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Training Physicians About Impaired Driving Issues

Number 235 December 2000

U.S. Department of Transportation

National Highway Traffic Safety Administration

400 Seventh Street, S.W., Washington, DC 20590

TRAINING PHYSICIANS ABOUT IMPAIRED DRIVING ISSUES

In 1997, the National Highway Traffic Safety Administration (NHTSA) awarded eight cooperative

agreements to support the development of innovative programs that have the potential to

substantially reduce alcohol-related fatalities. One of these grants was awarded to the

Harborview Injury Prevention and Research Center in Seattle, Washington. The Harborview team

has prepared a brief summary of the activities they conducted under the grant.

Alcoholism is the most common chronic disease in trauma patients, and one of the most common

in patients treated in primary care. Studies have shown that brief counseling intervention in

trauma centers is efficient in reducing drinking and its related illness and injury. Unfortunately,

although trauma centers and primary care clinics are ideal settings for such brief alcohol

interventions, routine screening and brief counseling for alcohol problems are not commonly

practiced by physicians in these settings. The objective of the project was to address alcohol

abuse at the individual patient level and at the community level.

At the individual patient level, the project encouraged physicians to perform a protocol for brief

alcohol interventions to address alcohol abuse. This protocol consists of screening for alcohol

problems, brief counseling, and referral. This was accomplished primarily by offering training to

physicians, residents, and medical students.

At the community level, the project involved health professionals acting as advocates for strong

DWI legislation and for coverage of care by health insurance plans.

Specifically, the goals of the project, which was conducted in the Pacific Northwest (Washington,

Alaska, Montana, and Idaho) were to:

Train medical students on the problems of impaired driving, methods to screen patients,

techniques of brief alcohol intervention, and indications for referral of patients for more

in-depth alcohol treatment.

Train University of Washington residents on the problems of impaired driving, methods of

screening, and brief interventions.

Integrate training in substance abuse and brief counseling interventions into the

University of Washington School of Medicine's curriculum.

Integrate methods of alcohol screening, intervention, and referral in continuing medical

education programs for primary care and other specialty physicians in the Pacific

Northwest.

Develop and disseminate user-friendly materials to promote and teach the brief

intervention approach.

Investigate barriers in the United States to implementing alcohol screening in hospital

emergency departments.

Work to establish alcohol screening and brief interventions as part of national practice

guidelines for medical care.

Disseminate the program nationally through professional organizations, national

publications, and national presentations.

Conclusions

Among the study's conclusions are:

Training medical students and residents about alcohol screening and intervention is

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Traffic Tech Publications | National Highway Traffic Safety Administration(NHTSA) | U.S. Department of Transportation

http://www.nhtsa.dot.gov/...mID=48051c8e13cbff00VgnVCM1000002c567798RCRD&orderTrafficTechSelect=3D&trafficTechYearSelect=2000&overrideViewName=Report[6/2/2009 8:42:20 AM]

feasible and well-received, but obtaining training time is difficult.

In order to institutionalize substance abuse training, champions (permanent faculty

members who are committed to addressing and teaching substance abuse) are needed.

Using a theme approach for training is best. Under this approach, substance abuse is

seen not as a curriculum topic but as a common theme appearing throughout medical

school, in all courses, and in all clinical settings.

Many physicians show little interest in learning about brief interventions. If medical

reimbursement patterns change, physicians maybe more likely to address alcohol

problems with their patients.

Physicians' concerns that screening for alcohol abuse may result in denial of coverage by

insurance companies appear to be based in fact, as codified in the statutes of most

states.

HOW TO ORDER

For a copy of Addressing Alcohol-Impaired Driving: Training Physicians to Detect and

Counsel their Patients Who Drink Heavily (30 pages), write to the Office of Research and

Traffic Records, NHTSA, NTS-31, 400 Seventh Street, S.W., Washington, DC 20590, fax (202)

366-7096, or download from http://www.nhtsa.dot.gov Jonathan Walker, Ph.D., and then Amy

Berning were the contract managers for this project.

U.S. Department

of Transportation

National Highway

Traffic Safety

Administration

400 Seventh Street, S.W. NTS-31

Washington, DC 20590

Traffic Tech is a publication to disseminate information about traffic safety programs,

including evaluations, innovative programs, and new publications. Feel free to copy it

as you wish. If you would like to receive a copy contact:

Linda Cosgrove, Ph.D., Editor, Evaluation Staff

Traffic Safety Programs

(202) 366-2759, fax (202) 366-7096

E-mail: lcosgrove@nhtsa.dot.gov

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