This project is funded by The University of Texas at El Paso via a BUILD Pilot/Seed Award (NIH 5RL5GM118969-04). Principal investigator is Craig Field, PhD.

The burden of physical injury in the United States is high and alcohol use is a major contributing factor. It is the leading cause of death among adults under age 45, and accounted for over 80 billion dollars in costs related to hospitalization and work lost among this age group in 2010. Brief interventions that are administered in emergency departments, inpatient hospitals, or trauma settings, and target seriously injured patients identified as heavy drinkers are generally effective interventions for alcohol use and related problems, including subsequent injury.

However, there is wide variation in the effects of brief intervention across treatment outcomes within and across studies. Investigations of mediators and moderators of brief intervention have been unable to significantly advance our understanding of how and under what circumstances brief intervention works. A major rationale for implementing brief interventions in hospital settings is that these are ‘ideal’ settings in which to ‘capitalize’ on the temporal proximity and salience of a ‘teachable moment’ or ‘sentinel event’; namely, the experience of an injury. Despite its presumed major role in behavior change and its potential explanatory power for brief intervention treatment effects, there have been few attempts to understand the process by which a sentinel event may lead to changes in alcohol use. Furthermore, there is no guiding theoretical framework for understanding or predicting the impact of the sentinel event on alcohol use outcomes.

The proposed study seeks to address this gap by conducting a grounded theory analysis of the lived experience of sentinel events among adult heavy drinking men previously admitted to a Level 1 Trauma Center due to injury. We seek to: 1) identify variables that serve as mechanisms by which a sentinel event impacts change in alcohol use; 2) determine the interrelationships among these variables, and 3) identify factors that influence these interrelationships.

The proposed study will utilize existing data from 27 in-depth individual interviews with adult men who were recently hospitalized in a Level 1 Trauma Center for treatment of an injury, and were identified as heavy drinkers. Grounded theory methodology will be applied to the secondary analysis of these data, the core analytic techniques of which include theoretical sampling, initial (or open) coding, focused coding (or category development), constant comparison, and memo writing. The expected outcome of this research is a detailed understanding, based on first-person accounts, of how experiencing a sentinel event triggers subsequent social, interpersonal, behavioral, cognitive, and/or affective processes to influence outcomes typically targeted by brief intervention. The positive impact of this research will be the advancement of our understanding of mechanisms of change underlying brief interventions in the hospital setting, which may elucidate treatment targets and contexts under which brief interventions may be most beneficial. Such advancements may clarify existing ambiguities in the literature and inform the development of more effective interventions, which may in turn reduce the public health burden of injury.