Sponsors:
AMERICAN COLLEGE OF SURGEONSCommittee on Trauma
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
National Institute on Alcohol Abuse and Alcoholism
Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment
DEPARTMENT OF TRANSPORTATION
National Highway Traffic Safety Administration
The Problem
Addiction to alcohol is not the country’s only
problem with alcohol. For every U.S. adult who is
dependent on alcohol, more than 6 other adults
who are not dependent are at risk of or have
already experienced problems from their drinking.1
Many of these at-risk drinkers incur injuries that
require trauma center services.
The triangle on the right (Figure 1) shows that
even if we were able to “cure” the 3.3% who are
dependent,1 we would not have addressed the
largest portion of the U.S. alcohol problem: the
22.7% who are not dependent but have experienced
problems or have significant risks related to their
drinking.1 For the purposes of this document,
these individuals engage in “at-risk drinking.” They
drink at levels that place them at elevated risk for
future alcohol-related problems, and some may
already have suffered injuries (e.g., ended up in a
trauma center). However, they are not dependent
on alcohol.
Not surprisingly, a high proportion of these atrisk
drinkers find their way to trauma centers,
where almost 50% of patients can have positive
blood alcohol concentrations (BAC).2 Despite the
prevalence of alcohol-related risk and problems,
trauma centers do not currently provide screening
and effective brief intervention as part of routine
care.
Because excessive drinking is a significant risk
factor for injury, it is vital for trauma centers
to have protocols in place to identify and help
patients. Trauma centers are in an ideal position to
take advantage of the teachable moment generated
from an injury by implementing screening and
brief intervention (SBI) for at-risk and dependent
drinkers.
Brief alcohol interventions conducted in trauma
centers have been shown to reduce trauma
recidivism by as much as 50%.2 Such interventions
also reduce rates of arrest for driving under the
influence3 and cut health care costs.4 For these
reasons, routine care in trauma centers should
include screening patients for alcohol misuse,
providing brief interventions for patients who
screen positive, and—when needed—referring
patients to specialty assessment and treatment.
The Response
In its publication Resources for Optimal Care of
the Injured Patient: 2006, the American College of
Surgeons Committee on Trauma (COT) includes
the following essential criteria for trauma centers.
“Trauma centers can use the teachable moment
generated by the injury to implement an effective
prevention strategy, for example, alcohol counseling
for problem drinking. Alcohol is such a significant
associated factor and contributor to injury that it
is vital that trauma centers have a mechanism to
identify patients who are problem drinkers. Such
mechanisms are essential in Level I and II trauma
centers. In addition, Level I centers must have the
capability to provide an intervention for patients
identified as problem drinkers. These have been
shown to reduce trauma recidivism by 50%.”
Although this guide is intended to help Level I
and II trauma centers implement SBI, the COT
recommends that all trauma centers incorporate
alcohol screening and brief intervention as part of
routine trauma care.
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