Maxillo-facial surgeons see a regular stream of young male casualties with alcohol related facial injuries. The majority of them have been involved in a fight, usually on a Friday or Saturday night. They attend an A&E department, receive appropriate treatment and are given an appointment for a follow-up clinic within the next 10 days. This clinic provides an ideal opportunity to influence the drinking patterns of these young men.
Can a brief alcohol intervention, given at this point, influence future alcohol consumption? Alyson Smith, Ray Hodgson and Jonathan Shepherd, from the University of Wales College of Medicine, carried out a randomised controlled trial, involving 150 young men, to test out this possibility. The nurse intervention was provided by Kathryn Bridgeman & Beth Charles.
In the 3 months prior to admission to Accident & Emergency with a facial it1jury , 54% of the men receiving treatment as usual were consistently drinking above the recommended limits. One year later this changed to 50%, showing that relatively small changes occurred without a specific alcohol intervention.
The alcohol intervention produced much greater changes. Even though the alcohol intervention took less than 20 minutes to complete, it resulted in a significant change in alcohol consumption during the following year when compared to treatment as usual. Prior to admission 60% of men in this group were consistently exceeding the recommended limits. One year later this had reduced to 27%.
A brief dialogue between a nurse and a patient was clearly more effective than the natural processes associated with the passage of time.
The actual intervention was completed as part of a routine service without the need for additional resources.
- The nurse-led alcohol intervention should now be replicated within other maxillo-facial services in order to check that the intervention is feasible and effective when completed as a routine activity, rather than a well-monitored research procedure.
- The brief alcohol intervention can be completed at the same time as a routine medical treatment such as removing sutures. It does not, therefore, require substantial additional resources and could be implemented within all maxillo-facial services.
- Commissioners of services should provide funding for nurse training and the evaluation of this service development.
A number of recent reviews have concluded that brief alcohol interventions are effective in reducing alcohol consumption in the large group of people who are drinking in a hazardous way or have an alcohol-related problem. However, these randomised controlled studies have mainly been carried out in a general hospital or primary care setting. The current study is the first to involve young men suffering from an alcohol-related facial il1iury. Less than 3% of these men were severely dependent on alcohol but 95% were hazardous or problem drinkers according to a frequently used screening questionnaire (The Alcohol Use Disorders Identification Test).
Jonathan Shepherd, Alyson Smith, Ray Hodgson, Kathryn Bridgeman & Beth Charles.