A Study of Differential Effects of Two Brief Counseling Interventions Used in a Hospital Trauma Center with Persons Exhibiting High-Risk Drinking Patterns

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Counseling and Human Services


Janine M. Bernard


Alcohol, Brief counseling, Brief intervention, Motivational Interviewing, Trauma

Subject Categories

Counseling Psychology


The American College of Surgeons Committee on Trauma (ACS-COT) has initiated policy requiring alcohol screening and brief intervention programs in all Level I trauma centers, and alcohol screening programs in all Level II trauma centers. This innovative policy mandates that trauma centers use the `teachable moment' generated by traumatic injury as a gateway to effective prevention of future alcohol abuse and other alcohol-related consequences.

Researchers have decried the lack of investigation regarding the "how and why" (Nilsen et al., 2008, p. 200) of brief intervention effects. The overall aim of the current study was to better understand the nature and possible active ingredients of the screening and brief intervention encounter. Specifically, this inquiry focused upon the effect of patient-level variables and two distinct brief motivational interviewing-based counseling interventions on patient engagement and on six-month drinking outcomes.

There were two primary findings of this study. One, that a new standardized brief counseling intervention interview exploring 1) the patient's reasons for seeking drunken states and 2) alternative coping strategies for healthier functioning appeared to be as efficacious as a widely-used brief intervention focusing upon quantity and frequency of drinking. Two, that patient pre-intervention AUDIT scores were a major predictor of changes in patient AUDIT scores at 6 months post-intervention in a way that was theoretically counter-intuitive: namely, that high scores (indicating possible alcohol dependence) were associated with the greatest changes at follow-up. The patient engagement variable did not emerge as a significant predictor or moderator of outcomes. Limitations and implications of findings are discussed. Future investigation of the construct of patient engagement is recommended.

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