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A Deadly Signal
Alcohol-Related Injuries Signals Dangerous Lifestyle
SAPRP News Release

Survivors of car crashes and other injury events who test positive for alcohol or drug use are more than twice as likely to die in just a few years from a subsequent injury under similar circumstances as those who do not test positive.

"Currently, many trauma centers do not screen patients for substance abuse problems," said Patricia Dischinger, Ph.D., University of Maryland School of Medicine researcher. "Fewer still offer treatment because many states deny or restrict payments for treatment of these types of victims. But not providing substance abuse treatment at the time they enter the trauma center is like not treating a heart attack patient for high blood pressure, which is a major factor for heart disease."

According to Dischinger, it is known that alcohol or other drug use is linked to injuries involving vehicular crashes, falls, and other types of trauma episodes. However, this is the first study to demonstrate an increased death rate among individuals who survived one serious injury episode and tested positive for alcohol and other drugs.

Underlying Cause

She and her colleagues from the National Study Center for Trauma and Emergency Medical Systems looked at 27,399 patients admitted to the R Adams Cowley Shock Trauma Center in Baltimore from 1983 to 1995. The patients were followed through 1997 and death certificates were obtained for those who died.

The results show that 34% of the deaths were attributable to injury among patients who had tested positive for alcohol or other drugs at the time of their original admission, compared with 15% of deaths among those who did not test positive for substance abuse. Further, the data showed that more than 40% of the patients had tested positive for alcohol or drug use, with alcohol being the most common.

The typical trauma patient in the Baltimore study was a white male between the ages of 20 and 44. Nearly a third of the patients had serious multiple injuries and another 24% had moderately severe injuries. Motor vehicle crashes accounted for 46% of the injuries, followed by falls (14%) and firearms (9%).

Dischinger and her colleagues conclude that the message to trauma center clinicians and to individuals with alcohol or drug problems is the same. "They both need to pay attention to a major underlying cause of injury, namely substance abuse." In particular, the trauma center is an excellent opportunity to provide substance abuse treatment "because the patient is likely to be highly motivated to seek it while being treated for the physical injuries caused by substance abuse."

According to one of the study's co-authors, Carl Soderstrom, M.D., Professor of Surgery at the University of Maryland School of Medicine, "There is mounting evidence that substance abuse treatment may be effective among trauma patients. Unfortunately, skepticism about the benefits of treatment for substance abuse, negative attitudes about patients who use alcohol and drugs, and lack of education about substance abuse treatment among trauma clinicians are some of the reasons why trauma patients with alcohol and other drug use problems do not get treatment."

Denial of Payment

The study notes that some trauma centers have stopped testing for alcohol and drug use because third party payer policies and statutes allow for denial of payments for patients who test positive for alcohol and other drugs at the time of injury, although such denials are rarely invoked. The researchers said that there are no data available on the extent to which trauma centers are not testing for alcohol and drugs because of fear of denial of payment of services. Soderstrom notes that a number of initiatives at the national and local level have begun to eliminate denial of payment policies and statutes. In Maryland, a law (SB 162) banning such denials will go into effect January 1, 2002.

Since the Baltimore trauma center admits patients from urban, rural and suburban settings, the patients are representative of trauma patients nationwide, and the findings should be applicable to all trauma patients throughout the country, Dischinger said.

These findings were published in the November issue of the Journal of Trauma. The research was funded by the Substance Abuse Policy Research Program of The Robert Wood Johnson Foundation.

The Substance Abuse Policy Research Program (SAPRP) of The Robert Wood Johnson Foundation (RWJF) funded the research. SAPRP (www.saprp.org) is a $54 million initiative that funds research into policies affecting alcohol, tobacco and illegal drugs. RWJF (www.rwjf.org) is the nation's largest philanthropy devoted exclusively to health and health care.

It concentrates its grant making in four goal areas: to assure that all Americans have access to basic health care at reasonable cost; to improve care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse -- tobacco, alcohol, and illicit drugs.

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