Emergency Rooms May Be Key to Substance Abuse Diagnosis

KNOXVILLE — Hospital emergency rooms can be a key source of information about patients with substance abuse problems, a University of Tennessee study has shown.

Dr. Ian Rockett and colleagues at the University of Tennessee’s Community Health Research Group studied 1,502 adults seeking emergency care in seven hospitals across Tennessee. The study, the first of its kind to assess both alcohol and other psychoactive drug use, abuse and dependence in any statewide ER population, compared patients’ self-reported health status and drug use with drug treatment need as assessed at the time of their ER visit.

A survey questionnaire was administered to the selected patients, and their urine and saliva were tested for the presence of alcohol and other drugs. Thirty-one percent tested positive for substance use. Only 1 percent had a diagnosis of substance abuse recorded in the ER, but 27 percent were determined to need substance abuse treatment.

The study results are reported in the June issue of the journal Annals of Emergency Medicine.

“Hospital emergency rooms do not routinely screen patients for alcohol and other drug problems, yet our research indicates that more than a quarter of these ER visitors needed substance abuse treatment,” Rockett said. “This is important in planning for treatment resource allocation and for matching need with appropriate services, a major goal of the Tennessee Department of Health’s Bureau of Alcohol and Drug Abuse Services which co-sponsored the study with the U.S. Center for Substance Abuse Treatment.”

The study was limited to hospitals in Tennessee, but the problem exists nationwide, he said.

“Nationally, we estimate that between 3 million and 22 million annual emergency room visits are made by patients with substance abuse problems. These figures well exceed the annual average of 1.6 million admissions into alcohol and other drug programs from 1993 through 1998.”

Rockett, now a professor at West Virginia University’s Department of Community Medicine, said the research suggests a new, expanded role for emergency rooms in screening and referring patients to treatment for chemical dependence.

“The ER is the front line for diagnosis and treatment,” he said. “Going there frequently represents a personal crisis. If an emergency is exacerbated by substance abuse, the patient may be more responsive to a brief intervention or to seeking appropriate treatment.

“Recognizing substance abuse will help doctors more effectively diagnose and treat the medical problems that brought their patients to the ER. Such knowledge could also prevent any harmful consequences to patients from mixing prescribed drugs with the drugs they abuse.”