Skip to main content

Co-occurring Substance-Use Disorder in the Emergency Department

  • Chapter
  • First Online:
Behavioral Emergencies for Healthcare Providers
  • 766 Accesses

Abstract

All healthcare professionals working in emergency settings will encounter patients with substance-use disorders. Sixty-four percent of emergency department (ED) patients have problematic substance use, and more than 10% have a significant use disorder [1, 2]. Over the last decade, the number of ED visits involving substance use has increased by 37% [3]. Half of the trauma visits are associated with alcohol use, and generally the presence of a substance-use disorder is associated with higher ED utilization [4, 5].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sanjuan PM, Rice SL, Witkiewitz K, Mandler RN, Crandall C, Bogenschutz MP. Alcohol, tobacco, and drug use among emergency department patients. Drug Alcohol Depend. 2014;138:32–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wu LT, Gersing KR, Swartz MS, Burchett B, Li TK, Blazer DG. Using electronic health records data to assess comorbidities of substance use and psychiatric diagnoses and treatment settings among adults. J Psychiatr Res. 2013;47(4):555–63.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Trends in emergency department visits involving mental and substance use disorders, 2006–2013. Rockville, MD: Agency for Healthcare Research and Quality. 2016. Updated December 6, 2016. Available at https://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.jsp. Accessed 17 Aug 2017.

  4. Strezsak V, Baird J, Lee CS, Mello MJ. Cross-sectional study of risky substance use by injured emergency department patients. West J Emerg Med. 2017;18(3):345–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vu F, Daeppen JB, Hugli O, Iglesias K, Stucki S, Paroz S, et al. Screening of mental health and substance users in frequent users of a general Swiss emergency department. BMC Emerg Med. 2015;15:27.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-V. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

    Book  Google Scholar 

  7. Substance Abuse and Mental Health Services Administration. Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. Rockville: National Institutes of Health. 2015. Updated September 2015. Available at https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. Accessed 21 Aug 2017.

  8. Gili-Miner M, Lopez-Mendez J, Bejar-Prado L, Ramirez-Ramirez G, Vilches-Arenas A, Sala-Turrens J. Alcohol use disorders and community-acquired pneumococcal pneumonia: associated mortality, prolonged hospital stay and increased hospital spending. Arch Bronconeumol. 2015;51(11):564–70.

    Article  PubMed  Google Scholar 

  9. Howes DS, Sanders AN. Management of the emergency department patient with co-occurring substance abuse disorder. In: Zun L, Chepenik LG, Mallory MN, editors. Behavioral emergencies for the emergency physician. Cambridge, UK: Cambridge University Press; 2013. p. 150–63.

    Chapter  Google Scholar 

  10. Vroegop MP, Franssen EJ, van der Voort PH, van den Berg TN, Langeweg RJ, Kramers C. The emergency care of cocaine intoxications. Neth J Med. 2009;67(4):122–6.

    CAS  PubMed  Google Scholar 

  11. Bazmi E, Mousavi F, Giahchin L, Mokhtari T, Behnoush B. Cardiovascular complications of acute amphetamine abuse: cross-sectional study. Sultan Qaboos Univ Med J. 2017;17(1):e31–e7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bui QM, Simpson S, Nordstrom K. Psychiatric and medical management of marijuana intoxication in the emergency department. West J Emerg Med. 2015;16(3):414–7.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Khan A, Levy P, DeHorn S, Miller W, Compton S. Predictors of mortality in patients with delirium tremens. Acad Emerg Med. 2008;15(8):788–90.

    Article  PubMed  Google Scholar 

  14. Maldonado JR, Sher Y, Das S, Hills-Evans K, Frenklach A, Lolak S, et al. Prospective validation study of the prediction of alcohol withdrawal severity scale (PAWSS) in medically ill inpatients: a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol Alcohol. 2015;50(5):509–18.

    Article  CAS  PubMed  Google Scholar 

  15. Foy A, March S, Drinkwater V. Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital. Alcohol Clin Exp Res. 1988;12(3):360–4.

    Article  CAS  PubMed  Google Scholar 

  16. Victor M, Brausch C. The role of abstinence in the genesis of alcoholic epilepsy. Epilepsia. 1967;8(1):1–20.

    Article  CAS  PubMed  Google Scholar 

  17. Victor M, Adams RD. The effect of alcohol on the nervous system. Res Publ Assoc Res Nerv Ment Dis. 1953;32:526–73.

    CAS  PubMed  Google Scholar 

  18. Mayo-Smith MF, Beecher LH, Fischer TL, Gorelick DA, Guillaume JL, Hill A, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. 2004;164(13):1405–12.

    Article  CAS  PubMed  Google Scholar 

  19. Gold JA, Rimal B, Nolan A, Nelson LS. A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med. 2007;35(3):724–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–44.

    Article  PubMed  Google Scholar 

  21. Rosenson J, Clements C, Simon B, Vieaux J, Graffman S, Vahidnia F, et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. J Emerg Med. 2013;44(3):592–8.

    Article  PubMed  Google Scholar 

  22. Espi Martinez F, Nieto Munuera J, Noguera Velasco JA, Espi FF. Detecting substance abuse in the emergency department: a 10-year comparative study. ISRN Emerg Med. 2013;2013:7.

    Article  Google Scholar 

  23. Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg. 2005;241(4):541–50.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Medhus S, Mordal J, Holm B, Morland J, Bramness JG. A comparison of symptoms and drug use between patients with methamphetamine associated psychoses and patients diagnosed with schizophrenia in two acute psychiatric wards. Psychiatry Res. 2013;206(1):17–21.

    Article  PubMed  Google Scholar 

  25. National Institute on Drug Abuse. The NIDA quick screen 2012. Updated March 1, 2012. Available at https://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen. Accessed 21 Aug 2017.

  26. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption—II. Addiction. 1993;88(6):791–804.

    Article  CAS  PubMed  Google Scholar 

  27. Merchant RC, Liu T, Baird JR. Variations in substance use prevalence estimates and need for interventions among adult emergency department patients based on different screening strategies using the ASSIST. West J Emerg Med. 2016;17(3):302–14.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kroll DS, Smallwood J, Chang G. Drug screens for psychiatric patients in the emergency department: evaluation and recommendations. Psychosomatics. 2013;54(1):60–6.

    Article  PubMed  Google Scholar 

  29. Wilson MP, Nordstrom K, Anderson EL, Ng AT, Zun LS, Peltzer-Jones JM, et al. American Association for Emergency Psychiatry Task Force on medical clearance of adult psychiatric patients. Part II: controversies over medical assessment, consensus recommendations. West J Emerg Med. 2017;18(4):640–6.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ti L, Milloy MJ, Buxton J, McNeil R, Dobrer S, Hayashi K, et al. Factors associated with leaving hospital against medical advice among people who use illicit drugs in Vancouver, Canada. PLoS One. 2015;10(10):e0141594.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Gili-Miner M, Bejar-Prado L, Gili-Ortiz E, Ramirez-Ramirez G, Lopez-Mendez J, Lopez-Millan JM, et al. Alcohol use disorders among surgical patients: unplanned 30-days readmissions, length of hospital stay, excessive costs and mortality. Drug Alcohol Depend. 2014;137:55–61.

    Article  PubMed  Google Scholar 

  32. Lee CA, Cho JP, Choi SC, Kim HH, Park JO. Patients who leave the emergency department against medical advice. Clin Exp Emerg Med. 2016;3(2):88–94.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Anis AH, Sun H, Guh DP, Palepu A, Schechter MT, O’Shaughnessy MV. Leaving hospital against medical advice among HIV-positive patients. CMAJ. 2002;167(6):633–7.

    PubMed  PubMed Central  Google Scholar 

  34. Yong TY, Fok JS, Hakendorf P, Ben-Tovim D, Thompson CH, Li JY. Characteristics and outcomes of discharges against medical advice among hospitalised patients. Intern Med J. 2013;43(7):798–802.

    Article  CAS  PubMed  Google Scholar 

  35. Buckley PF. Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. J Clin Psychiatry. 2006;67(Suppl. 7):5–9.

    PubMed  Google Scholar 

  36. Wells BG, Marken PA, Rickman LA, Brown CS, Hamann G, Grimmig J. Characterizing anticholinergic abuse in community mental health. J Clin Psychopharmacol. 1989;9(6):431–5.

    Article  CAS  PubMed  Google Scholar 

  37. Lyapustina T, Castillo R, Omaki E, Shields W, McDonald E, Rothman R, et al. The contribution of the emergency department to opioid pain reliever misuse and diversion: a critical review. Pain Pract. 2017;17(8):1097–104.

    Article  PubMed  Google Scholar 

  38. Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med. 2017;376(7):663–73.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Grover CA, Elder JW, Close RJ, Curry SM. How frequently are “classic” drug-seeking behaviors used by drug-seeking patients in the emergency department? West J Emerg Med. 2012;13(5):416–21.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the opioid risk tool. Pain Med. 2005;6(6):432–42.

    Article  PubMed  Google Scholar 

  41. Bachhuber MA, Maughan BC, Mitra N, Feingold J, Starrels JL. Prescription monitoring programs and emergency department visits involving benzodiazepine misuse: early evidence from 11 United States metropolitan areas. Int J Drug Policy. 2016;28:120–3.

    Article  PubMed  Google Scholar 

  42. Department of Veterans Affairs, Department of Defense. VA/DOD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder: clinician summary. Washington, DC. 2017. Updated June 2017. Available at https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGClinicianSummaryFinal.pdf. Accessed 21 Aug 2017.

  43. Cooper J, Kapur N, Dunning J, Guthrie E, Appleby L, Mackway-Jones K. A clinical tool for assessing risk after self-harm. Ann Emerg Med. 2006;48(4):459–66.

    Article  PubMed  Google Scholar 

  44. Maldonado JR. Novel algorithms for the prophylaxis and management of alcohol withdrawal syndromes-beyond benzodiazepines. Crit Care Clin. 2017;33(3):559–99.

    Article  PubMed  Google Scholar 

  45. Broida RI, Gronowski T, Kalnow AF, Little AG, Lloyd CM. State emergency department opioid guidelines: current status. West J Emerg Med. 2017;18(3):340–4.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Osborn SR, Yu J, Williams B, Vasilyadis M, Blackmore CC. Changes in provider prescribing patterns after implementation of an emergency department prescription opioid policy. J Emerg Med. 2017;52(4):538–46.

    Article  PubMed  Google Scholar 

  47. Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. New York, NY: Guilford Press; 2013.

    Google Scholar 

  48. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305–12.

    PubMed  PubMed Central  Google Scholar 

  49. Kohler S, Hofmann A. Can motivational interviewing in emergency care reduce alcohol consumption in young people? A systematic review and meta-analysis. Alcohol Alcohol. 2015;50(2):107–17.

    Article  CAS  PubMed  Google Scholar 

  50. Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: a randomized controlled trial. Subst Abuse Treat Prev Policy. 2015;10(1):46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Blow FC, Walton MA, Bohnert ASB, Ignacio RV, Chermack S, Cunningham RM, et al. A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study. Addiction. 2017;112(8):1395–405.

    Article  PubMed  Google Scholar 

  52. D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Bernstein SL, D’Onofrio G, Rosner J, O’Malley S, Makuch R, Busch S, et al. Successful tobacco dependence treatment in low-income emergency department patients: a randomized trial. Ann Emerg Med. 2015;66(2):140–7.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Jarosz J, Miernik K, Wachal M, Walczak J, Krumpl G. Naltrexone (50 mg) plus psychotherapy in alcohol-dependent patients: a meta-analysis of randomized controlled trials. Am J Drug Alcohol Abuse. 2013;39(3):144–60.

    Article  PubMed  Google Scholar 

  55. Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, et al. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011;168(7):709–17.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. J Psychoactive Drugs. 2012;44(4):307–17.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Bernstein SL, D’Onofrio G. Screening, treatment initiation, and referral for substance use disorders. Addict Sci Clin Pract. 2017;12(1):18.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Estee S, Wickizer T, He L, Shah MF, Mancuso D. Evaluation of the Washington state screening, brief intervention, and referral to treatment project: cost outcomes for Medicaid patients screened in hospital emergency departments. Med Care. 2010;48(1):18–24.

    Article  PubMed  Google Scholar 

  59. Horn BP, Crandall C, Forcehimes A, French MT, Bogenschutz M. Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments. J Subst Abuse Treat. 2017;79:6–11.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction. 2015;110(9):1404–15.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Neighbors CJ, Zywiak WH, Stout RL, Hoffmann NG. Psychobehavioral risk factors, substance treatment engagement and clinical outcomes as predictors of emergency department use and medical hospitalization. J Stud Alcohol. 2005;66(2):295–304.

    Article  PubMed  Google Scholar 

  62. Mee-Lee D, American Society of Addiction Medicine. The ASAM criteria: treatment for addictive, substance-related, co-occurring conditions. 3rd ed. Chevy Chase, MD: American Society of Addiction Medicine; 2013.

    Google Scholar 

  63. Simpson SA, Wilson MP, Nordstrom K. Psychiatric emergencies for clinicians: emergency department management of alcohol withdrawal. J Emerg Med. 2016;51(3):269–73.

    Article  PubMed  Google Scholar 

  64. Ostergaard MLD, Nordentoft M, Hjorthoj C. Associations between substance use disorders and suicide or suicide attempts in people with mental illness: a Danish nation-wide, prospective, register-based study of patients diagnosed with schizophrenia, bipolar disorder, unipolar depression or personality disorder. Addiction. 2017;112(7):1250–9.

    Article  PubMed  Google Scholar 

  65. Nordentoft M, Erlangsen A, Madsen T. Removing firearms from the home after attempted suicide can be life saving. Am J Psychiatry. 2017;174(8):721–2.

    Article  PubMed  Google Scholar 

  66. Magnusson AR, Hedges JR, Vanko M, McCarten K, Moorhead JC. Follow-up compliance after emergency department evaluation. Ann Emerg Med. 1993;22(3):560–7.

    Article  CAS  PubMed  Google Scholar 

  67. Kyriacou DN, Handel D, Stein AC, Nelson RR. BRIEF REPORT: factors affecting outpatient follow-up compliance of emergency department patients. J Gen Intern Med. 2005;20(10):938–42.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Scott A. Simpson .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Simpson, S.A., Taub, J. (2021). Co-occurring Substance-Use Disorder in the Emergency Department. In: Zun, L.S., Nordstrom, K., Wilson, M.P. (eds) Behavioral Emergencies for Healthcare Providers. Springer, Cham. https://doi.org/10.1007/978-3-030-52520-0_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-52520-0_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52519-4

  • Online ISBN: 978-3-030-52520-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics