More than half of the seriously injured patients treated at Maryland Shock Trauma Center were found to have a current or past problem with drugs or drinking, according to a study in today's Journal of the American Medical Association.
The survey results have prompted officials at the trauma center to contemplate ways to persuade patients while they are still in the hospital to get treatment for their addictions or to change on their own.
"If you find those problems, you ought to treat those problems," said Dr. Carl A. Soderstrom, a professor of surgery who directed the study. "That's just part of good medicine. You shouldn't just send them out the door."
People who have abused drugs or alcohol are often predisposed to engage in thrill-seeking behaviors such as speeding, driving recklessly or not wearing a seat belt, said Dr. David McDuff, a psychiatrist who participated in the study.
Added Soderstrom: "One of the major things that is linked with having a substance-abuse problem is eventual injury."
In the study, researchers interviewed 1,118 adult patients whose injuries were severe enough to warrant a hospital stay of two days or more. The patients were admitted between September 1994 and November 1996.
Researchers found that 54 percent had at one time abused or been dependent on alcohol or drugs. Almost 25 percent had a drinking problem around the time of their injuries, while 18 percent were dependent on drugs such as heroin or cocaine.
Shock Trauma is perhaps best known for treating victims of serious traffic accidents occurring in Maryland; many of the injured are flown to the downtown hospital by helicopter.
In the past few years, however, Shock Trauma has also become an emergency center for the southwestern quadrant of Baltimore -- a designation that has meant an influx of patients suffering from gunshot and knife wounds, as well as traffic injuries, falls and baseball-bat assaults.
Soderstrom said the change has significantly but not dramatically altered the patient mix. In the past, 90 percent were victims of "unintentional injuries" such as those resulting from traffic accidents. Now, about 70 percent fit that description, with the remaining 30 percent falling into the category of "intentional" injuries such as those stemming from assaults.
The study was limited by researchers' inability to interview patients who were unconscious or not sufficiently alert to give complete answers.
McDuff said it was important to identify patients with a history of substance abuse -- not just those who were intoxicated at the time of injury.
"Substance problems are chronic in nature and frequently are characterized by relapses from one time period to another," said McDuff, director of clinical programs in psychiatry at the University of Maryland School of Medicine.
Shock Trauma tests all its patients for drugs and alcohol, and sends a counselor to talk to those who test positive. Counselors try to encourage patients to get into treatment.
The tests also have medical implications. A positive test result, for instance, could flag a potential cross-reaction with medications being used in treatment.
Shock Trauma hopes to start a program in which the staff will try to identify patients who are in the early stages of drug or alcohol dependence. They would participate in a short interview aimed at helping them to recognize their addiction and make constructive changes.
"We want to capitalize on a moment of opportunity, a teachable moment to try to talk to the person about the drinking or the drug use," said Dr. Carlo Diclemente, a psychologist at the University of Maryland Baltimore County.
Under a grant proposal now under consideration, Shock Trauma would implement a system of "motivational intervention" designed by Diclemente.
Pub Date: 6/11/97
