People who abuse both alcohol and other drugs have the highest risk of injury. The association among alcohol and other drug use and injury is well documented. Alcohol alone is known to be a factor in 60 to 70 percent of homicides, 40 percent of suicides, 40 to 50 percent of fatal motor vehicle crashes, 60 percent of fatal burn injuries, 60 percent of drownings, and 40 percent of fatal falls. Miller and his co-authors examined medical claims data from a database for 1.5 million people with health care coverage provided by 70 large corporations. Specifically, they analysed the injury-claims histories during a three-year period of people who were treated for an alcohol-or drug-related diagnosis.

“We included all medically treated non-work injuries except alcohol and drug poisonings,” said Miller. “This included falls, car crash injuries, assaults, suicide attempts, near-drownings, suffocations, poisonings that were not substance-abuse related, injury deaths in the hospital, among many others. We excluded medical misadventures that resulted in injury. We also excluded injuries treated at the same time that someone was admitted to the hospital primarily for substance-abuse treatment, because some of those injuries might not have been treated in the absence of the substance-abuse treatment. This latter decision considerably lowered our injury counts for substance abusers, making them conservative.’ Despite the conservatism of their injury findings, the researchers found a notable difference in the risk of injury between those who abused alcohol and other drugs and those who did not. Those individuals clinically identified as substance abusers had an elevated risk of injury. Alcohol-and-drug abusers had the highest risk of injury (58%), followed by drug-only abusers (49%), alcohol-only abusers (46%), and those who did not abuse any drugs (38%). Compared to those without a diagnosed substance-abuse problem, said Miller, alcohol abusers were twice as likely, drug abusers were three times as likely, and alcohol-and-drug abusers were almost four times as likely to be hospitalized for an injury during the three years examined.

“This study provides important evidence regarding the extent of substance abuse disorders and injuries in a population of people who are employed and receive insurance coverage through their employers, said Linda C. Degutis, assistant professor of surgery and public health at Yale University. Each year, she added, substance abuse costs businesses at least $10 billion in absenteeism, injuries, medical liability and health care costs.

Investment in treatment is an effective strategy to reduce these costs,’ said Degutis “Research shows that, following substance abuse treatment, absenteeism, disability days and disciplinary actions all decrease by more than 50%. Adults who complete inpatient alcohol treatment have significantly lower health care utilization than they had prior to treatment. Their use of medical services is cut in half, while they use 60 percent fewer psychiatric services, have a third fewer emergency admissions, and show a 75% reduction in detoxification admissions. However, in order for treatment to occur, the problems must first be identified.”

Both Miller and Degutis noted that health care practitioners – particularly family physicians and trauma personnel – have an invaluable, yet often overlooked, role in detecting, intervening on the behalf of, and referring substance-abusing patients to the appropriate care. Miller said that family physicians have an especially important role in helping older, female substance abusers. “Addiction is a brain disease,” she said “Too often, addiction is treated as a moral issue, or a ‘defect’ in someone’s personality or behaviour or judgement. There are many things that can place someone at risk for developing an addiction, and we now know that it can have a genetic basis, It is a chronic disease, just like heart disease, diabetes, and other diseases. Unfortunately, there is still a great deal of stigma related to addiction and substance abuse, In fact, the very term ‘substance abuse’ somehow implies that the person with an addiction is responsible for the problem. We should not be reluctant to discuss these issues, and should bring them out into the open, just as we have done with diseases such as breast cancer, prostate cancer, and heart disease.”

Source: Miller et al at Pacific Institute for Research and Education Dec 2000