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

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. In this study, investigators 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 participating in the National Drug Abuse Treatment Clinical Trials Network protocol CTN-0047 (“Screening Motivational Assessment and Referral to Treatment in Emergency Departments (SMART-ED)”). Younger age, male gender, higher triage acuity, and other substance use severity were expected to be associated both with use versus abstinence and with severity of each substance use type. Negative binomial hurdle models were used to examine the association between covariates and these two elements.

Rates of use and problem use in the study sample were similar to or higher than in 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.

Related protocols: CTN-0047