Alcohol, tobacco, and drug use among emergency department patients

Abstract

Background The prevalence of alcohol, tobacco, and other drug (ATOD) use among emergency department (ED) patients is high and many of these patients have unrecognized and unmet substance use treatment needs. Identification of patients in the ED with problem substance use is not routine at this time. Methods We examined screening data, including standardized measures of ATOD use (HSI, AUDIT-C, DAST-10), from 14,866 ED patients in six hospitals across the United States. We expected younger age, male gender, higher triage acuity, and other substance use severity (ATOD) to be associated both with use versus abstinence and with severity of each substance use type. We used negative binomial hurdle models to examine the association between covariates and (1) substance use versus abstinence (logistic submodel) and with (2) severity among those who used substances (count submodel). Results Rates of use and problem use in our sample were similar to or higher than other ED samples. Younger patients and males were more likely to use ATOD, but the association of age and gender with severity varied across substances. Triage level was a poor predictor of substance use severity. Alcohol, tobacco, and drug use were significantly associated with using other substances and severity of other substance use. Conclusion Better understanding of the demographic correlates of ATOD use and severity and the patterns of comorbidity among classes of substance can inform the design of optimal screening and brief intervention procedures addressing ATOD use among ED patients. Tobacco may be an especially useful predictor.

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

“…9,13,14,24 Since our medical comorbidity measure combined acute and chronic conditions, it will be important for future work to identify which individual medical conditions (e.g., overdose, injury, respiratory infections, etc.) contribute most strongly to ED admission.…”

Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention

“…5 In addition, in agreement with previously published work, ED patients of both sexes also report more tobacco, alcohol, and drug use than previously published national averages. 9,22 …”

“…Although this observation is similar to a recent multicenter study, patterns of substance use may vary geographically and our study findings may not be generalizable to other areas of the country. 9 …”

“…This finding supports recent work that found a similar pattern of substance use and suggests that substance-using women are as just as prone to problematic behavior as substance using men. 9 In fact, it is plausible that women should have lower cutoffs for what constitutes problematic behavior or positive screens for misuse and need for treatment. It is well known that sex differences in body composition, physiology, and metabolism may make women more prone to the negative sequelae of substance use at lower levels of use than their male counterparts.…”

Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

“…In a multi-hospital study across several states, it was found that 45% of adult ED patients were risky alcohol users (Sanjuan, et al 2014); this suggests that the ED may be a prime environment to identify and begin intervening with patients with a spectrum of alcohol use disorders (Brown et al 2012; Field et al 2010; Sommers et al 2013). Studies have investigated the feasibility and efficacy of using behavioral interventions in the ED setting to change drinking and driving behaviors.…”