Alcohol, tobacco, and drug use among emergency department patients

Sanjuán, Pilar; Rice, Samara L.; Witkiewitz, Katie; Mandler, Raúl N.; Crandall, Cameron; Bogenschutz, Michael P.

doi:10.1016/j.drugalcdep.2014.01.025

Cited by 47 publications

(50 citation statements)

References 33 publications

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“…9,13,14,24 Since our medical comorbidity measure combined acute and chronic conditions, it will be important for future work to identify which individual medical conditions (e.g., overdose, injury, respiratory infections, etc.) contribute most strongly to ED admission.…”

Section: Discussionmentioning

confidence: 99%

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

et al. 2018

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Background Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a large sample of patients with alcohol, marijuana, and opioid use disorders in an integrated health system. Methods In a retrospective design, electronic health record (EHR) data identified patients with ≥1 of 3 common SUDs in 2010 (n = 17,574; alcohol, marijuana, or opioid use disorder) and patients without SUD (n = 17,574). Logistic regressions determined odds of ED use between patients with SUD versus controls (2010–2014); mixed-effect models examined 5-year differences in utilization; moderator models identified subsamples for which patients with SUD may have a greater impact on ED resources. Results Odds of ED use were higher at each time point (2010–2014) for patients with alcohol (odds ratio [OR] range: 5.31–2.13, Ps < .001), marijuana (OR range: 5.45–1.97, Ps < .001), and opioid (OR range: 7.63–4.19, Ps < .001) use disorders compared with controls; odds decreased over time (Ps < .001). Patients with opioid use disorder were at risk of high ED utilization; patients were 7.63 times more likely to have an ED visit in 2010 compared with controls and remained 5.00 (average) times more likely to use ED services. ED use increased at greater rates for patients with alcohol and opioid use disorders with medical comorbidities relative to controls (Ps < .045). Conclusions ED use is frequent in patients with SUDs who have access to private insurance coverage and integrated medical services. ED settings provide important opportunities in health systems to identify patients with SUDs, particularly patients with opioid use disorder, to initiate treatment and facilitate ongoing care, which may be effective for reducing excess medical emergencies and ED encounters.

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Section: Discussionmentioning

confidence: 99%

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

et al. 2018

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“…5 In addition, in agreement with previously published work, ED patients of both sexes also report more tobacco, alcohol, and drug use than previously published national averages. 9,22 …”

Section: Discussionmentioning

confidence: 99%

“…Although this observation is similar to a recent multicenter study, patterns of substance use may vary geographically and our study findings may not be generalizable to other areas of the country. 9 …”

Section: Discussionmentioning

confidence: 99%

“…This finding supports recent work that found a similar pattern of substance use and suggests that substance-using women are as just as prone to problematic behavior as substance using men. 9 In fact, it is plausible that women should have lower cutoffs for what constitutes problematic behavior or positive screens for misuse and need for treatment. It is well known that sex differences in body composition, physiology, and metabolism may make women more prone to the negative sequelae of substance use at lower levels of use than their male counterparts.…”

Section: Discussionmentioning

confidence: 99%

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Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention

Beaudoin

Baird

Liu

et al. 2015

Academic Emergency Medicine

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Background Substance use is prevalent among emergency department (ED) patients, and sex has been implicated as an important factor in the etiology, pathophysiology, sequelae, and treatment of substance use disorders. However, additional information is needed about the epidemiology of substance use as it relates to sex among ED patients. Objectives This study examined sex differences in the prevalence and severity of self-reported tobacco, alcohol, and drug use among adult ED patients. Methods A random sample of English- or Spanish-speaking, non–critically ill or injured, 18- to 64-year-old patients was approached at two urban EDs and asked to self-report their lifetime and past 3-month tobacco, alcohol, and drug use. Participants completed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) using an audio computer-assisted self-interview. Participants were categorized by their substance severity (ASSIST score) and need for a brief or more intensive intervention per World Health Organization recommendations. Substance misuse prevalence, frequency, severity, and need for interventions were compared between sexes by substance category. Multivariable logistic regression models were used to examine the association between sexes and the need for intervention after adjusting for sociodemographic characteristics. Results Of the 6,432 participants in the study, the median age was 37 years (interquartile range = 26 to 48 years), and 56.6% were female. Overall, lifetime, and past 3-month use was higher for men across all substances (tobacco, alcohol, and drugs). Among those reporting past 3-month use, the frequency of use was similar between sexes for tobacco and all drugs, but men reported more frequent alcohol use. Men had higher mean ASSIST scores compared to women, 30.3 (standard error [SE] ± 0.8) vs. 21.1 (SE ± 0.5); mean difference 9.2 (95% confidence interval [CI] = 7.4 to 10.9). The need for any intervention (brief or intensive) was similar between sexes for tobacco and drugs. After sociodemographic factors were adjusted for, women were less likely than men to need any intervention for alcohol (odds ratio [OR] = 0.6; 95% CI = 0.4 to 0.8), but not other substances: tobacco (OR = 0.9; 95% CI = 0.6 to 1.3), marijuana (OR = 0.8; 95% CI = 0.6 to 1.1), or other drugs (OR = 1.1; 95% CI = 0.7 to 1.7). Conclusions Although men have a higher overall prevalence of substance use, the frequency and severity of use were similar for men and women for most substances. After other characteristics were adjusted for, sex appears associated with the need for interventions for alcohol, but not tobacco, marijuana, or other drugs.

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“…In a multi-hospital study across several states, it was found that 45% of adult ED patients were risky alcohol users (Sanjuan, et al 2014); this suggests that the ED may be a prime environment to identify and begin intervening with patients with a spectrum of alcohol use disorders (Brown et al 2012; Field et al 2010; Sommers et al 2013). Studies have investigated the feasibility and efficacy of using behavioral interventions in the ED setting to change drinking and driving behaviors.…”

Section: Introductionmentioning

confidence: 99%

Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

Baird

Yang

Strezsak

et al. 2017

Traffic Injury Prevention

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Objective: To measure the effect of motor vehicle crash (MVC) involvement and readiness to change drinking and driving behaviors on subsequent driving and drinking behaviors among injured emergency department (ED) patients who use alcohol at harmful levels. Methods: A secondary analyses of a randomized controlled trial of injured ED patients who screened positive for harmful alcohol use, who at recruitment reported driving in the past 12 months and received at least one of the intended intervention sessions (brief behavioral intervention versus attention placebo control [N = 407]). Outcome variables were: 1) change in six impaired driving behaviors, 2) report of MVCs and traffic violations in the 12 months following recruitment; predictor variables were: 1) treatment assignment, 2) MVC involvement at recruitment, and 3) baseline readiness to change alcohol use and drinking and driving. Results: Modeling of change in the six impaired driving variables indicated that neither the recruitment visits being MVC-related, nor baseline readiness to change alcohol use and drinking and driving behaviors, predicted greater changes in impaired driving over time. Baseline reports of past moving traffic violations and the ED visit being MVC related predicted a greater likelihood of each behavior at 12 months following study recruitment. Conclusions: This study and others have demonstrated that ED patients with harmful alcohol use are willing to engage in behavioral interventions directed at changing risky behaviors. However, this study did not demonstrate that patients considered having the potential to be more engaged with the intervention, because their ED visit was MVC-related and/or they had expressed intent to change their risky alcohol use and drinking and driving behaviors, were more likely to change these risky behaviors.

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Alcohol, tobacco, and drug use among emergency department patients

Cited by 47 publications

References 33 publications

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention

Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

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