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Randomized Controlled Trial
. 2011 Sep;69(9):2396-411.
doi: 10.1016/j.joms.2010.12.040. Epub 2011 Apr 15.

Randomized Controlled Trial of Personalized Motivational Interventions in Substance Using Patients With Facial Injuries

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Randomized Controlled Trial

Randomized Controlled Trial of Personalized Motivational Interventions in Substance Using Patients With Facial Injuries

Vivek Shetty et al. J Oral Maxillofac Surg. .
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Abstract

Purpose: The proximate use of illicit drugs or alcohol (substance use) is the most common precipitator of facial injuries among socioeconomically disadvantaged populations. Reducing these risky behaviors could minimize adverse health sequelae and potential reinjury. The objective of our study was to test whether a culturally competent, personalized motivational intervention incorporated into surgical care could significantly reduce existing substance use behaviors in facial injury patients.

Patients and methods: Substance-using subjects (n = 218) presenting with facial injuries to a level 1 trauma center were randomly assigned to either a personalized motivational intervention (PMI) condition or a health-information (HI) control condition. After a brief assessment of the individual's substance use severity and willingness to change these behaviors, both groups attended 2 counseling sessions with a trained interventionist. The PMI subjects (n = 118) received individualized, motivational interventions, whereas the HI subjects (n = 100) received only general health information. Both groups were reassessed at 6 and 12 months postinjury, and changes in substance-use patterns were measured to assess the effects of intervention.

Results: The PMI and HI groups were closely matched on their sociodemographic and substance use characteristics. Subjects in the PMI group showed statistically significant declines in drug use at both the 6- and 12-month assessments. The intervention's effect on lowering illicit drug use was greatest at the 6-month assessment but had weakened by the 1-year follow-up. The efficacy of the PMI was moderated by an individual's initial drug use severity; individuals with greater drug use dependency at baseline were seen to have larger intervention effects, as did individuals who were most aware of their drug problem and willing to change their substance use behaviors. Unlike illicit drug use, changes in alcohol use did not differ significantly between the intervention and control groups, irrespective of an individuals' recognition of the alcohol problem or willingness to take steps to address it.

Conclusion: A culturally competent, motivational intervention integrated into the care of vulnerable patients with facial injury can reduce illicit drug use behaviors. Subgroups of injured patients appear to benefit most from such personalized motivational interventions. A better articulation of target populations, intervention content, and delivery would allow for directed interventions and an appropriate focusing of limited time and health care resources.

Figures

FIGURE 1
FIGURE 1
Study flow.
FIGURE 2
FIGURE 2
Plots of change scores from baseline (horizontal dotted line) for drug use outcomes at follow-up assessments. Error bars represent ± 2 SE. Solid vertical lines are for control group; dashed vertical lines are for personalized motivational intervention group. A, Texas Christian University Drug Screen—II (TCUDS) score. B, Drug-days. C, Primary drug.
FIGURE 3
FIGURE 3
Plots of change scores from baseline (horizontal dotted line) for alcohol use outcomes at follow-up assessments. Error bars represent ± 2 SE. Solid vertical lines for control group; dashed vertical lines are for personalized motivational intervention group. A, Alcohol Use Disorders Identification Test (AUDIT) score. B, Alcohol use. C, Alcohol to intoxication.
FIGURE 4
FIGURE 4
Plots of change scores from baseline (horizontal dotted line) for drug use outcomes at follow-up assessments for different categories of baseline drug use. Error bars represent ± 2 SE. Solid vertical lines for control group; dashed vertical lines for personalized motivational intervention group. A, Texas Christian University Drug Screen—II (TCUDS) score. B, Drug-days. C, Primary drug.
FIGURE 5
FIGURE 5
Plots of change scores from baseline (horizontal dotted line) for drug use outcomes at follow-up assessments for different categories of baseline alcohol use. Error bars represent ± 2 SE. Solid vertical lines for control group; dashed vertical lines for personalized motivational intervention group. A, Alcohol Use Disorders Identification Test (AUDIT) score. B, Alcohol use. C, Alcohol to intoxication.
FIGURE 6
FIGURE 6
Plots of change scores from baseline (horizontal dotted line) for drug use outcomes at follow-up assessments for subjects at different stages of change at baseline. Error bars represent ± 2 SE. Solid vertical lines for control group; dashed vertical lines for personalized motivational intervention group. A, Texas Christian University Drug Screen—II (TCUDS) by Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) D, Recognition. B, TCUDS by SOCRATES D, Taking Steps.
FIGURE 7
FIGURE 7
Plots of change scores from baseline (horizontal dotted line) for alcohol use outcomes at follow-up assessments for subjects at different stages of change at baseline. Error bars represent ± 2 SE. Solid vertical lines for control group; dashed vertical lines for personalized motivational intervention group. A, Alcohol Use Disorders Identification Test (AUDIT) score by Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) D, Recognition. B, ADUIT by SOCRATES D, Taking Steps.

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