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June 11, 1997

Psychoactive Substance Use Disorders Among Seriously Injured Trauma Center Patients

Author Affiliations

From the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center (Dr Soderstrom); the Center for Injury Research and Policy, Johns Hopkins University (Dr Smith); the National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine (Dr Dischinger, Mr Kerns, and Mss Ho and Read); the Departments of Psychiatry (Dr McDuff) and Epidemiology (Dr Hebel), University of Maryland School of Medicine; and the Division of Intramural Research, National Institute on Drug Abuse (Dr Gorelick), Baltimore, Md.

JAMA. 1997;277(22):1769-1774. doi:10.1001/jama.1997.03540460033029

Objective.  —To assess the prevalence of psychoactive substance use disorders (PSUDs) among a large, unselected group of seriously injured trauma center patients, using a standardized diagnostic interview and criteria.

Design.  —Prevalence study.

Setting.  —A level I regional trauma center.

Patients.  —Trauma center patients fulfilling the following criteria were eligible subjects: aged 18 years or older, admission from injury scene, length of stay of 2 days or longer, and intact cognition.

Outcome Measures.  —The PSUDs were diagnosed using the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) and were categorized as abuse or dependence and past or current (within past 6 months). The SCID results were analyzed with respect to demographic factors, injury type, and blood alcohol concentration and urine toxicology results, using ϰ2 and logistic regression techniques.

Results.  —Of the 1220 patients approached for study, 1118 (91.6%) consented. More than half (54.2%) had a diagnosis of a PSUD in their lifetime. Approximately 90% of alcohol and other drug use diagnoses were for dependence and more than 62% were current. Overall, 24.1% of patients were currently alcohol dependent (men, 27.7%; women, 14.7%; P<.001), and 17.7% were currently dependent on other drugs (men, 20.2%; women, 11.2%; P<.001). Current alcohol dependence rates were not associated with race; rates of dependence on other drugs were higher among nonwhites and victims classified with intentional injuries. While 54.3% of blood alcohol—positive patients were currently alcohol dependent and 38.7% of patients with positive urine screening test results for drugs other than alcohol and nicotine were currently drug dependent, 11.7% of blood alcohol—negative and 3.9% of drug-negative patients, respectively, had current diagnoses of dependence on psychoactive substances.

Conclusions.  —A high percentage of seriously injured trauma center patients are at risk of having current PSUDs. Patients with positive toxicology screening test results and/or positive screening questionnaire responses should be referred for formal evaluation and treatment.