title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA. Electronic address: psanjuan@unm.edu.
authors.forename: Pilar M
authors.initials: PM
authors.lastname: Sanjuan
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA; Research Institute on Addictions, State University of New York at Buffalo, 1021 Main Street, Buffalo, NY 14203, USA.
authors.forename: Samara L
authors.initials: SL
authors.lastname: Rice
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Witkiewitz
authors.affiliation: Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard Room 3105, Bethesda, MD, 20892-9557, USA.
authors.forename: Raul N
authors.initials: RN
authors.lastname: Mandler
authors.affiliation: Department of Emergency Medicine, Health Sciences Center, University of New Mexico, MSC10 5560, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Crandall
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, 2650 Yale Boulevard, SE, MSC11-6280, Albuquerque, NM, 87106, USA; Department of Psychiatry, Health Sciences Center, University of New Mexico, MSC 09 50301 University of New Mexico, Albuquerque, NM, 87131, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bogenschutz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Addiction; Alcohol; Emergency department; Negative binomial model; Substance abuse; Tobacco