Patterns of drinking four weeks prior to an alcohol-related vehicular crash.

OBJECTIVE: The primary objective of the study was to determine if drinking patterns on the days immediately prior to an alcohol-related motor vehicle crash (ARMVC) were significantly different than drinking patterns in the weeks prior to the crash. METHODS: Following ARMVC, 187 hospitalized non-alcohol dependent young-adults (43 females, 144 males) were enrolled. Mean age was 29.03 years, mean blood alcohol level was 165.18 mg/dL, and mean injury severity score was 10.50. When alcohol-free, subjects were interviewed by nurse clinicians to determine the quantity/frequency of alcohol consumption during the 28 days prior to the crash. Subjects reported the number of standard drinks using the Timeline Followback procedure. Total drinks/day were determined, with day 1 considered 4 weeks prior to the crash and day 28 the day of the crash. A random-intercepts general linear mixed model (GLMM) was used to test the effect of several covariates (segment 1 [days 1-26], segment 2 [days 27-28], age, sex, race, holiday/non-holiday period, driver/passenger status, and weekend/weekday crash) on the amount of standard drinks/day. RESULTS: There was no significant interaction among the covariates. The only significant predictors of drinks/day were segment 2 (b = .322, p < .0001) and gender (b = -.221, p = .016). The positive, statistically significant slope for segment 2 indicated an increase in consumption of drinks/day in the two-day period prior to the ARMVC and the negative slope for gender indicated greater consumption of drinks/day for men than women. CONCLUSION: Persons injured in an ARMVC had a significant increase in alcohol consumption on the day before and the day of vehicular crashes (days 27 and 28) as compared to the first 26 days in the 28-day period preceding the crash. When non-alcohol-dependent subjects are counseled to reduce their risk of traffic crashes, they should be alerted that when their patterns of drinking change, they are at higher risk than usual for a crash.

Laboratory measures of alcohol (ethanol) consumption: strategies to assess drinking patterns with biochemical measures.

Alcohol (ethanol) use is a global, health-related problem that spans a continuum ranging from low-risk, at-risk, and problem drinking to alcohol dependence and chronic abuse. Clinicians and researchers alike have the need to quantify drinking patterns to determine the risk for adverse, health-related events such as injury, liver damage, and cancer Biochemical measures of ethanol consumption are affected by temporal patterns of drinking as well as individual characteristics such as gender and age. The choice of a laboratory analysis to determine ethanol consumption is complex; no single laboratory test will predict drinking accurately across all drinking patterns, across the life span, and across gender. In conjunction with interviews and physical assessment, however, biochemical laboratory tests are sensitive tools used to measure both recent and long-term patterns of alcohol consumption.

"Nurse, I only had a couple of beers": validity of self-reported drinking before serious vehicular injury.

BACKGROUND: Of the more than 40000 Americans killed each year in vehicular crashes, 40% are involved in alcohol-related collisions. Although self-reported alcohol use has become an anchor for alcohol intervention after traffic crashes, clinicians are often skeptical about the truthfulness of self-reporting. OBJECTIVE: To determine the validity of self-reported alcohol consumption of vehicular occupants hospitalized for a serious, alcohol-related injury. METHODS: Non-alcohol-dependent subjects 18 years and older who were injured in motor vehicle crashes were interviewed. The self-reported number of standard drinks, time that drinking commenced, sex, and weight were used to calculate estimated blood alcohol concentration. This value was compared with the blood alcohol concentration measured at admission. RESULTS: Of the 181 subjects, 60% provided sufficient data to calculate the estimated concentration. Seven men with admission concentrations of 10 mg/dL or more denied drinking. Among the 113 subjects with estimated concentrations who acknowledged drinking (excluding the 7 who denied drinking), the mean concentration at admission was 158.67 mg/dL, and mean estimated concentration was 83.81 mg/dL. According to multiple regression analyses, weight and number of drinks accounted for 3% of the variance in alcohol concentration at admission for women (R=0.174, F2,40=0.623, P=.54) and for 29% of the variance in men (R=0.543, F2,128=26.71, P< .001). CONCLUSIONS: Most persons who drink before vehicular injury acknowledge drinking. Self-reported data from men generally reflect the overall trend of alcohol consumption but with systematic underreporting. Reports from women are less predictable.

Assessing acute and critically ill patients for problem drinking.

More critically ill patients have acute drinking problems than chronic problems with alcohol dependence. A hospitalization offers an opportunity for nurses to perform a brief assessment and initiate a simple intervention to advise patients to reduce their drinking. A few minutes of advice may make a long-term difference in a patient's health.

Effectiveness of brief interventions after alcohol-related vehicular injury: A randomized controlled trial.

BACKGROUND: Because 40% of motor vehicle fatalities in the United States are alcohol-related, interventions delivered by trauma clinicians targeted to reduce drinking are of particular importance to public health. The objective of this study was to test the effectiveness of hospital-based brief intervention strategies to reduce alcohol consumption and other health-related outcomes in the year after an alcohol-related vehicular injury. Brief interventions are clinically based strategies including assessment and direct feedback about drinking alcohol, goal setting, behavioral modification techniques, and the use of a self-help manual. METHODS: The study was a randomized controlled trial of two types of brief intervention with a 12-month follow-up. Participants with alcohol-related vehicular injury who were admitted to Level I trauma centers were eligible for enrollment. Enrolled participants were randomized to a control, simple advice, or brief counseling condition. Primary outcome variables were alcohol consumption (standard drinks/month, binges/month), adverse driving events (driving citations, traffic crashes), and changes in health status (hospital and emergency department admissions). RESULTS: The study enrolled 187 participants at baseline and retained 100 across 12 months. Participants had a significant decrease in alcohol consumption and traffic citations at 12 months as compared with baseline. Mean standard drinks/month declined from 56.80 (SD 63.89) at baseline to 32.10 (SD 53.20) at 12 months. Mean binges/month declined from 5.79 (SD 6.98) at baseline to 3.21 (SD 6.17) at 12 months. There were no differences in alcohol consumption, adverse driving events, or health status by condition. CONCLUSIONS: Whether the reductions in alcohol consumption and traffic citations were a result of the crash, hospitalization for injury, screening for alcohol use, or combination of these factors is difficult to determine. Further work is needed to understand the mechanisms involved in reductions of health-related outcomes and the role of brief intervention in this population.