Background and Rationale

The problem of alcohol impairment as a cause of motor vehicle crash (MVC) injury and death is well documented. Approximately 40% of motor vehicle fatalities are related to the use or abuse of alcohol. This problem is a public health emergency mandating aggressive intervention by the health care community. The National Highway Traffic Safety Administration (NHTSA), through its Partners in Progress initiative, has encouraged the health care community to address alcohol use and impaired driving, through its own initiatives and in partnership with law enforcement and other governmental entities.

Physicians, particularly trauma physicians working in the emergency department (ED) and elsewhere within trauma centers, may be in a key position to intervene with patients at high risk for motor vehicle crash injury. Accordingly, patients in the ED for any reason may be identified as being at high risk of driving while impaired by alcohol through the use of established screening tools. Those patients screening positive for alcohol abuse or alcohol dependency (AA/AD) may be referred for definitive evaluation and treatment.

We undertook this project focusing on the population of drivers who abuse alcohol or who are alcohol dependent and presented to the ED following a MVC. Patients who abuse alcohol are more likely to drive after drinking. They are also more likely to have a crash while sober, due to greater risk-taking behavior.1 This population is well known to escape detection by police if taken to the ED for treatment of crash injury.2 Approximately 20% of patients treated in the ED following a MVC are at high risk for AA/AD.3 Since more than 90% of them are discharged home from the emergency departments (ED), it is imperative to determine the usefulness of a process for screening, intervention, and initiating a plan for treatment while the patient is still in the ED. We therefore sought to determine the efficacy of an emergency department based intervention program for identifying and referring persons at high risk of AA/AD to substance abuse treatment programs, and to determine what factor or combination of factors best predicts treatment enrollment. If the intervention is effective, individuals at high risk for further alcohol-impaired driving could be identified and referred in a structured fashion for alcohol dependency treatment through a standardized emergency department protocol that could be reproduced throughout the nation.

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