Collaborative Care Reduces Alcohol Problems and PTSD in Trauma Patients
Of the 2.5 million Americans who sustain acute injuries that require hospitalization each year, approximately 20%–40% meet criteria for current or lifetime alcohol abuse or dependence, and 10%–40% will develop posttraumatic stress disorder (PTSD). This study assessed a multifaceted collaborative care intervention (delivered by a master's level case manager, a trauma support specialist, a psychiatrist, and a psychologist) to prevent or ameliorate these conditions among acutely injured trauma survivors.
Researchers randomly assigned 120 trauma center patients aged 18 or older (50% with alcohol abuse and/or dependence) to usual care (UC) or collaborative care (CC). Collaborative care combined usual trauma services with stepped care consisting of postinjury case management, motivational interviewing to reduce alcohol use, and pharmacotherapy and/or cognitive behavioral therapy for persistent PTSD. In the subsequent year, alcohol abuse/dependence decreased 24% on average in the CC group while increasing 13% in the UC group (a significant difference). PTSD rates did not change in the CC group, but increased 6% in the UC group (also a significant difference).
This study suggests that early behavioral health intervention for injured survivors of trauma can be effectively delivered in trauma centers. Routine integration of mental health and substance abuse services into the acute management of individual or mass trauma appears to decrease alcohol consequences and even prevent PTSD, although studies of health-related quality of life and cost-effectiveness are warranted. Nonetheless, with a growing acceptance of alcohol screening and intervention by trauma surgeons, the time is right for the dissemination of effective collaborative care models.Peter D. Friedmann, MD, MPH
D, Roy-Byrne P, Russo J, et al. A randomized effectiveness
trial of stepped collaborative care for acutely injured
trauma survivors. Arch Gen Psychiat. 2004;61(5):498–506.