FORT MYERS, FLA. – Depression and/or impulsivity do not get in the way of behavioral change for trauma patients who have participated in a brief motivational intervention for alcohol abuse, results of a study presented at the annual meeting of the Eastern Association for the Surgery of Trauma show.
Researchers performed a secondary analysis of data from the DELTA project, an ongoing study funded by the National Institute on Alcohol Abuse and Alcoholism. DELTA is a randomized controlled trial aimed at demonstrating that a brief intervention was effective in reducing alcohol use among 497 trauma patients. In the current study, researchers surveyed 248 participants at 12 months and found no significant differences in decreases in alcohol use between participants who reported depression and/or impulsivity, compared with those who did not, Dr. Gabriel E. Ryb said at the meeting, sponsored by Wake Forest Unversity.
The findings may only apply to mild to moderate problem drinkers because researchers excluded severely alcohol-dependent patients, said study discussant Dr. Michael Aboutanos.
“The reason we excluded the severe alcohol dependence patients … [was] … we assumed they would not be responsive to brief interventions,” said Dr. Ryb, a trauma surgeon and researcher at the National Study Center for Trauma and Emergency Medical Systems, University of Maryland, Baltimore.
In addition, the investigators should have assessed patients using validated depression and impulsivity assessment tools instead of self-reports, said Dr. Aboutanos, who serves as director of the Injury Prevention Program and on the surgery faculty at Virginia Commonwealth University, Richmond. Therefore, this secondary analysis may be limited by the design of the initial study.
“I essentially agree with criticisms relating to the study being a post hoc analysis,” Dr. Ryb said. “I also agree that more rigorous assessment of the psychologic state is needed.”
Despite his criticisms, Dr. Aboutanos said, “The finding that neither impulsivity nor depression diminishes alcohol use intervention will be welcome by clinicians. I applaud their efforts for completing this study in a very difficult population.”
Patients reported depression and impulsivity on the initial questionnaire. A total of 217 responded yes to the depressive indicator and 280 responded no. Not surprisingly, depression was associated with higher drinking rates.
“The co-occurrence of depression and alcohol abuse has been well studied,” Dr. Ryb said. “Alcohol use disorders occur in a lot of trauma patients. There is also a high incidence of psychiatric illness in the trauma population.”
Impulsivity is associated with risky behavior within the trauma population, Dr. Ryb said. Patients rated their impulsivity on scale of 1 to 4, according to this statement: “I often act on the spur of the moment without stopping to think.” Impulsive patients reported increased alcohol use in the 90 days preinjury (an average of 237 drinks), compared with nonimpulsive participants (190 drinks). Similarly, the impulsive group reported a higher average number of binge drinking episodes (23), compared with the nonimpulsive patients (17).
The researchers assessed change in average number of drinks and average binge drinking at 12 months after the brief intervention. The motivational intervention consists of a 20-minute interview, feedback letter, and two follow-up telephone calls. “Essentially, everyone showed improvement after the interventions,” Dr. Ryb said.
They found that impulsivity, but not depression, was associated with an average 50 more alcoholic drinks and 4.2 more binge episodes at 12 months. However, overall decreases in the impulsive patients were not significantly different from any other patients in the study. Therefore, “impulsivity, depression, intervention type, and other covariates were not predictive of behavior change.”
Limitations of the study include its 50% follow-up rate, Dr. Ryb said. In addition, this study did not address any causal relationship between alcohol abuse and impulsivity.