Alcohol and violence-related injuries in the emergency room

Dissolution of lipids from mucus: a possible mechanism for prompt disruption of gut barrier function by alcohol

Acute and/or chronic alcohol ingestion has been shown to exacerbate the morbidity and mortality rate associated with acute mechanical and/or thermal trauma. While alcohol ingestion can affect many organs and systems, clinical and preclinical studies indicate that alcohol ingestion can cause a 'leaky gut' syndrome which in turn contributes to infection and systemic organ dysfunction. This study investigated the acute effect of alcohol on gut barrier function. Using an in vivo isolated gut sac model of naïve male rats, each individual gut sac was injected with different concentrations (0, 5, 10, 20, and 40%, v/v) of alcohol. After different times of alcohol exposure, each isolated gut segment was harvested and intestinal permeability and mucosal surface hydrophobicity (a physiologic marker of mucus barrier function) were measured as well as luminal DNA, mucus, protein and free fatty acids. The results showed that alcohol caused dose-dependent and time-dependent increases in gut permeability and decreases in mucosal surface hydrophobicity, with significant changes to be observed 5 min after treatment with 10% alcohol. In addition, it is further found that these changes in permeability and hydrophobicity are more closely associated with increased intestinal luminal free fatty acids levels but not protein or DNA levels. These results suggest that alcohol may cause loss of gut barrier function by extracting and dissolving lipids from the mucus with a resultant decrease in mucosal surface hydrophobicity, which is a critical component of gut barrier function.

Characteristics and treatment interests among individuals with substance use disorders and a history of past six-month violence: findings from an emergency department study

The study examined clinical characteristics and treatment interests of individuals identified to have substance use disorders (SUDs) in an urban emergency department (ED) who reported past six-month history of violence or victimization. Specifically, participants were 1441 ED patients enrolled in a randomized controlled trial of interventions designed to link those with SUDs to treatment. To examine factors related to violence type, four groups based on participants' reports of violence toward others were created: no violence (46.8%), partner violence only (17.3%), non-partner violence only (20.2%), and both partner and non-partner violence (15.7%). Four groups based on participants' reports of victimization were also created: no violence (42.1%), victimization from partner only (18.7%), victimization from non-partner only (20.2%), and both partner and non-partner victimization (17.7%). Separate multinomial logistic regression analyses were conducted to examine which variables distinguished the violence and victimization groups from those reporting no violence or victimization. For violence toward others, demographic variables, alcohol and cocaine disorders, and rating treatment for psychological problems were higher for violence groups, with some differences depending on the type of violence. For victimization, demographic variables, having an alcohol disorder, and rating treatment for family/social problems were higher for violence groups, also with some differences depending on the type of violence. Findings from the present study could be useful for designing effective brief interventions and services for ED settings.

Alcohol and drug use as predictors of intentional injuries in two emergency departments in British Columbia

BACKGROUND

While a substantial literature exists demonstrating a strong association of alcohol and intentional injury, less is known about the association of intentional injury with recreational drug use, either alone, or in combination with alcohol.

OBJECTIVES

The risk of intentional injury due to alcohol and other drug use prior to injury is analyzed in a sample of emergency department (ED) patients.

METHODS

Logistic regression was used to examine the predictive value of alcohol and drug use on intentional versus non-intentional injury in a probability sample of ED patients in Vancouver, BC (n = 436).

RESULTS

Those reporting only alcohol use were close to four times more likely (OR = 3.73) to report an intentional injury, and those reporting alcohol combined with other drug(s) almost 18 times more likely (OR = 17.75) than those reporting no substance use. Those reporting both alcohol and drug use reported drinking significantly more alcohol (15.7 drinks) than those reporting alcohol use alone (5 drinks).

CONCLUSIONS

These data suggest that alcohol in combination with other drugs may be more strongly associated with intentional injury than alcohol alone.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The strong association of alcohol combined with other drug use on injury may be due to the increased amount of alcohol consumed by those using both substances, and is an area requiring more research with larger samples of intentional injury patients.

Alcohol and drug use among patients presenting to an inner-city emergency department: a latent class analysis

The inner city Emergency Department (ED) provides a window of opportunity for screening for alcohol and other drug misuse and substance use disorders (SUDs), in order to facilitate linkage for individuals who are in need of services targeting such issues. The majority of prior work in this area has focused on alcohol use. This study used latent class analyses to characterize substance use/SUDs among adults presenting to the ED for medical complaints or injuries. Participants (n=14,557; 77% participation; 45% male; 54% African-American) completed a computerized survey assessing demographics, health functioning, and substance use/SUDs. Although injured patients were significantly more likely to use tobacco, alcohol, and marijuana, and were more likely to have an alcohol use disorder, presenting complaint was not related to other drug use/diagnoses. Five latent classes were identified: (1) low users/SUDs (65.9%) (2) binge drinkers (24.3%), (3) marijuana users/SUD (3.5%), (4) cocaine users/SUD (2.9%), and (5) poly-drug users (3.3%). Compared to class 1, participants in the other classes were younger, male, without health insurance, with poor mental health functioning, tobacco users, and had prior substance use treatment. African-Americans were most likely to be in classes 3 or 4 and employed participants were most likely to be in class 2. In comparison to class 1, classes 2 and 3 reported better physical health; class 2 was more likely to present for injury whereas class 5 was more likely to present for a medical complaint. ED-based screening and interventions approaches need to address the co-occurrence of alcohol, illicit drug, and psychoactive prescription drug use.

ALCOHOL AND VIOLENCE-RELATED INJURIES AMONG EMERGENCY ROOM PATIENTS IN AN INTERNATIONAL PERSPECTIVE

While alcohol has been found to be more closely associated with violence-related injury than with injury from other causes, little data is available which documents heterogeneity in this association across countries or cultures, taking into consideration usual drinking patterns and other socio-cultural variables. Data are reported from 15 countries comprising the Emergency Room Collaborative Alcohol Analysis Project and the WHO Collaborative Study on Alcohol and Injury. Case-crossover analysis was used to analyze the risk of injury (among current drinkers) from drinking six hours prior to the event, based on frequency of usual drinking, for violence-related injuries and separately for non-violence related injuries. Relative risk (RR) for a violence-related injury was significantly greater than for injuries from other causes across all countries (pooled RR=22.22 vs. 4.33), but the magnitude of risk varied considerably (ranging from 4.68 in Spain to 942 in Canada). Pooled effect size was found to be heterogeneous across countries, and was explained, in part, by the level of detrimental drinking pattern in a country. Risk for a violence-related injury was not significantly different by age (<30 and 30+), reporting 5 or more drinks on at least one occasion during the last year, or reporting symptoms of alcohol dependence. A number of methodological concerns suggest that risk of a violence-related injury compared to injuries from other causes may be inflated, and such variables as context of drinking should be taken into consideration in establishing relative risk and alcohol attributable fraction of violence-related injury across countries and cultures.

Predictors of fighting attributed to alcohol use among adolescent drinkers

This study examined demographic and psychosocial factors to determine the predictors of fighting attributed to alcohol use among adolescent drinkers. Analyses were based on the National Longitudinal Study of Adolescent Health which is a nationally representative sample of adolescents in Grades 7 through 11. The prospective analyses were restricted to those adolescent drinkers who participated in both data waves (n=6041) collected in 1995 and 1996. A logistic regression model was constructed using a backward elimination procedure to identify the significant predictors of initiating fighting attributed to alcohol use at Time 2 (1996). We found that frequent drinking, high-volume drinking, trouble in school, low college expectations and weekly involvement in sports were significant predictors of initiating fighting attributed to alcohol use. These findings suggest that prevention efforts targeting the reduction of frequent and heavy alcohol use may be particularly useful strategies for preventing fighting attributed to alcohol use.

Attributable risk of injury associated with alcohol use: cross-national data from the emergency room collaborative alcohol analysis project

OBJECTIVES

We sought to determine gender- and age-specific attributable risks of all-cause and violence-related injuries associated with alcohol use.

METHODS

We used meta-analytic techniques to estimate attributable risks observed in emergency room studies conducted in 7 countries (n=17708).

RESULTS

In the case of both alcohol consumption before the injury event and individual drinking patterns, pooled attributable risk effect sizes for all-cause injuries were significant but minimal (2% to 6%). Effect sizes for violence-related injuries were 43% for drinking before an injury event and 27% for individual drinking pattern. Risks were greater for men, but no age-specific differences were found.

CONCLUSIONS

This meta-analysis showed that attributable risk of injury is greater for drinking before the injury event than for drinking pattern; in addition, risks were more pronounced for violence-related injuries. Differences in risk were explained by variables related to sociocultural contexts.

Psychosocial and substance-use risk factors for intimate partner violence

OBJECTIVE

Few emergency department (ED) studies have described the relationship between family violence and subsequent intimate partner violence (IPV) or accounted for partner alcohol use in IPV victimization. This study sought to identify family history and substance-use factors associated with IPV among women presenting to an urban emergency department.

METHODS

Case-control study in which cases (women identified as having IPV concerns and an IPV history) and controls (women without IPV) were frequency-matched by age group and race/ethnicity. Logistic regression was performed to calculate adjusted odds ratios (AOR) for any IPV, physical IPV, and sexual IPV.

RESULTS

The sample included 182 cases and 147 controls. Living with a partner (not married) and witnessing parental violence were independent risk factors for any IPV (AOR 2.55 and AOR 2.21, respectively). Partner's alcohol use (AOR 1.22 for every five drinks consumed per week) and heavier drinking (AOR 5.07) were also significant risk factors, but not subject's substance-use. The pattern of risk factors varied only slightly for physical IPV and sexual IPV.

CONCLUSION

This study suggests a substantial relationship between partner alcohol use and IPV among women beyond the woman's substance-use and confirms previous reports regarding the cycle of violence in women's lives.

Violence-related injury and intimate partner violence in an urban emergency department

BACKGROUND

To facilitate the identification of ED patients at risk for intimate partner violence (IPV), we assessed the relationship of acute violence-related injury and history of IPV victimization or perpetration.

METHODS

: This cross-sectional study systematically sampled patients presenting to an urban ED. Reason for visit, past year history of IPV victimization and perpetration, alcohol and drug use and abuse, and sociodemographic factors were assessed. We hypothesized that violence-related injury would be positively associated with a history of IPV victimization and with IPV perpetration.

RESULTS

The odds of violence-related injury was increased three-fold among persons with a history of IPV victimization and nearly two-fold (although not statistically significant) among those with IPV perpetration history. Male gender, younger age, and problem drinking were independent risk factors in both models.

CONCLUSION

Screening for IPV among individuals presenting with a violence-related injury may be helpful in identifying individuals at risk of partner violence.

Risk of injury after alcohol consumption: a case-crossover study in the emergency department

This paper reports a case-crossover analysis in a sample of 961 patients who consulted the emergency department (ED) due to an injury in Santa Clara, California, and in Pachuca, Mexico. In the analysis in which usual alcohol consumption during the last 12 months served as the control value, the estimated relative risk of injury in the hour after alcohol consumption, as compared with no alcohol consumption during that time, was 4.33 (CI, 3.55-5.27). After controlling for alcohol use in the 1-h period before injury, the relative risks for consecutive 1-h periods (2-6 h) before the injury were not significantly greater than one, indicating that the induction time was less than 1 h. The relative risk varied greatly depending on race-ethnicity and acculturation among the Hispanics in Santa Clara, with Mexicans in Pachuca showing the highest risk and the high acculturation group in Santa Clara showing the lowest risk. Violence-related injuries were associated with higher relative risk. Relative risk also varied depending on the presence of alcohol dependence and usual frequency of drunkenness: patients with alcohol dependence and patients with high frequency of usual drunkenness had lower risks than patients without alcohol dependence and with lower self-reported episodes of drunkenness in the last year. When blood alcohol content at ED admission was used instead of self-reported alcohol consumption, similar results were obtained. These findings have important public health consequences. Each episode of alcohol consumption results in an increase in the short-term risk for an injury, especially for a violence-related injury. Patients with the lowest usual involvement with alcohol are subject to a higher elevation in their risk for an injury immediately after alcohol consumption compared to patients who drink more heavily.

Biological markers in alcoholism

Alcohol biomarkers include tests indicative of acute or chronic alcohol consumption (state markers), and markers of a genetic predisposition to develop alcohol dependence after chronic exposure (trait markers). While a comprehensive trait marker for alcohol dependence has not been identified, a number of successful state markers for monitoring drinking status are used clinically. These tests provide direct or indirect ways to estimate the amounts of alcohol consumed and the duration of ingestion, and to detect any harmful effects on body functions resulting from long-term misuse. The most obvious method to prove recent drinking is by demonstrating the presence of ethanol in body fluids or breath, but, because ethanol is cleared fairly rapidly from the body, this method is limited to detect only very recent drinking. Measurement of urinary 5-hydroxytryptophol or ethyl glucuronide provide more sensitive methods to disclose recent drinking, because their washout constants are much longer than for ethanol. The liver functions test (GGT, AST and ALT in serum) and the mean corpuscular volume of erythrocytes (MCV) are among the standard diagnostic tools used to identify chronic alcohol exposure. The main disadvantage with these measures is that they have low sensitivity for recent excessive intake, and that raised levels may result from several causes besides heavy drinking, implying a low specificity for alcohol. Carbohydrate-deficient transferrin (CDT), which refers to changes in the carbohydrate composition of serum transferrin, is a more specific marker for identifying excessive alcohol consumption and monitoring abstinence during outpatient treatment. The alcohol biomarkers improves knowledge of drinking patterns in both individuals and populations, and they are also valuable tools for the objective evaluation of treatment efforts. Alcohol markers have, for example, found uses in early identification of at-risk and harmful drinking, and they help to monitor abstinence and relapse in response to outpatient treatment.