Study Protocol: Screening and Treatment of Alcohol-Related Trauma (START) – a randomised controlled trial

Abstract

BackgroundThe incidence of mandibular fractures in the Northern Territory of Australia is very high, especially among Indigenous people. Alcohol intoxication is implicated in the majority of facial injuries, and substance use is therefore an important target for secondary prevention. The current study tests the efficacy of a brief therapy, Motivational Care Planning, in improving wellbeing and substance misuse in youth and adults hospitalised with alcohol-related facial trauma.Methods and designThe study is a randomised controlled trial with 6 months of follow-up, to examine the effectiveness of a brief and culturally adapted intervention in improving outcomes for trauma patients with at-risk drinking admitted to the Royal Darwin Hospital maxillofacial surgery unit. Potential participants are identified using AUDIT-C questionnaire. Eligible participants are randomised to either Motivational Care Planning (MCP) or Treatment as Usual (TAU). The outcome measures will include quantity and frequency of alcohol and other substance use by Timeline Followback. The recruitment target is 154 participants, which with 20% dropout, is hoped to provide 124 people receiving treatment and follow-up.DiscussionThis project introduces screening and brief interventions for high-risk drinkers admitted to the hospital with facial trauma. It introduces a practical approach to integrating brief interventions in the hospital setting, and has potential to demonstrate significant benefits for at-risk drinkers with facial trauma.Trial RegistrationThe trial has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) and Trial Registration: ACTRN12611000135910.

Epidemiology, Etiology, and Motivation of Alcohol Misuse Among Australian Aboriginal and Torres Strait Islanders of the Northern Territory: A Descriptive Review

“…These places are the primary sites of the Indigenous assaults in the Northern Territory urban area. Alcohol-related violent assaults among the Indigenous population leads to high incidences of facial trauma patients at Royal Darwin Hospital (Jayaraj, Thomas, Kavanagh, et al, 2012;Jayaraj et al, 2013;Nagel, Jayaraj, Ah Kit, Thompson, & Spencer, 2010).…”

“…Indigenous drinkers commonly migrate from the rural and remote communities, where access to alcohol is restricted, to Darwin and Alice Springs to engage in binge drinking activity with family members and friends (Jayaraj, Thomas, Thomson, et al, 2012). Binge drinking among the Indigenous population is often funded by government Centrelink allowances.…”

“…Alcohol-related violence involves large numbers of young adults in pubs and clubs in the two major cities of Northern Territory-Darwin and Alice Springs-on weekend nights. The close family members and friends of Indigenous people involved in binge drinking are highly prone for violent assaults (Jayaraj, Thomas, Thomson, et al, 2012). In the Northern Territory, the proportion of alcohol-related assaults are 60% (Northern Territory Quarterly Crime and Justice Statistics, 2010).…”

Prevalence of traumatic dental injuries and its association with binge drinking among 12‐year‐olds: a population‐based study

“…Although Brazilian law prohibits the sale of alcoholic beverages to minors (Law n° 9294, July 15, 1996), the consumption of alcohol is commonplace among adolescents either in the home or in the public environments. Alcohol intake is also considered a risk factor for antisocial behaviour, criminal behaviour, poor scholastic performance, interpersonal violence, injuries, and traffic accidents, which can result in TDI and maxillofacial trauma. Thus, the 23.1% prevalence rate of binge drinking in a population of 12‐year‐olds is worrisome due to the possible consequences with regard to dependence, systemic health problems, and dental/maxillofacial trauma.…”

Importance of multidisciplinary trauma prevention program for youth

“…Carrasco et al studied 479 cases of deaths from motorcycle crashes in Campinas and observed the following: 90.8% were male, the mean age was 27.8 (range: 0-73) and blood alcohol was positive in 42.2% of the victims (mean score: 0.627 g/L), corroborating the fact that alcohol is a significant factor in relation to accidents and is an important risk factor contributing to fatal collisions 6 . Laws and prevention programs are an excellent long-term solution in reducing traffic-related trauma and general trauma rates [7][8][9] . An excellent example of such an initiative is Sunnybrook RBC First Office for Injury Prevention, which was established in 1986 within Sunnybrook's Trauma, Emergency and Critical Care department, in Toronto.…”