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Binge Drinking & Fatalities: EDs at the Forefront

Binge Drinking & Fatalities: EDs at the Forefront

Substantial progress has been made over the last 20 years in the United States to curb drinking and driving among teenagers. Since 1991, there has been about a 54% decrease in the prevalence of drinking and driving among high school students aged 16 and older. However, about 10% of adolescents in this age range report that they have driven after consuming an alcoholic beverage (Figure 1). Although progress has been made, the overall prevalence of drinking and driving still affects about 950,000 high school students, killing more than 800 each year. National data have illustrated significant differences in drinking and driving among genders, races, ages, and patterns of binge drinking. Male students are more likely than female students to drink and drive. Hispanics have the highest prevalence of drinking and driving when compared with Caucasians and African Americans. Drinking and driving rates increase with age throughout the teenage years. These rates are more than three times higher among students who report binge drinking when compared with those reporting they use alcohol but do not binge drink. The prevalence of drinking and driving per state also varies significantly, ranging from a low of about 5% in Utah to a high of nearly 15% in North Dakota (Figure 2). Making Efforts: Alcohol Screening & Intervention To reduce the prevalence of alcohol-related injuries, the CDC has worked with EDs and trauma centers to implement alcohol screening and brief intervention (SBI) programs. “Currently, major trauma centers are required by the American College of Surgeons to use SBI programs to screen all incoming patients for alcohol use in an effort to identify risky drinking...
Substance & Alcohol Use After Weight Loss Surgery

Substance & Alcohol Use After Weight Loss Surgery

Weight loss surgery (WLS) has been an effective treatment for many patients with clinically severe obesity and comorbid medical con­ditions. Despite its merits, WLS requires major lifestyle changes for potential candidates, and many patients may not be adequately prepared to make such changes. Studies have suggested that substance and alcohol abuse is more common among patients undergoing WLS, but this research has been limited by the lack of preoperative baseline data as well as longitudinal data. The symptom substitution theory states that eliminating a particular symptom without treating the underlying cause will lead to the development of a substitute symptom. Under this theory, it’s possible that the risk of substance use may rise after WLS; while the surgery helps eliminate excessive eating, it doesn’t address any potential underlying psychopathology. Since drugs, alcohol, and other substances trigger responses in the brain similar to that of food, it’s possible that they can serve as a food substitute in the WLS population. A Closer Look At Substance Use After Weight Loss Surgery My colleagues and I had a study published in JAMA Surgery that examined the likelihood of WLS patients to develop substance use—specifically alcohol, cigarettes, and recreational drugs—after their operation. We analyzed 155 patients undergoing WLS—100 who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and 55 who received laparoscopic adjustable gastric band (AGB) surgery. Participants undergoing either RYGB or AGB surgery reported significant increases in the frequency of substance use—using a composite of drug use, alcohol use, and cigarette smoking—when assessed 2 years after surgery. Notably, patients in the RYGB group reported a significantly higher frequency of alcohol use at 2...
Behavioral Mechanisms: Linking Depression & CHD

Behavioral Mechanisms: Linking Depression & CHD

It’s estimated that about 20% of patients with coronary heart disease (CHD) meet the criteria for major depression, and as many as 40% have at least some depressive symptoms. Depression among CHD has been consistently shown to increase the risk of adverse events, including death and myocardial infarction (MI). National guidelines recommend screening and treating depression in patients with CHD, but there is still a lack of complete understanding of the mechanisms by which depression increases cardiac risk. Gaining knowledge on this relationship may lead to new approaches for improving outcomes in this patient group. More Clarity on CHD & Behavioral Mechanisms Recent studies have indicated that behavioral mechanisms appear to explain part of the increased risk for adverse cardiac outcomes conveyed by depression. In a study published in the Journal of the American College of Cardiology, my colleagues and I sought to clarify these relationships further. Using data from more than 4,600 patients with CHD, we examined the explanatory role played by alcohol use, smoking, physical inactivity, and medication non-adherence in the association between depressive symptoms and MI or death. According to our results, self-reported behavioral mechanisms explained a substantial proportion of the excess risk of MI or death that was associated with elevated depressive symptoms in CHD patients. Collectively, the four behavioral mechanisms explained 40% of the increased risk for MI or death conveyed by elevated depressive symptoms. Smoking and physical inactivity were the most substantial behavioral mechanisms contributing to this risk. These mechanisms each accounted for about 20% of the relationship between elevated depressive symptoms and cardiac risk. We also confirmed that patients with CHD who...

Hand Sanitizer Use & Breathalyzer Results

Breathalyzer machines are commonly used in the ED to help clinicians and law enforcement officials determine the degree to which patients are intoxicated with alcohol, with the legal limit being 0.080 g/dL. Most commercially available hand sanitizers contain ethyl alcohol, but studies suggest that these products don’t significantly elevate blood alcohol levels in individuals who have applied them to themselves, even when applied excessively. What remains unclear, however, is whether applying hand-sanitizer mixtures to people measuring breathalyzer levels could falsely elevate breathalyzer results of patients whose alcohol level is being measured. There is reason to suspect that it might because alcohol is volatile and, thus, may distort breathalyzer readings. “Patients who are improperly assumed to be intoxicated may be held longer than necessary in the ED, resulting in crowding and longer wait times for other patients.” Hand Sanitizer’s Effect on Breathalyzers In a study published in Academic Emergency Medicine, my colleagues and I sought to determine if applying alcohol-based hand sanitizer on the hands of people holding a breathalyzer affected readings of others. The initial breathalyzer readings of all study participants were 0.000 g/dL. We found that some common alcohol-based hand sanitizers may affect breathalyzer readings when used improperly, presumably by vaporization of the hand sanitizer on the part of the person holding the breathalyzer. This in turn affected the readings in patients who had not ingested alcohol. The breathalyzer readings were further elevated if more sanitizer was used or if it wasn’t allowed to dry appropriately. According to the results, the median breathalyzer reading was 0.119 g/dL in the group who used two pumps (3 mL) without allowing...

Looking at Alcohol Use Disorders Among Surgeons

The prevalence of substance use disorders in the United States has been well documented in published research. Nearly 8% to 12% of Americans aged 12 and older meet criteria for alcohol abuse or dependence, with men being twice as likely to depend upon or abuse alcohol as women. The prevalence of substance use disorders among U.S. physicians has been estimated to range from 10% to 15%, but less is known about alcohol dependence and abuse in particular. “Although actual injury to patients from impaired physicians is incredibly rare, alcohol abuse and dependence are important factors to consider when thinking about patient safety in surgery,” says Michael R. Oreskovich, MD. “These disorders can play a major role in causing clinically significant impairment or distress in social, occupational, and other areas of functioning.” Alcohol Use Disorder: A Problem for Surgeons Nationwide Dr. Oreskovich and colleagues conducted a study, published in the February 2012 Archives of Surgery, in which American surgeons completed online surveys anonymously. “We wanted to gain a better picture of the actual prevalence of alcohol dependence and abuse,” he says. “We also wanted to explore personal and professional characteristics, surgeon distress, and recent self-reported events.” According to the results, about 15% of respondents overall appeared to suffer from alcohol abuse or dependence, a figure that exceeds what has typically been cited for the general public. “Surprisingly, male surgeons were less likely to have these disorders than female surgeons,” Dr. Oreskovich says. “About 14% of male surgeons reported having alcohol issues, compared with a 26% rate that was observed for female surgeons.” In addition, the study found that alcohol issues...
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