Executive Summary

Addressing Alcohol-Impaired Driving:
Training Physicians to Detect and Counsel their Patients Who Drink Heavily

Alcoholism is the most common chronic disease in trauma patients, affecting 25% to 40% of those treated in major trauma centers. Alcoholism results in repeated episodes of trauma, drunk driving and alcohol related crashes. A prior study by our group found that trauma patients with alcohol problems were more than twice as likely to be readmitted with injuries during the next two years than patients without problem drinking.

Interventions for problem drinking are effective. A summary of 32 randomized trials of brief interventions enrolling 5,718 patients indicate that such interventions are effective in decreasing problem drinking and lowering subsequent health care utilization. A randomized controlled trial of trauma patients indicated that interventions reduce drinking at 12 months after intervention by two-thirds and cut recidivism for new injuries by 50%.

Despite these findings, few trauma centers or primary care physicians routinely screen for alcohol problems. The goal of this project was to decrease the risk of driving while intoxicated and the risk of alcohol related crashes by encouraging health care providers to address alcohol abuse at the individual patient level and at the community level. Specifically, we did the following:

• Trained medical students in the northwestern states on the problems of impaired driving, methods to screen patients in the office and hospital settings, techniques of brief alcohol intervention, and indications for referral of patients for more in-depth alcohol treatment. All 160 students in each of the classes were exposed to the training through courses during the pre-clinical years, as well as through training during clerkships, particularly psychiatry and surgery.

• Trained University of Washington residents in the northwestern states on the problems of impaired driving, methods to screen patients in the office and hospital settings, techniques of brief alcohol intervention, and indications for referral of patients for more in-depth alcohol treatment. As a result of the intervention, residents reported increases in screening from 27% to 38%, and reported increased sense of self-efficacy to conduct screening and brief interventions.

• Trained University of Washington residents in the northwestern states on the problems of impaired driving, methods to screen patients in the office and hospital settings, techniques of brief alcohol intervention, and indications for referral of patients for more in-depth alcohol treatment. As a result of the intervention, residents reported increases in screening from 27% to 38%, and reported increased sense of self-efficacy to conduct screening and brief interventions.

• Trained University of Washington residents in the northwestern states on the problems of impaired driving, methods to screen patients in the office and hospital settings, techniques of brief alcohol intervention, and indications for referral of patients for more in-depth alcohol treatment. As a result of the intervention, residents reported increases in screening from 27% to 38%, and reported increased sense of self-efficacy to conduct screening and brief interventions.

• Worked to integrate training in substance abuse and brief counseling interventions into the University of Washington School of Medicine curriculum. Surveyed UW course and clerkship coordinators to determine the substance abuse content of their courses. The survey indicated that alcohol abuse and problem drinking is integrated into the curriculum in multiple courses during the four years of medical school. Recommendations were made to the curriculum committee on how to best follow the National Institute of Alcoholism and Alcohol Abuse�s (NIAAA) "An International Model for the Prevention and Treatment of Alcohol Use Disorders."

• Worked to integrate methods of alcohol screening, intervention and referral in continuing medical education programs (CME) for primary care and other specialty physicians in this region. CME was conducted with approximately 1,200 physicians in the region.

• A survey was conducted of 400 physicians and found that one-half did not use a standard screening questionnaire. Developed and disseminated user-friendly materials to promote and teach the brief intervention approach by physicians.

• Researched barriers in the U.S. to implementing alcohol screening in hospital emergency departments. We talked with all 50 state insurance commissioners and reviewed the legislation governing exclusion of insurance coverage for alcohol involved injuries in all 50 states. This revealed that 38 states and the District of Columbia allowed, by statute, exclusion of insurance coverage for alcohol related injuries.

• Worked to establish alcohol screening and brief intervention as part of national practice guidelines for medical care. We worked with the Washington Circle Group to include alcohol screening as a measure of quality of care to be used by the National Committee on Quality Assurance in judging the quality of health care systems.

• Disseminated the program nationally through professional organizations, national publications and national presentations.