Advocacy

Trauma and Chemical Misuse/Dependency

Adoption Date:
April 1, 1991

Public Policy Statement on Trauma and Chemical Misuse/Dependency

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Trauma is the leading cause of death attributable to alcohol use and, along with other drugs, the most important contributing factor to injuries seen in hospitalized trauma patients. These injuries represent an enormous public health problem and an opportunity to provide appropriate medical care that is usually ignored. Physicians are reluctant to obtain basic screening tests, and when they do, positive results are not used as indicators of patient management, assessment, and intervention. This omission frequently occurs because of physician attitudes toward alcoholism and other drug dependencies, thus resulting in patient mismanagement.

Alcohol and drug testing of hospitalized trauma patients and the assessment of those with positive results is an appropriate approach to the problem, because the procedure contributes to differential diagnoses; provides objective data for making appropriate clinical choices concerning the use of pharmacological agents; permits an evaluation of the likelihood of medical complications of alcoholism; aids in determining those at risk of withdrawal syndromes; and serves as a basic screening test for those with possible substance abuse problems.

The American Society of Addiction Medicine believes it is medically proper to identify these patients, so that their immediate medical care is improved and the risk of future suffering reduced.

Therefore, the Society supports the following as standards of clinical practice:

1. All hospitalized trauma patients should have blood alcohol concentration (BAC) determinations and urine drug screens performed on admission. Children under 14 years of age should be tested if there is suspicion of alcohol or other drug involvement.

2. Attending physicians responsible for care of trauma patients should promptly address positive BAC and urine drug screen determinations in their trauma patients and obtain:

a) Consultation or referral for evaluation of underlying chemical misuse/dependency problems; and

b) Treatment for these problems.

3. Ongoing periodic quality assurance reviews of these policies should be performed.

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