Article

Alcohol-Attributable Fraction for Injury in the U.S. General Population: Data From the 2005 National Alcohol Survey

Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, California 94608, USA.
Journal of studies on alcohol and drugs (Impact Factor: 2.27). 07/2008; 69(4):535-8. DOI: 10.15288/jsad.2008.69.535
Source: PubMed

ABSTRACT Although studies of patients seen in emergency department (ED) settings have documented a strong association of alcohol with injury, such patients are not necessarily representative of the larger population, and less is known of alcohol's association with risk of injury in patient samples outside the ED.
Drinking before injury was analyzed in the 2005 National Alcohol Survey among the 1,149 respondents (18.5%, weighted) who reported an injury during the past year; analysis was by injury treatment type (ED-treated, 29.2%; other-treated, 47.8%; and nontreated, 22.9%).
Based on case-crossover analysis, the relative risk of injury from drinking was 1.85 (p < .01) for those with an ED-treated injury, 1.42 (ns) for those with an other-treated injury, and 1.43 (ns) for those with a nontreated injury. Alcohol-attributable fractions based on these relative risk estimates were 2.96% for an ED-treated injury, 1.59% for an other-treated injury, and 1.89% for a nontreated injury. Comparative attributable fractions based on the person's causal attribution of injury to his or her drinking were 3.06%, 1.61%, and 1.47%, respectively. Although these attributable fractions based on case-crossover analysis and subjective evaluation of causal attribution were not greatly different, all estimates were considerably smaller than those found in studies of ED patients.
The data suggest that alcohol plays a larger role in those injuries for which treatment is sought in EDs, and this may be related to the severity of the injury. Additional studies of alcohol and injury in general populations that take into account the intensity of exposure to alcohol before the event, as well as recall bias by eliciting data on the proximity of the event to the time of the respondent interview, are necessary for determining unbiased estimates of the attributable fraction of alcohol in injury morbidity.

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    • "It is estimated that the total economic cost of alcohol and drug abuse in the region is more than $240 billion annually, with about $97 billion due to drug abuse [2]. Patients who visit hospital emergency departments (EDs) may be at particularly high risk for a variety of behavioral risk factors such as illicit substance use [3]. "
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    ABSTRACT: BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227.
    Addiction science & clinical practice 05/2014; 9(1):8. DOI:10.1186/1940-0640-9-8
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    • "Heavy alcohol consumption is the major preventable cause of injury resulting in an emergency department (ED) visit; however, many alcohol-related injuries occur in people who drink in a hazardous manner without meeting criteria for alcohol dependence.1,2 Because such hazardous drinkers are excellent candidates for a brief intervention (BI) aimed at decreasing future alcohol-related problems, screening and BI has been recommended for ED patients.2,3 "
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