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The rates of substance use in patients admitted for traumatic injuries by far exceed those of the general population. Besides being a major risk factor for a patient’s initial injury, substance use is also a risk factor for readmissions and death due to injuries. In fact, one study found that patients admitted to trauma centers were 2.5 times more likely to be readmitted with injuries within 3 years of the index admission. Although the link between substance use and injuries is strong and tests for substance use are readily available from urine and blood samples, testing in patients admitted to trauma centers for injuries is not routine. Studies have shown that as few as 35% of trauma centers routinely test injured patients for drug and alcohol use.

Analyzing Rates of Substance Abuse Testing

In a study published in the July 2007 Archives of Surgery, my colleagues and I used data from the National Trauma Data Bank to analyze patients between the ages of 15 and 50 who were admitted to trauma centers with injuries from 1998 to 2003. We found that only half of the patients who were admitted with injuries were tested for alcohol use; of these patients, half had positive test results during the past 6 years. In addition, about one of every three patients admitted with injuries were tested for drug use; nearly half of which had positive test results.

Considering Existing Barriers

Testing patients for substance use can often serve as the first step toward identifying the problem and providing intervention. However, several barriers exist to routine testing. Many physicians believe that injured patients who use alcohol are heavy drinkers beyond help, yet several studies have shown that the majority of injured patients are moderate drinkers who participate in binge drinking. Furthermore, physicians may not be aware that effective treatments exist or are skeptical of their efficacy. Several studies have shown that short motivational interviews called “brief interventions” can reduce alcohol consumption and readmission due to injuries.

Legal barriers may also serve as a disincentive for routine testing of substance abuse. The Uniform Accident Sickness Policy Provision Law, for example, allows insurance companies to deny payments to trauma centers for injuries relating to drugs and alcohol. About 40% of physicians reporting that they didn’t routinely test for substance abuse have cited this law as their primary reason. It should be noted, however, that the law is now enacted only on a state-by-state basis. Recently, many states have established revisions that void this law, an important note because it can further impede the use of routine testing for substance use.

Making a Difference

Clinical investigations have supported using brief interventions in trauma settings when caring for alcohol abusers. The only way to use brief interventions effectively is to identify patients with abuse problems. Routine testing will maximize our ability to find patients who may benefit from brief interventions. Further efforts are needed to educate physicians on the techniques and benefits of brief interventions in the future. In addition, physicians need to be on the frontline to advocate changes in the legislation.

Jason A. London, MD, MPH has indicated to Physician’s Weekly that he has or has had no financial interests to report.