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).

Comments:

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

Reference:

Zatzick

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.
(view
abstract)