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Psychoactive Substance Dependence Among Trauma Center Patients
Carl A. Soderstrom, MD;
Patricia C. Dischinger, PhD;
Gordon S. Smith, MD, MPH;
David R. McDuff, MD;
J. Richard Hebel, PhD;
David A. Gorelick, MD, PhD
JAMA. 1992;267(20):2756-2759.
Abstract
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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)
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).
Footnotes
This article is one of a number of articles on violence that will appear in upcoming issues of The Journal. The reader is referred to the June 10, 1992, issue, which will be dedicated to studies of violence.
Reprint requests to Department of Surgery, Maryland Institute for Emergency Medical Services Systems, 22 S Greene St, Baltimore, MD 21201-1595 (Dr Soderstrom).
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