Difficulties in substance abuse rehabilitation in a rural trauma center

Objective

Drug and alcohol abuse is prevalent among trauma patients. The trauma incident however may provide an opportunity to confront the patient with a potential abuse problem and facilitate rehabilitation. We sought to evaluate the effectiveness of a program designed to assist trauma patients with their substance abuse problems in our rural Level I trauma center.

Methods

Starting in April, 1994, our Trauma service identified and referred all trauma patients judged to have a potential substance abuse problem to our Drug, Alcoholism and Addictions Program (DAAP). These patients received pertinent in-hospital counselling and education and were informed of available follow-up. Telephone interviews were conducted to determine the long-term effectiveness of the program in regards to a substance-free lifestyle and a potential for further morbidity.

Results

From 4/8/94 to 6/26/96, a total of 3397 trauma patients were entered into the Trauma Registry. Of these, 762 (22.4%) tested positive for alcohol and 473 (13.9%) tested positive for other substances. Of these, 100 patients or 10.3% of the net 966 patients who tested positive for one or more substances were identified and confronted regarding their substance abuse problem(s). Reasons cited for other patients not being included in the program were abbreviated hospital stays, physician apathy, and a failure of the subspecialty services to seek this consultation. Only 16 patients could be contacted for follow-up. All but 2 of the 16 patients who were contacted had stopped or curtailed their alcohol or drug use. Notably, one of the non-rehabilitated patients did subsequently have a traffic citation driving under the influence of an intoxicating sustance.

Conclusions

Despite a programmatic approach, only a fraction of substance-abusing trauma patients are successfully approached into altering their lifestyles. In patients where counselling is provided, lifestyle changes are potentially attainable. The poor long-term follow-up of these patients may underscore the difficulty of rehabilitation of the trauma population.