Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: A prospective randomised controlled trial

Abstract

Aims

To assess the impact of two methods of brief nurse-delivered brief interventions in reducing drinking variables in hazardous drinkers with alcohol-related facial injuries.

Methods

A randomised controlled trial of two brief interventions involving hazardous drinkers with facial trauma in three Oral and Maxillofacial Surgery outpatient clinics in the West of Scotland; 194 patients were recruited and randomised to have either a nurse-led brief motivational intervention (intervention group) or a leaflet about alcohol misuse (control group). Patients were followed up at 3 and 12 months after the intervention and drinking variables reassessed.

Results

A brief motivational intervention for alcohol provided by a nurse was more effective than a leaflet in helping some patients with facial trauma to reduce their alcohol consumption 12 months after the intervention (p < 0.05).

Conclusions

Facial trauma in the West of Scotland is strongly associated with alcohol misuse and is a recurrent disease, particularly among those who drink heavily. A nurse-delivered brief motivational intervention is effective in helping patients with high scores in the Alcohol Use Disorders Identification Test to reduce their drinking, and this effect was apparent 12 months after the intervention.

Introduction

Over one third of men and a quarter of women in Scotland have reported that they exceed daily benchmarks for drinking.¹ One of the consequences of excess alcohol is the increased likelihood of trauma; this has led the Scottish Executive to identify reduction of both alcohol related injuries and violence as key priorities in the National Plan for Alcohol in Scotland.²

Excessive alcohol excess and interpersonal violence are strongly associated with facial trauma in the UK³ and other developed countries.4, 5 In Scotland, 69% of 235 victims of assault had consumed alcohol before they were injured,⁶ and most mandibular fractures were associated with interpersonal violence.⁷

Facial trauma is particularly prevalent among young men³ who are also the group most likely to drink to excess¹ and to indulge in interpersonal violence. Binge drinking is a major factor for head injury in young adults in the UK.⁸ In addition, a recent study has shown that alcohol-related falls from a standing height are more often associated with craniofacial injury than injury elsewhere in the body, probably because alcohol inhibits the protective reflexes.⁹

There is some evidence that maxillofacial trauma is a recurrent phenomenon; estimates of repeat injuries vary widely; one study in the UK has shown that 3% (25/760) of patients had sustained one or more previous fractures in the maxillofacial region¹⁰ while another showed a 42.4% (39/92) recurrence rate.⁵ Layton et al,¹⁰ found that patients with recurrent injuries were more likely to have been drinking at the time of injury. Laski et al,⁵ found that patients with facial injuries who had previously been assaulted were more likely to have “assault” as the recurrent mechanism of injury. Recrudescence among patients with alcohol related trauma is also seen among the general population of people who are injured.¹¹ Warburton and Shepherd,¹² stated that maxillofacial surgeons should be involved in prevention of injuries and should address their patients’ alcohol issues, which are often a major aetiological factor. Despite this and the clear association of facial injury with alcohol, few surgeons broach these issues with patients. Possible reasons for this are lack of time and training, both of which have been cited in studies undertaken Accident and Emergency departments.¹³

Smith et al,¹⁴ showed that nurses could expand their role within the trauma team and could successfully deliver brief motivational interventions about alcohol to patients with facial trauma. These interventions are cost-effective and have helped patients with facial trauma to reduce their alcohol consumption.¹⁴ Several studies have shown that patients who have alcohol-related injuries are motivated to consider changing their drinking behaviour,¹⁵ and that this motivation is increased if they understand and perceive the association between drinking alcohol and their injury.¹⁶ Schermer et al,¹⁷ found that trauma patients are not offended by the concept of alcohol screening and intervention, and 94% of 150 injured patients thought that this subject should be discussed with them.

In this study we aimed to describe a group of patients with alcohol-related facial trauma in the West of Scotland and to assess the effect of a nurse-led brief motivational intervention in reducing their alcohol consumption.