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Psychoactive substance dependence among trauma center patients
C A Soderstrom1, P C Dischinger, G S Smith
1Department of Surgery, R Adams Cowley Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
JAMA
|May 27, 1992
Summary
Trauma patients with and without elevated blood alcohol concentrations (BACs) frequently have psychoactive substance use disorders (PSUDs). Universal screening for alcoholism and other PSUDs in trauma patients is recommended.
Area of Science:
- Traumatology
- Addiction Psychiatry
- Clinical Psychology
Background:
- Current practice often limits psychoactive substance use disorder (PSUD) screening in trauma patients to those with elevated blood alcohol concentrations (BACs) or positive drug screens.
- This study evaluates the efficacy of this selective screening approach.
Purpose of the Study:
- To determine the prevalence of PSUDs in trauma patients, irrespective of BAC levels.
- To assess the diagnostic yield of screening for alcoholism and other PSUDs in a trauma population.
Main Methods:
- Adult trauma patients were divided into two groups: BAC-negative (BAC < 0) and BAC-positive (BAC ≥ 22 mmol/L).
- The Structured Clinical Interview (SCI) from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) was used to diagnose alcoholism and other PSUDs.
- Patient demographics and injury circumstances (e.g., vehicular crash victims) were recorded.
Main Results:
- A significant proportion of trauma patients (68.9%) were diagnosed with PSUDs, predominantly alcohol dependence.
- Among BAC-positive patients, 66.7% met criteria for alcohol dependence, and a substantial number also had non-alcohol-related PSUDs.
- Notably, 45.8% of BAC-negative patients also had alcohol dependence, and many in both groups had co-occurring non-alcohol PSUDs, indicating widespread substance use disorders.
Conclusions:
- The findings underscore the high prevalence of PSUDs across the spectrum of BAC levels in trauma patients.
- Selective screening based solely on BAC or drug screens misses a considerable number of individuals with substance use disorders.
- Universal assessment for alcoholism and other PSUDs in all trauma admissions is crucial for comprehensive patient care.
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