The first part of the follow-up was conducted as a component of a quality improvement program and involved patients who were admitted to the hospital between August 1, 1998, and June 30, 1999. These patients were contacted between September 1999 and January 2000. One of the investigators attempted to contact the patient and/or a relative or friend identified from the medical record 6 to 12 months after the subject (n=86) was discharged from the hospital. A standard introduction was read to the respondent, and verbal consent was obtained. Following this, a series of open-ended questions was asked (eg, “Are you better?” and “In what way?”). Then some specific questions were asked. The responses were summarized according to the subject’s patterns of alcohol use since hospital discharge and whether the subject had initiated substance abuse treatment or a self-help program. During March 2000, the responses about drinking patterns and initiation of treatment or self-help during the first 6 months following hospital discharge were categorized and coded by 2 of the authors (S.B.R. and R.L.M.).
The second part of the follow-up was conducted as a medical student summer research project and involved patients who were admitted to the hospital between June 1, 1999, and March 31, 2000. These patients were contacted during June and July of 2000. There was a 1-month overlap in admission dates with the first part of the study because of a variation in hospital length of stay. Another investigator attempted to contact the patient and/or a relative or friend identified from the medical record 4 to 12 months after the study subject (n=228) was discharged from the hospital. A standard introduction was read to the respondent, and verbal consent was obtained. Following this, a series of structured questions was asked (eg, “During the first 6 [4 or 5 months in 7 cases] months following your discharge from the hospital did you try to cut down or quit drinking?”). The responses were coded according to the patient’s patterns of alcohol use during the 6 months following hospital discharge and whether the subject had initiated substance abuse treatment or a self-help program.
Interventions
Patients who received usual care served as the control group (n=125). There were 2 groups that received an intervention: a brief intervention group (n=119) and a peer intervention group (n=70).
Usual Physician Care. Patients in this group received care by the residents and attending surgeons of the trauma service only, because the addiction medicine consultant was not available to see them. The surgeons and the hospital’s social workers may or may not have specifically addressed the patients’ substance abuse problems before discharge. During the study period, the hospital nurses, social workers, and resident physicians were given a 1-hour educational conference (in 12 separate sessions) about alcohol detoxification, screening, and brief intervention based on a national standard.25 Preprinted protocols for detoxification were available in the hospital.
Brief Intervention. Patients in this group received the services of an addiction medicine consultant as part of their overall hospital care. Before discharge, these patients were given brief (5 to 15 minutes) advice following a previously described method.26
Peer Intervention. Patients in this group received the same type of brief physician advice of those in the brief intervention group, and a 30- to 60-minute visit from a peer who was active in AA. Patients had to agree to a peer visit, but refusals were rare. Volunteers were recruited through a local residential facility for individuals with substance abuse problems. There were separate facilities for men and women, but they were administered by the same organization and followed the same basic program based on the AA model. The volunteers, called assistant staff, had successfully completed the program at that facility. These volunteers attended 3 2-hour training workshops designed to increase their skills at carrying the message of AA to others. These training workshops included both didactic and role-playing sessions that were designed to help the volunteers follow a protocol based on the AA model. These peers visited with the patient in pairs before hospital discharge. They did not give advice or make treatment recommendations. Instead, they shared their personal stories and their “experience, strength, and hope” with the patient. The peers were always matched with the patients’ sex and usually with the patients’ race. There was a period of time (approximately 6 months) during the study when women volunteers were not available because the facility for women was being relocated.
Statistical Analysis
The data sets from the 2 parts of the study were combined by one of the authors who also performed the data analysis. We used the exact version of the Fisher-Freeman-Halton test27 to compare the 3 treatment groups in terms of categorical baseline characteristics and follow-up rates. One-way analysis of variance was used for continuous baseline characteristics. The same analysis was performed to compare those patients for whom follow-up data could be obtained with those for whom such data could not be obtained.