongoing daily practice. Patients who recently experienced an alcohol-related injury are particularly receptive to brief intervention.

Brief intervention as an advanced practice strategy for seriously injured victims of multiple trauma.

Trauma is the leading cause of death during the first 4 decades of life. Approximately 40-50% of seriously injured patients who require hospitalization have an alcohol-related injury. The traumatic injury offers nurses in advanced practice roles a unique opportunity to discuss the relation between the patients' traumatic injuries and their alcohol use. One strategy that has shown promise in recent research is the Brief Intervention, a simple and quick clinical tool used to motivate patients to consider the consequences of their alcohol-related behavior. The Brief Intervention technique uses a screening instrument, the Alcohol Use Disorders Test, to determine whether the patient is a sensible, heavy, or dependent drinker. A counseling session, focusing on reducing alcohol use in the nondependent drinker, follows while the patient is still acutely injured. Through the use of Brief Intervention, the nurse has an opportunity to motivate trauma patients to change their patterns of drinking and limit their risk for repeated injuries. If nurses can prevent future injuries, the potential savings in lives lost and dollars spent are huge.

Corporate perspective of the role of the occupational health nurse.

One hundred and twenty-three Ohio employers were surveyed about expectations for occupational health nurse performance of 20 current and desired future activities. Employers identified activities that (a) the nurse was currently performing, or (b) would be desired in the future, or (c) were not appropriate for the nurse. Findings showed occupational health nurses are counseling employees, treating illness and injury, evaluating safe return to work, and tracking workers' compensation cases. Activities most desired in the future are analyses of trends in health programs and study of cost-effective health program alternatives. Activities most frequently selected require skills of evaluation, budgeting, and cost-benefit analysis. Most occupational health nurses have not had the opportunity to learn skills of fiscal management; therefore meeting employer expectations will require new education.