This TIP Alcohol and Other Drug Screening of Hospitalized Trauma Patients examines the extensive role that alcohol and other drug abuse plays in traumatic injury. The costs of injury to both individuals and society are high. In financial terms, the annual direct and indirect costs of providing care for injured persons are higher than the costs of care for persons with cancer or heart disease. Persons who sustain one injury are at greatly increased risk of reinjuring themselves and others. Untreated substance use disorders are thought to be the cause of a large portion of reinjury. For these and other reasons, the consensus panel recommends universal alcohol and drug screening of injured patients ages 14 and older upon hospital admission.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• A Note to Readers
• Chapter 1—Introduction
  • The Goals of This TIP
  • Injury as Disease and the Role of Alcohol and Other Drugs
  • The Need for Screening
  • Scope of the Problem
  • Barriers and Opportunities
  • Ethical and Legal Issues
  • Background of This TIP
  • Some Final Notes
  • Overview of This TIP
  • Conclusion
• Chapter 2—Trauma Patients
  • Purpose of This Chapter
  • Overview of the Problem
  • Definition of Traumatic Injury and Views of the Trauma Patient Definition
  • Treatment of Trauma Patients
  • Types of Injury
  • Special Populations of Trauma Patients
• Chapter 3 -- Effects of Alcohol and Other Drugs on Trauma Patients
  • General Physiological and Cognitive Effects of AODs
  • How AODs Complicate Assessment and Treatment of Trauma Patients
  • The Importance of AOD Interventions in Traumatic Injury
• Chapter 4—Screening and Assessment
  • Level 1 Trauma: Screening and Assessment
  • Definitions and Overview
  • When to Screen
  • Description of Laboratory Screening Tests
  • Description of Screening Questionnaires and Interviews
  • Evaluating Results of AOD Screening
  • AOD Assessment
  • Postassessment Considerations
  • Role of the Primary Care Physician
  • Brief Interventions
  • Summary
• Chapter 5—Cost-Benefit Issues Affecting Implementation of Screening
  • Weighing Benefits and Costs Of Screening
• Chapter 6—Legal and Ethical Concerns
  • Overview of Legal and Ethical Issues
  • Federal Regulations Governing Confidentiality
  • Common Issues Surrounding AOD-Related Information
  • Ethical Considerations: Weighing Benefits and Harms to Society and the Individual
  • Case Example
  • Summary
• Chapter 7—Recordkeeping and Quality Improvement
  • Overview
  • Protecting Information in Patients' Records
  • Quality Improvement and Assurance
• Appendix A -- Bibliography
• Appendix B—Glossary of Medical Terms
• Appendix C—Federal Resource Panel
• Appendix D—Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, MS, served as the CSAT Government project officer, and Roberta Messalle was the Government content advisor. Text development was provided by Carl Leukefeld, DSW Writers were Carolyn Davis, Joni Eisenberg, Constance Gartner, Randi Henderson, and Deborah Shuman.

The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.