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40 - Substance abuse

Published online by Cambridge University Press:  12 January 2010

By
Ted Parran
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Ted Parran
Affiliation:
Case Western Reserve University, School of Medicine, Cleveland, OH
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Problems of drug and alcohol abuse are ubiquitous in hospitalized patient populations. A prevalence study at Johns Hopkins Hospital in 1986 demonstrated active alcoholism in 23% of surgical patients, with subgroup rates ranging from 14% in patients on the urology service, 28% in those on the orthopedic service, to 43% in those on the otorhinolaryngology service. Although this study did not evaluate the prevalence of drug abuse, consideration of the abuse of drugs other than alcohol could only increase the overall rate of affected patients on surgical services. Detection rates by physician staff of patients with substance abuse problems are low in general and lowest on surgery and obstetrics-gynecology services. Data indicate that under 25% of affected patients are identified on these specialty services. In addition, less than half the substance-abusing patients who are identified receive any form of intervention, counseling, or even a medical treatment plan that addresses the substance abuse issues. Therefore, only about 10% of surgical patients with substance abuse problems have their abuse addressed in any way by their physicians.

In a few special populations of surgical patients, problems of substance abuse are of even greater magnitude. Trauma service data indicate that between 30% and 75% of all injured patients have positive results on toxicology testing for legal levels of alcohol intoxication or for drugs of abuse at the time of hospital admission.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 493 - 502
Publisher: Cambridge University Press
Print publication year: 2006

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