- Considerable research has linked alcohol and drug use to both major and minor trauma.
- Most studies have used emergency-department admissions data to establish this relationship.
- A new study looks at patients entering detoxification for alcohol and other drug dependence.
- People with alcohol problems seem more injury prone than people who use illicit drugs.
Numerous publications have documented the association between alcohol and drug use - particularly alcohol use - and motor vehicle crashes, pedestrian and bicycle injuries, falls, burns, drownings, suicides, assaults, domestic violence, and even murder. Most studies have examined the association between alcohol consumption and injury using hospital emergency-department admissions data. A study in the February issue of Alcoholism: Clinical & Experimental Research reconsiders the issue in a different clinical setting, among patients entering detoxification for alcohol and other drug dependence. The findings indicate that injury is a serious problem for a substantial proportion of patients undergoing detoxification, particularly those with alcohol dependence.
"Our hypothesis was simply that when it comes to substance abuse, the consequences vary for each substance and for the group of users," explained Jeffrey H. Samet, associate professor of medicine and public health at Boston University, and the study's senior author. "What the substance is may be an important factor in the outcomes of the user. In particular, in the case of injury, we hypothesized that alcohol use is more of a risk factor for injury than illicit drug use. Furthermore, we hypothesized that this was the case amongst the most severely affected substance abusers, those receiving care in a detoxification unit."
The authors recruited 470 patients (360 males, 110 females) from a Boston detoxification unit. Study participants were divided into three groups: those considered alcohol dependent; those considered alcohol and drug dependent; and those considered drug dependent. Reported drug choices were cocaine, heroin or other (mainly sedatives and marijuana). Participants were interviewed at baseline (during detoxification), and then at six months, 12 months, 18 months, and 24 months following detoxification. Self-reported episodes of injury were defined as: a gunshot wound, a stab wound, accidents or falls requiring medical attention, fractures or dislocation of bones or joints, an injury from a road traffic accident such as a car or motorcycle, or a head injury.
"One key finding is that among the health-related complications of alcohol and drug abuse," noted Samet, "serious injury is common. We found that 24 percent of the 470 subjects reported at least one instance of injury during the six-month period prior to detoxification. The other key finding is that problems with alcohol, more so than illicit drugs, are associated with injury."
Samet added that researchers had originally thought that a significant proportion of those entering detoxification were doing so because recent serious injury had helped them realize they might have a substance-abuse problem. "And this is probably true," he said. "But then we found that at the follow-up interviews during the next two years, the prevalence of injury in the previous six months was still nearly one out of five."
"It is very interesting that this increased risk for serious injury persisted for two years after detoxification," said Gail D'Onofrio, associate professor in the Section of Emergency Medicine at Yale University School of Medicine, "even when patients were not drinking. The fact that even in recovery, alcohol-dependent patients still continue to be at risk for injury, may be a result - as the authors hypothesize - of chronic nerve and muscle damage that occurs with dependence creating unsteady gaits, problems with coordination and poor sensation. The idea that they are 'risk takers' with impulsive behavior, or may have depressive symptoms which may influence injury, needs to be further investigated."
Samet said that the continuing high incidence of injury did not necessarily mean that the alcoholics had relapsed and were once again drinking alcohol. In fact, he said, "the follow-up high prevalence of injury came as a bit of a surprise. Our hypothesis that injury at follow up would be significantly associated with ongoing alcohol consumption was not shown to be a strong association. We conjectured that perhaps a personality trait of the alcohol dependent person accounted for the injury prevalence to an extent even greater than consumption itself. Although this issue will require further study, another issue has become abundantly clear. These individuals comprise a prime opportunity to focus on injury prevention within the confines of, or directly linked to, substance-abuse treatment programs."
"The identification of the detoxification center as place to offer prevention is a unique contribution to the field," said D'Onofrio. "This may include educating patients about the risks of injury as well as including assessments of their living conditions to prevent falls and subsequent fractures and dislocations. Identifying patients with depressive symptoms and impulsive behaviors may also be beneficial, so that additional counseling sessions be provided. Future studies should look at different prevention strategies offered in detoxification programs for their ability to decrease injury rates."
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Vaughan W. Rees of the Clinical Addiction Research and Education Unit in the Department of Medicine; Nicholas J. Horton and Richard Saitz of the Clinical Addiction Research and Education Unit in the Department of Medicine, and the Department of Epidemiology and Biostatistics; and Ralph W. Hingson of the Department of Social and Behavioral Sciences - all of the Boston University Schools of Medicine and Public Health. The study was funded by the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism.