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12-09-2011 | Article

Trauma center may present opportunity for substance abuse intervention


Free abstract

MedWire News: Motivational intervention for patients who present with facial injuries and underlying substance use achieves some short-term reduction in illicit drug use relative to health information, a randomized controlled trial shows.

However, although the greatest improvements were seen at 6 months, they had significantly weakened after 1 year.

The findings "suggest the need for repeat, booster interventions to have a sustained effect on drug use behaviors in trauma patients," say Vivek Shetty (University of California, Los Angeles, USA) and colleagues in the Journal of Oral and Maxillofacial Surgery.

Oral and maxillofacial surgeons at regional trauma centers commonly treat patients with facial injuries resulting from interpersonal violence, linked to the proximate use of illicit drug or alcohol (substance use), explain the authors.

Indeed, Murphy et al found in 2009 that 58% of individuals presenting to an urban trauma center with a jaw fracture qualified as problem drinkers, and 24% met criteria for problem drug use.

The causal relationships among substance use, violence, and injury are complex, but follow two dominant themes: violence related to attempts to procure drugs or substance use-induced disinhibition that leads to aggressive behaviour, note the authors.

Shetty et al therefore believe that the trauma center is "an opportunistic setting for conducting behavioural interventions targeting risky behaviors,"

The researchers recruited 218 patients who presented to a level 1 trauma center with facial injuries and evidence of underlying substance use. Of these, 118 were randomly allocated to personal motivation intervention (PMI) and 100 to brief general health information.

The interventionist's role was to encourage the participants to think differently about their substance use behaviors, raise awareness of the consequences, and generate an interest in quitting.

Subjects in the PMI group showed statistically significant declines in drug use at both the 6- and 12-month assessments. The intervention's effect on lowering illicit drug use was greatest at the 6-month assessment but had weakened by the 1-year follow-up.

The efficacy of the PMI was moderated by an individual's initial drug use severity; individuals with greater drug use dependency at baseline were seen to have larger intervention effects, as did individuals who were most aware of their drug problem and willing to change their substance use behaviors.

Unlike illicit drug use, changes in alcohol use did not differ significantly between the intervention and control groups, irrespective of an individuals' recognition of the alcohol problem or willingness to take steps to address it.

Shetty et al comment: "A better articulation of target populations, intervention content, and delivery would allow for directed interventions and an appropriate focusing of limited time and health care resources."

By Andrew Czyzewski