title: Readiness to change and the role of inpatient counseling for alcohol/substance abusing youth with major trauma.
abstract: BACKGROUND
  The data regarding trauma recidivism among youth suggest that alcohol and/or substance abuse counseling should be an integral part of an injury prevention program in Level I trauma centers. Analysis of attitudes and motivation toward changing substance use is an important part of counseling. This study explores the willingness of a patient population at risk for recurrent injury to address their alcohol or substance use habits.
  
  
  METHODS
  Young patients (ages 15-24) admitted with major trauma and positive alcohol/toxicology screens to a Level I trauma center were offered a previously described "readiness-to-change" interview tool. Responses were analyzed using a modified methodology to identify those patients motivated toward curtailing subsequent use.
  
  
  RESULTS
  From February 2002 to August 2003, 120 patients (study group) consented to be interviewed. Within the study group, 109 (91%) were male patients, 110 (92%) were black, 85 (71%) suffered penetrating trauma injuries, and 75 (63%) had dropped out of high school. According to their interview tool responses, 61 (87%) of those patients using alcohol and 63 (85%) of those patients using drug were either "contemplative" or "action oriented" toward addressing their substance use behaviors. Furthermore, 35 patients (29%) in the study group indicated an absolute willingness to address their alcohol/drug use. No patient accessed treatment resources provided once discharged.
  
  
  CONCLUSIONS
  Although findings regarding the assessment of attitudes toward readiness to change among young drug/alcohol-using patients experiencing penetrating trauma were initially very encouraging, facilitating and engaging these patients in actual behavior changing activities was far more challenging. Further exploration into the existing barriers to accessing treatment services and cultivating attitudes toward changing substance use behaviors is necessary.
authors.affiliation: The Johns Hopkins School of Medicine, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287-1884, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Yonas
authors.forename: Deborah
authors.initials: D
authors.lastname: Baker
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: Judith
authors.initials: J
authors.lastname: Phillips
authors.forename: Jane
authors.initials: J
authors.lastname: Paradise
authors.forename: Michael
authors.initials: M
authors.lastname: Paradise
authors.forename: Erica
authors.initials: E
authors.lastname: Sutton
authors.forename: Arvand
authors.initials: A
authors.lastname: Elihu
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D001290:Attitude; D015897:Comorbidity; D003376:Counseling; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D019966:Substance-Related Disorders / Q000453:epidemiology*