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May 27, 1992

Psychoactive Substance Dependence Among Trauma Center Patients

Author Affiliations

From the Department of Surgery, R Adams Cowley Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore (Dr Soderstrom); the Charles McC. Mathias National Study Center for Trauma and Emergency Medical Systems, Baltimore, Md (Dr Dischinger); the Injury Prevention Center, The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md (Dr Smith); the Departments of Psychiatry (Drs McDuff and Gorelick) and Epidemiology and Preventive Medicine (Dr Hebel), University of Maryland School of Medicine, Baltimore; and the National Institute on Drug Abuse, Bethesda, Md (Dr Gorelick).

JAMA. 1992;267(20):2756-2759. doi:10.1001/jama.1992.03480200064025

Introduction.  —The practice of assessing only trauma patients with elevated blood alcohol concentrations (BACs) or positive drug screens for psychoactive substance use disorders (PSUDs) was evaluated.

Methods.  —Twenty-four BAC-negative (BAC-) (BAC, 0) and 21 BAC-positive (BAC+) (BAC, ≥22 mmol/L or 100 mg/dL; mean, 41 mmol/L; range, 24.3 to 79 mmol/L) adult trauma patients were evaluated for alcoholism and other PSUDs using the Structured Clinical Interview (SCI) from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R). Approximately half were vehicular crash victims and 78% were men.

Results.  —A total of 64 PSUDs were diagnosed in 31 (68.9%) of the 45 patients; all but one was for dependence (vs abuse). Of the BAC+ patients, 14 (66.7%) met DSM-III-R criteria for alcohol dependence, 11 (78.6%) of whom also had other PSUDs not related to alcohol. Two other BAC+ patients had nonalcohol PSUDs. Of the BAC- patients, 11 (45.8%) had alcohol dependence, six (54.5%) of whom also had nonalcohol PSUDs. Another four BAC- patients had nonalcohol PSUDs. Overall, 76.2% of the BAC+ patients and 62.5% of the BAC patients had a diagnosis of psychoactive substance dependence.

Conclusion.  —All patients admitted to trauma centers should be assessed for alcoholism and other PSUDs.(JAMA. 1992;267:2756-2759)