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Journal of Trauma-Injury Infection & Critical Care:
doi: 10.1097/01.ta.0000174867.13017.7e

The Challenge of Change

DiClemente, Carlo C. PhD, ABPP

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From ABPP University of Maryland, Baltimore County Department of Psychology, Baltimore, Maryland.

Submitted for publication March 31, 2005.

Accepted for publication April 20, 2005.

This article was written for the proceedings from a conference entitled Alcohol Problems among Hospitalized Trauma Patients: Controlling Complications, Mortality, and Trauma Recidivism, in Arlington, Virginia, May 28–30, 2003. It does not reflect the official policy/opinions of the participating agencies, the U.S. Department of Health and Human Services, or the Centers for Disease Control and Prevention, and does not constitute an endorsement of the authors or their programs by the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, or the federal government, and none should be inferred.

Address for reprints: Carlo C. DiClemente, PhD, University of Maryland, Baltimore County Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250; email:

What motivates people to modify or change hazardous drinking behavior? First, problem drinkers will not reduce drinking habits or quit drinking until they become concerned about the problem, are convinced of the need for change, are committed to making the effort, and are prepared with a plan to change. Then, of course, this plan must be implemented and revised as needed. An individual’s ability to move toward change is greatly influenced by family, friends, peers, and role models. Furthermore, it is clear that the advice and influence of doctors and other medical professionals plays a special role in this behavior change process. Research demonstrates that assessment, advice, and brief interventions given in medical settings can dramatically change patient behavior.

Physical injuries and illnesses that necessitate a visit to a trauma center or emergency department (ED) bring large numbers of individuals who are abusing alcohol into a medical setting. This opens a window of opportunity for medical professionals to assess these individuals for excessive drinking and, if appropriate, to deliver brief interventions that can change the entire course of their lives. A growing number of studies indicates the viability and effectiveness of brief interventions on the drinking behavior of patients in trauma centers and EDs. Implementing brief interventions as standard practice in every trauma and ED setting can make a significant impact on reducing drinking, preventing reinjury, and promoting the health and well-being of these patients.

Changing standard practice is often even more difficult for medical professionals than changing behavior is for alcohol abusers. There are significant barriers to implementing screening and brief intervention protocols. Attitudes about alcohol and addiction, privacy and confidentiality matters, staff priorities, and legal issues complicate implementation. As with any change, medical professionals must be concerned, convinced of the need for change, and committed to implementing new protocols. The series of articles in these proceedings explain the need for intervention programs and present the benefits and challenges of incorporating such programs into standard trauma and ED care. Commitment to these innovative programs can empower trauma and ED professionals to offer effective treatment to patients with alcohol problems.

One significant barrier to implementing universal screening and intervention involves a myth about addiction and ability to change behavior. Many health professionals are pessimistic about the alcohol and drug abuser’s capacity for change.

They have watched many of their alcohol- and drug-addicted patients struggle to modify or stop problematic substance abuse only to relapse. However, this pessimism is shortsighted and misguided. Although substance abusers do relapse several times before successfully changing their drinking or drug use, relapse is not simply a problem of substance abuse. Often, the injuries and illnesses that bring patients to trauma units and EDs require extensive short- and long-term behavior changes (e.g., rehabilitation, medication compliance, dietary restrictions, and specific physical activities). Many patients do not follow through on treatment recommendations by trauma center staff. In fact, rates of noncompliance with recommendations for other medical problems often meet or exceed the relapse rates of substance abusers. Relapse and noncompliance are not unique to substance abusers but are universal problems associated with behavior change.

Even though patients often do not follow recommendations, we would not refrain from screening and giving advice to heart patients or diabetics. We should do no less when treating alcohol or drug abusers.

Outcomes from brief intervention studies demonstrate that screening and intervention can help patients make significant changes in alcohol and drug use. When the motivating aspects of injury and illness are coupled with a targeted, competent, and caring intervention, patients can and do change their substance use behavior. It is time to offer this opportunity for change to all of our patients.

I challenge my colleagues in the addiction field to join with trauma professionals and offer their help and expertise in creating and implementing early intervention programs for problem drinkers and drug users. Addiction professionals must leave the comfort of addiction treatment facilities and services and meet trauma patients with alcohol and drug problems in these critical moments when circumstances and motivation create unique opportunities for promoting change. By working together, medical and addiction professionals can change practice to promote the prevention of injury and behavior change among trauma and ED patients who abuse alcohol and other drugs.

Cited By:

This article has been cited 1 time(s).

Emergency Medicine Clinics of North America
Injury prevention and control
Betz, M; Li, GH
Emergency Medicine Clinics of North America, 25(3): 901-+.
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© 2005 Lippincott Williams & Wilkins, Inc.

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