Dataset Information

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. CONCLUSION: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.

SUBMITTER: Sanjuan PM

PROVIDER: S-EPMC4030520 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Alcohol, tobacco, and drug use among emergency department patients.

Sanjuan Pilar M PM Rice Samara L SL Witkiewitz Katie K Mandler Raul N RN Crandall Cameron C Bogenschutz Michael P MP

Drug and alcohol dependence 20140212

<h4>Background</h4>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.<h4>Methods</h4>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 ...[more]

PMID: 24594289

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Project description:Most previous brief intervention (BI) studies have focused on alcohol or drug use, instead of both substances. Our primary aim was to determine if an alcohol- and drug-use BI reduced alcohol use and increased alcohol treatment services utilization among adult emergency department (ED) patients who drink alcohol and require an intervention for their drug use. Our secondary aims were to assess when the greatest relative reductions in alcohol use occurred, and which patients (stratified by need for an alcohol use intervention) reduced their alcohol use the most. In this secondary analysis, we studied a sub-sample of participants from the Brief Intervention for Drug Misuse in the Emergency Department (BIDMED) randomized, controlled trial of a BI vs. no BI, whose responses to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) indicated a need for a BI for any drug use, and who also reported alcohol use. Participants were stratified by their ASSIST alcohol subscore: 1) no BI needed, 2) a BI needed, or 3) an intensive intervention needed for alcohol use. Alcohol use and alcohol treatment services utilization were measured every 3 months for 12 months post-enrollment. Of these 833 participants, median age was 29 years-old, 46% were female; 55% were white/non-Hispanic, 27% black/non-Hispanic, and 15% Hispanic. Although any alcohol use, alcohol use frequency, days of alcohol use, typical drinks consumed/day, and most drinks consumed/day decreased in both the BI and no BI arms, there were no differences between study arms. Few patients sought alcohol use treatment services in follow-up, and utilization also did not differ by study arm. Compared to baseline, alcohol use reduced the most during the first 3 months after enrollment, yet reduced little afterward. Participants whose ASSIST alcohol subscores indicated a need for an intensive intervention generally had the greatest relative decreases in alcohol use. These results indicate that the BI was not efficacious in reducing alcohol use among alcohol- and drug-using adult ED patients than the self-assessments alone, but suggest that self-assessments with or without a BI may confer reductions in alcohol use.

Project description:BackgroundHousing insecurity is prevalent among emergency department (ED) patients. Despite a surge of interest in screening for patients' social needs including housing insecurity, little research has examined ED social needs interventions. We worked together with government and community partners to develop and pilot test a homelessness prevention intervention targeted to ED patients with drug or unhealthy alcohol use.MethodsWe approached randomly sampled patients at an urban public hospital ED, May to August 2019. Adult patients were eligible if they were medically stable, not incarcerated, spoke English, had unhealthy alcohol or any drug use, and were not currently homeless but screened positive for risk of future homelessness using a previously developed risk screening tool. Participants received a three-part intervention: (1) brief counseling and referral to treatment for substance use delivered through a preexisting ED program; (2) referral to Homebase, an evidence-based community homelessness prevention program; and (3) up to three troubleshooting phone calls by study staff. Participants completed surveys at baseline and 6 months.ResultsOf 2183 patients screened, 51 were eligible and 40 (78.4%) participated; one later withdrew, leaving 39 participants. Participants were diverse in age, gender, race, and ethnicity. Of the 32 participants reached at 6 months, most said it was very or extremely helpful to talk to someone about their housing situation (n = 23, 71.9%) at the baseline ED visit. Thirteen (40.6%) said their housing situation had improved in the past 6 months and 16 (50.0%) said it had not changed. Twenty participants (62.5%) had made contact with a Homebase office. Participants shared ideas of how to improve the intervention.ConclusionsThis pilot intervention was feasible and well received by participants though it required a large amount of screening to identify potentially eligible patients. Our findings will inform a larger future trial and may be informative for others seeking to develop similar interventions.

Project description:BackgroundEmergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED.MethodsAn ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool.Results150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes "flow," "risky environment," and "physical spaces and artefacts" are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients' and HCPs' encounters unfold in everyday practice. Subtheme "Professional differences" showcases how nurses and doctors address patients' alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes "gut-feeling vs. clinical parameters," "ethical reasoning," and "from compliance to zero-tolerance"; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are "occupiers" and "alcoholic or party animal?".ConclusionsUnhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use-characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior-shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach.

Dataset Information

Alcohol, tobacco, and drug use among emergency department patients.

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Alcohol, tobacco, and drug use among emergency department patients.

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