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Article Excerpt
ALCOHOL-USE DISORDERS ARE COMMON throughout the world and are associated with a number of health effects and co-occurring disorders. An emergency department (ED) study in Australia found that 20.2% of women and 28.7% of men were hazardous or harmful drinkers according to the Alcohol Use Disorders Identification Test (AUDIT; Alati et al., 2004). Similarly, a Swedish ED study found that 28% of women and 40% of men were risky drinkers using AUDIT-C (consumption) scores with a cutoff score of 4 points for women and 5 for men (Nordqvist et al., 2004). Studies conducted in primary care settings in the United States found that 20% of men and 12% of women ages 18-64 were hazardous drinkers (Fleming et al., 1998).
Alcohol-use disorders are not only common but also associated with a number of adverse health effects. The number-one cause of death in young men is alcohol-related injuries (Hingson and Winters, 2003). Women who drink more than two to three drinks per day have an increased risk of breast cancer (Longnecker et al., 1995; National Cancer Institute, 2006) and overall morbidity (Bradley et al., 1998). Heavy drinking is also associated with throat cancer, ischemic heart disease, colon cancer, liver failure, and stroke (National Institute of Alcohol Abuse and Alcoholism [NIAAA], 2000).
In addition to the direct health effects, alcohol-use disorders are associated with a number of co-occurring disorders (Degenhardt et al., 2001). Tobacco use is strongly associated with alcohol use and relapse (Schuit et al., 2002). ED attendees who report alcohol-related problems are also likely to be smokers. Conjugate alcohol and tobacco use is more common for women than for men (Horn et al., 2000). Friend (2005) showed that the combination of at-risk drinking and tobacco use is correlated with more harmful side effects than either behavior alone. Alcohol use is often combined with other drug use in ED patients (Lang et al., 2000; Romero et al., 2001; Woolard et al., 2003). Marijuana use is more likely for conjugate alcohol and tobacco users, although women who are heavy drinkers have an increased risk of taking other drugs regardless of smoking status (Horn et al., 2000).
As a result of these observations, a number of governmental agencies and health care systems throughout the world recommend routine alcohol screening of all adults seeking care in clinical settings (NIAAA, 2005; Whitlock et al., 2000). However, there are limited epidemiological data on the prevalence and co-occurring factors of--and effective treatment methods for--at-risk drinking in ED settings, especially among women.
The primary aim of this study was to characterize alcohol consumption in women and men presenting to an ED as well as to highlight differences in alcohol-use patterns among different age groups. The second aim was to examine associations among alcohol use, co-occurring disorders such as tobacco and illegal drug use, and co-occurring depression. We hope this information will increase physician recognition of at-risk drinking among women and men seeking care in EDs.
Method
The data used for this article were obtained from the screening portion of a randomized clinical trial conducted to test the efficacy of brief intervention in an ED. The ED is located in an academic teaching hospital in Lausanne, Switzerland (Centre Hospitalier Universitaire Vaudois), and serves a population of 700,000 people. Lausanne is a French-speaking community, with more than 90% of people living in this part of Switzerland using French as their primary language. Because more than 90% of patients seen in the Lausanne ED speak French, this is the primary language used by the ED staff. All screening questions were asked in French. Fewer than 5% of patients approached for the study were non-French speaking and were excluded.
Research procedures
Patients entering the surgical ward of the ED were screened using a face-to-face interview conducted by trained researchers. The screening occurred during an 18-month period between January 1, 2003, and June 30, 2004. Every patient seeking care between 11 AM and 11 PM, 7 days per week, were approached for screening. The ED in Lausanne services 90% of its patients during this period, with fewer than 10% of patients seeking care between 11 PM and 11 AM. This pattern of ED use reflects the size (<700,000 people) and culture of Lausanne. The ED in Lausanne is different than ED settings in many large urban cities, where the hours after 11 PM have higher rates of use.
Exclusion criteria for the screening portion of the study included age less than 18 years and presence of a medical condition that did not allow for the screening. Verbal consent was obtained before patients completed the screening survey. A formal, signed consent was obtained for patients who qualified for the intervention and who continued in the primary study. Human subject approval was obtained from the University Hospital Ethics Committee.
The study used the first three questions of the French version of the AUDIT, which are standard questions of alcohol consumption. Speaking French, a researcher administered the questions during a face-to-face interview. The literal English translation is as follows: "In the past 12 months: (1) How many days per week do you usually drink alcohol?; (2) How many alcohol drinks do you have on a regular drinking day?; and (3) How many times a month do you have the occasion to drink 5 (4 for women) or more drinks?" A fourth and final question asked about alcohol consumption within the past 24 hours: "Have you consumed alcohol in the past 24 hours and, if so, what type of...
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