"We know that people often have alcohol on board when they get injured," explained Ted R. Miller, a principal research scientist at Pacific Institute for Research and Evaluation and lead author of the study. "We need to sort out how many injuries result from the effects of alcohol versus the lifestyle of those who abuse alcohol. Very little is known about the injury risk associated with drug abuse, or whether alcohol and drug abusers have higher injury risks than those who abuse only drugs. If substance abusers have excess injury risks, physicians need to know that so they can reduce this health threat."
Miller and his co-authors examined medical claims data from a database for 1.5 million people with health care coverage provided by 70 large corporations. Specifically, they analyzed the injury-claims histories during a three-year period of people who were treated for an alcohol- or drug-related diagnosis.
"We included all medically treated non-work injuries except alcohol and drug poisonings," said Miller. "This included falls, car crash injuries, assaults, suicide attempts, near-drownings, suffocations, poisonings that were not substance-abuse related, injury deaths in the hospital, among many others. We excluded medical misadventures that resulted in injury. We also excluded injuries treated at the same time that someone was admitted to the hospital primarily for substance-abuse treatment because some of those injuries might not have been treated absent the substance-abuse treatment. This latter decision considerably lowered our injury counts for substance abusers, making them conservative."
Despite the conservatism of their injury findings, the researchers found a notable difference in the risk of injury between those who abused alcohol and other drugs and those who did not. Those individuals clinically identified as substance abusers had an elevated risk of injury. Alcohol-and-drug abusers had the highest risk of injury (58%), followed by drug-only abusers (49%), alcohol-only abusers (46%), and those who did not abuse any drugs (38%). Compared to those without a diagnosed substance-abuse problem, said Miller, alcohol abusers were twice as likely, drug abusers were three times as likely, and alcohol-and-drug abusers were almost four times as likely to be hospitalized for an injury during the three years examined.
"This study provides important evidence regarding the extent of substance abuse disorders and injuries in a population of people who are employed and receive insurance coverage through their employers," said Linda C. Degutis, assistant professor of surgery and public health at Yale University. Each year, she added, substance abuse costs businesses at least $10 billion in absenteeism, injuries, medical liability and health care costs.
"Investment in treatment is an effective strategy to reduce these costs," said Degutis. "Research shows that, following substance abuse treatment, absenteeism, disability days and disciplinary actions all decrease by more than 50%. Adults who complete inpatient alcohol treatment have significantly lower health care utilization than they had prior to treatment. Their use of medical services is cut in half, while they use 60 percent fewer psychiatric services, have a third fewer emergency admissions, and show a 75% reduction in detoxification admissions. However, in order for treatment to occur, the problems must first be identified."
Both Miller and Degutis noted that health care practitioners - particularly family physicians and trauma personnel - have an invaluable, yet often overlooked, role in detecting, intervening on the behalf of, and referring substance-abusing patients to the appropriate care. Miller said that family physicians have an especially important role in helping older, female substance abusers.
"Among working-age adults who are not substance abusers," said Miller, "women are much less likely to be injured than men. Among substance abusers, that's not true. Indeed, by age 50, we found that substance abusers are significantly more likely to get injured if they are women. This finding is alarming, because substance-abusing women are not typically targeted for intervention. Usually it's the men who get attention for substance abuse problems and are pushed into treatment. More physicians, especially family physicians, need to identify female abusers, assess their treatment needs, and see that those needs are met."
Degutis added that, in the context of discussing substance-abuse disorders, a more fundamental issue must first be addressed.
"Addiction is a brain disease," she said. "Too often, addiction is treated as a moral issue, or a 'defect' in someone's personality or behavior or judgement. There are many things that can place someone at risk for developing an addiction, and we now know that it can have a genetic basis. It is a chronic disease, just like heart disease, diabetes, and other diseases. Unfortunately, there is still a great deal of stigma related to addiction and substance abuse. In fact, the very term 'substance abuse' somehow implies that the person with an addiction is responsible for the problem. We should not be reluctant to discuss these issues, and should bring them out into the open, just as we have done with diseases such as breast cancer, prostate cancer, and heart disease."
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Diane C. Lestina of the Public Services Research Institute; and Gordon S. Smith of the Center for Injury Research and Policy at The John Hopkins University School of Hygiene and Public Health. The study was funded by the National Institute on Alcohol Abuse and Alcoholism.