Psychoactive substance use disorders among seriously injured trauma center patients.
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.


METHODS
Prevalence study.


METHODS
A level I regional trauma center.


METHODS
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.


METHODS
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 chi2 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.
Soderstrom
C A
CA
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore 21201-1595, USA. csoderstrom@trauma.ab.umd.edu
Smith
G S
GS
Dischinger
P C
PC
McDuff
D R
DR
Hebel
J R
JR
Gorelick
D A
DA
Kerns
T J
TJ
Ho
S M
SM
Read
K M
KM
D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D015142:Baltimore; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011619:Psychotropic Drugs; D015813:Substance Abuse Detection / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications*
D011619:Psychotropic Drugs