Alcohol and violence in the emergency room: a review and perspectives from psychological and social sciences

Comparison of emergency transport for acute alcohol intoxication before and after the coronavirus disease 2019 pandemic: A retrospective observational study

The ongoing coronavirus disease 2019 (COVID-19) pandemic has had a broad effect on social, economic, educational, and political systems. We investigated the effect of COVID-19 on emergency transportation due to acute alcohol intoxication in the Kochi Prefecture in Japan, a region with high alcohol consumption. This retrospective observational study was conducted using the data of 62,138 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-square tests and multiple logistic regression analyses were performed to examine the association between emergency transportation and alcohol intoxication. This analysis compared the monthly number of transportations during 2019 (as reference) with that throughout 2020 and 2021. Approximately 1.5 % of all emergency transportation cases were related to acute alcohol intoxication. The number of emergency transportation cases due to acute alcohol intoxication declined by 0.5 % in 2020 and 0.7 % in 2021 compared with that in 2019. Moreover, compared with that in 2019, the number of cases of emergency transportation due to acute alcohol intoxication significantly decreased in 2020 (incidence rate ratio: 0.78; 95 % confidence interval: 0.67-0.91) and 2021 (incidence rate ratio: 0.73; 95 % confidence interval: 0.63-0.86). Lifestyle changes due to the COVID-19 pandemic affected the number of emergency transports due to acute alcohol intoxication in 2020 and 2021 (during the COVID-19 pandemic) compared to that in 2019 (before the pandemic).

Nationwide Alcohol-related visits In Singapore's Emergency departments (NAISE): A retrospective population-level study from 2007 to 2016

INTRODUCTION

Excessive alcohol consumption is associated with increased morbidity and mortality, and its societal impact is substantial. The Nationwide Alcohol-related visits In Singapore Emergency departments study aims to characterise trends in ED visits involving acute and chronic alcohol consumption between 2007 and 2016.

METHODS

Data from the Singapore Ministry of Health, comprising all ED visits in Singapore from 2007 to 2016, were used. The data were aggregated by year and analysed for changes in prevalence and rates of ED visits for acute and chronic alcohol consumption, broken down by age, gender and ethnicity.

RESULTS

Over the study period, the number of ED visits involving alcohol consumption increased 98.3%, from 2236 in 2007 to 4433 in 2016. During the same period, the rate per 100 000 population increased 62.4% from 48.7 to 79.1, and total ED-related costs rose by 140%, from 528 680 to 1 269 638 SGD. The increase in alcohol-related visits rates and costs was higher than non-alcohol-related visits rates and costs, which increased by 12.1% and 115% respectively. While trends in acute and chronic alcohol-related ED visits stayed stable amongst women, they rose substantially in men. Older men aged 50-69 show the highest rates and rate of increase for both acute and chronic alcohol-related ED visits.

DISCUSSION AND CONCLUSIONS

Alcohol-related visits contributed disproportionately to the increasing number of ED visits in Singapore between 2007 and 2016. Older men form the demographic with the highest rates and increase in rates of alcohol-related ED visits and form a potential group for targeted intervention.

Hazardous drinking and violence-related hospitalizations in the Danish general population: A historical cohort study

BACKGROUND

It is well documented by case-control and case-crossover studies that hazardous drinking and the risk of experiencing violence-related injuries are related. The present study investigated this relationship in a cohort of general population survey respondents in Denmark using subsequent hospital admissions for violence.

METHODS

The cohort consisted of participants in the 2011 Danish national survey on alcohol and drugs (N = 5126). Survey responses were used to identify those with hazardous alcohol use. Register data on the cohort's hospital admissions for violence from 2010 through 2018 served as the outcome. The relationship between respondents' hazardous drinking and counts of subsequent hospital admissions was investigated using a Poisson regression model.

RESULTS

After controlling for confounding, respondents with hazardous consumption (Alcohol Use Disorders Identification Test Consumption [AUDIT-C] cut off: 5 points) had an increased rate of hospital admissions for violence, with an incidence rate ratio (IRR) of 2.28 (95% CI: 1.16-4.50) compared to respondents without hazardous alcohol use. Each additional AUDIT-C point was associated with a 20% increase in the incidence rate for violence-related admission (IRR=1.20, 95% CI: 1.06-1.37). Furthermore, interaction analyses showed a significant interaction between gender and AUDIT-C score on hospital admissions for violence (IRR=0.69, 95% CI: 0.53-0.90).

CONCLUSIONS

Results provide evidence that hazardous alcohol use is associated with subsequent hospital admissions for violence in the Danish general population and that gender moderates this relationship.

The Role of ADHD in Predicting the Development of Violent Behavior Among Juvenile Offenders: Participation Versus Frequency

Past research has identified attention-deficit/hyperactivity disorder (ADHD) as a risk factor for engagement in violent offending. Despite the link between the disorder and violent offending, this risk factor has yet to be examined as a predictor of heterogeneity in the development of violent offending among juvenile offenders. It is likely that the impulsivity, genetic link, and generally chronic disorder course which are characteristics of the disorder play roles in predicting violent offending, which is consistent with both self-control theory and general developmental theory related to early life deficits and life-course persistent offending. Past research has also elucidated a developmental trajectory model of violent offending, which is utilized by the present research. The present research examines ADHD as a risk factor predicting trajectory group assignment. The Pathways to Desistance data followed 1,354 juvenile offenders for 84 months following conviction for a serious offense. Using multinomial logistic regression, this study extends past research on the development of violent offending among juvenile offenders by examining ADHD as a risk factor predicting assignment to violent offending trajectory groups. Results indicate that meeting criteria for ADHD at baseline predicted membership to all trajectory groups relative to the Abstaining group when all covariates were included. This increase in risk is highest for the trajectory group characterized by the highest frequency of violent offending. This indicates the relevance of identifying and treating ADHD among juvenile offenders to best mitigate risk of violent recidivism throughout adolescence and early adulthood.

Current emergency response in montreal: How does it fit in the services offered to homeless people who use substances?

Background This paper presents an assessment of the current emergency response to homeless people who use substances in Montreal, a major North American city. This project addresses the rising concern about homelessness in high-income countries. Several studies have shown that homeless people frequently use emergency services (i.e., police, paramedical, and hospital), especially in the context of substance use. Yet, the key actors' perspectives are poorly documented. Method Our team conducted a needs analysis using a deliberative democratic evaluation. Data collection strategies included an intersectoral World Café (n = 34, including police, specialized professionals, community stakeholders, political representatives, researchers, and people who have been homeless) and individual interviews with health professionals (n = 5) and homeless people (n = 8). We performed a thematic content analysis based on a conceptual framework of access to health care and of collaboration. Findings This study provided key information on the role of emergency services and the needs of key actors, in terms of the dimensions of access to health care (approachability, acceptability, availability, and appropriateness) and continuity. Our main results show that, according to the participants, the emergency response is relevant when homeless people are a danger to themselves or to others, and during episodes of acute physical and psychological care. However, emergency service providers still stigmatize homelessness and substance use, which negatively affects intervention quality. Finally, our main results highlight the interdependence between the emergency services and health, social, and community services. Conclusion The emergency response is necessary and appropriate in some situations. It remains important to intervene upstream and to improve the attitudes and practices of emergency service providers. Finally, it is necessary to adapt services to the needs of homeless substance users and improve service continuity, for example, by adopting a population-based approach.

Brief interventions to de-escalate disturbances in emergency departments

This study aimed to systematically review evidence to assess the efficacy of non-pharmacological brief interventions in the emergency department to reduce the incidence, severity and impact of acute behavioural disturbances. The literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 18 articles were identified as meeting the inclusion criteria and read in full. Following a full read and a consensus discussion, it was subsequently considered the studies chosen had not met the inclusion criteria. Research into the use of non-pharmacological brief interventions in the management of acute behavioural disturbance in the emergency department is warranted given the absence of evidence found by this systematic review.

Perceived changes and perceived transferability for treating intoxicated women victims of violence among emergency clinicians after an alcohol and other drugs training program

INTRODUCTION AND AIMS

Given the significant overlap between alcohol intoxication and violence against women, it is imperative that emergency clinicians are equipped to care for women presenting with both issues. This research aimed to explore emergency clinicians' perceived changes and ability to apply training, particularly to intoxicated women victims of violence.

DESIGN AND METHODS

Using a pre-post questionnaire, 74 participants of the Emergency Mental Health Alcohol and Drug program were surveyed about their education/training, awareness and use of guidelines and tools, perceived changes in knowledge, skills and confidence and ability to apply the training.

RESULTS

Low levels of previous education/training, awareness and use of best practice tools were reported. Although high rates of change in knowledge and confidence were reported after the program, a minority (38%) felt able to apply this to intoxicated women victims of violence. Working in an emergency department (P = 0.03) and having higher qualifications (P < 0.01) were the only significant factors affecting their ability to apply the training.

DISCUSSION AND CONCLUSIONS

The lower rates of perceived ability to apply to intoxicated women victims of violence suggest a deficit in ability to translate knowledge into practice. Higher qualifications affected respondents' ability to apply the training to intoxicated women victims of violence, suggesting that general skills learned regarding translating knowledge into practice rather than specific content may have more impact. This research indicates that clinicians' knowledge and confidence can be positively impacted by targeted education/training, but any future education/training must include knowledge translation skills.

A multi-dimensional evaluation of craving and impulsivity among people admitted for alcohol-related problems in emergency department

Craving and impulsivity are key psychological dimensions involved in the development and maintenance of severe alcohol-use disorders. This study proposes an integrative evaluation of craving (Visual Analogue Scale, VAS and Obsessive Compulsive Drinking Scale, OCDS) and impulsivity (UPPS Scale and Barratt Impulsiveness Scale) among patients admitted in emergency department for alcohol misuse. Ninety-eight patients were included. Regression analyses showed that the scores obtained at the compulsive subscale of the OCDS, at the VAS and at the Urgency subscale of impulsivity constitute the main predictors of the severity of alcohol-use disorders (indexed by the AUDIT). These results suggest that specific sub-dimensions of craving and impulsivity may play a critical and joint role in the maintenance of excessive alcohol consumption.

Lifestyles and discomfort in a sample of young Romanian students

INTRODUCTION

The 40.3% of the Romanian youth population is at risk of poverty or social exclusion, and, in addition, the abuse of substances increases. It was interesting to evaluate the attitudes shared by pupils as well as their knowledge of these substances with a view to analyzing causes and types of risky behaviour in young people.

METHODS

This is an observational study on the harassment influence in the lifestyle of a sample of Craiova high-school students The Fagerström Test was applied to evaluate the degree of nicotine dependence, and the data processed to assess the Odds Ratio.

RESULTS

The sample was composed by 1,980 students with an average age of 17, of which 1,727 correctly responded to the questionnaire. The 37.4% of students admit to smoke, and the 67% to drink alcohol. The Fagerström test showed that the 68.2% of respondents are not highly addicted to smoke while the 31.8% was associated with a middle-to-high addiction level. A worrying weekly consumption of beer has been registered in the students. Regarding psychological distress caused by harassment a high Odds Ratio was recorded between the smokers and the drug users.

CONCLUSIONS

More than half of students did not know about the health consequences of smoking, and the same result was recorded about the consumption of alcohol. A special attention should be done to the understanding of harassment problem in the young people. In fact, almost all the respondents declared to have suffered abuse and admits to use drug and cigarettes.

[Alcohol and emergencies]

Thirty percent of emergency department admissions are related to an alcohol misuse. Eighty percent of acute intoxications admitted in emergency departments concern patients with alcohol addiction. Care protocols validated in all of emergency departments are necessary for prevention of alcohol withdrawal syndrome. Risky uses require ultra-brief interventions, situations of abuse (light use disorders) require brief interventions and situations of dependence (moderate to severe use disorders) require motivational interviews to promote the emergence of a process of change. The key word for alcohol intervention in emergencies is: empathy. Search addictive comorbidities (tobacco and cannabis) and psychiatric comorbidities (depression and suicidal risk) must be systematic. The coordination between emergency departments and addictology departments is essential. In the emergency department, the goal is to optimise patient care path for all addictive behaviors.

Emergency clinicians' perceived self-efficacy in the care of intoxicated women victims of violence

BACKGROUND

Previous research has identified perceived self-efficacy to be a vital component of clinicians' positive attitudes towards caring for intoxicated patients and women who have been assaulted. To date, little is known about the perceived self-efficacy and influences among emergency clinicians towards intoxicated women victims of violence.

METHOD

Using mixed methods, 179 emergency clinicians were surveyed and 22 emergency clinicians were interviewed in South Australia about their education/training, their awareness and use of best practice guidelines and tools, and their perceived self-efficacy toward treating intoxicated women victims of violence.

FINDINGS

There were statistically significant relationships between use of best practice tools (n = 32) and knowledge (χ² = 6.52; p = .02) and confidence (χ² = 6.52; p = .02) treating women victims of violence. There were also statistically significant relationships between previous alcohol and other drug education/training and knowledge (n = 43), skills and confidence treating both intoxicated patients (χ² = 7.85; p = .01) and women victims of violence (χ² = 11.63; p < .01). The interviews identified four themes about confidence, knowledge and use of research evidence, education and training, and resources.

CONCLUSION

Emergency clinicians reported low levels of perceived self-efficacy, and infrequent use of guidelines and tools to support the care of intoxicated women victims of violence. Participants wanted more knowledge and education/training in caring for intoxicated women who have been assaulted, as they felt lacking in these skills.

Primary Care for Mentally Ill Adults in Acute Residential Treatment Facilities

Psychiatric bed capacity has decreased nationally with an impact on the number and the types of patients admitted to acute in-patient units. Acute residential programs provide alternatives to hospitals for patients with problems that do not meet criteria for admission. However, these settings may not have resources to respond to the medical co-morbidities associated with severe mental illness. To understand the medical needs of patients in these settings, this research examined data from a nurse-managed primary care outreach service. Prevalent problems included acute issues and chronic disorders associated with severe mental illness. In multivariate analyses, demographic and substance related factors contributed to all chronic illness. However, age was the over-riding predictor of cardio-metabolic disorders. Drug abuse consistently predicted HIV/AIDS and HCV risk. Findings demonstrate that patients diverted to alternative forms of acute psychiatric care are no less in need of medical services than those admitted to hospitals. This underscores the importance of primary care that is provided at the site of acute residential treatment and integrated with overall care.

Ambiente ocupacional e o consumo de substâncias psicoativas entre enfermeiros

Resumo Objetivo Analisar a relação entre o ambiente de trabalho e o consumo de substâncias psicoativas entre enfermeiros hospitalares. Métodos Estudo transversal e descritivo, realizado com enfermeiros de três instituições hospitalares públicas localizados em um município da Região Sul do Brasil, sendo duas de média complexidade e uma de alta complexidade. A população deste estudo foi composta por 221 enfermeiros. Com base nesse número, calculou-se o tamanho amostral por estratos, considerando-se a proporção de 50%, nível de confiança de 95% e erro máximo de 5%, o que resultou no número mínimo de 175 participantes. Mediante a estratificação proporcional por instituição definiu-se o mínimo de 103 enfermeiros da alta complexidade e 36 de cada instituição de média complexidade. Adotou-se como critérios de inclusão: trabalhar na instituição há pelo menos um ano e não estar afastado por licença. A coleta de dados foi realizada entre outubro de 2015 e abril de 2016. Na coleta de dados utilizaram-se informações sociodemográficas e ocupacionais, o Nursing Work Index - Revised e o Alcohol, Smoking and Substance Involvement Screening Test. Os dados foram analisados no programa Statistical Package for Social Sciences, versão 20.0. Inicialmente, verificou-se a normalidade pelo teste de Kolmogorov-Smirnov. Foram realizadas análises descritivas, por frequências absoluta e relativa para as variáveis categóricas; e medianas e medidas de dispersão para as numéricas. Resultados Álcool, tabaco e sedativos foram as substâncias mais consumidas. Renda mensal apresentou correlação positiva com o consumo de álcool entre enfermeiros dos hospitais de média complexidade (p=0,01). No hospital de alta complexidade, o consumo de álcool relacionou-se negativamente a relação médico-enfermeiro (p=0,03). Autonomia, relação médico-enfermeiro e suporte organizacional estiveram correlacionados negativamente ao uso de sedativos (p<0,01; p<0,01; p=0,02, respectivamente). Conclusão Quanto mais desfavorável o ambiente de trabalho do enfermeiro, sobretudo na relação com médicos, suporte organizacional e autonomia, maior foi o consumo de substâncias psicoativas.

Binge drinking among young adults in an urban tertiary care emergency department in Israel

BACKGROUND

Alcohol use is a major preventable public health problem with serious health and social consequences especially among youth. In Israel, alcohol use has become an emerging problem during the last decade, and its use has increased among adolescents and young adults. Binge drinking is the common pattern of alcohol consumption among young adults who drink for recreational purposes. The present survey was conducted among 16-35 years old visitors to the ED. The aim was specifically to identify binge drinkers in order to assess the scope of the need for a brief counseling intervention among young people who arrive intoxicated to a large tertiary care urban ED in Israel.

METHODS

The survey was conducted throughout a 1 week period (24 h per day) at the general EDs in a large, tertiary care center, situated in Tel Aviv. During the survey week, 946 individuals, aged 16-35, visited the ED and 573 (63%) of them were approached for an interview. 89% of those approached agreed to be interviewed. Consenting patients [N = 348] were asked whether they drink any alcohol, how often they drink and how much.

RESULTS

About one fifth of those interviewed were in the habit of consuming more than four units of alcohol per occasion. Drinking several times a week or every day was reported by 19% of the males and 26% of the females. Frequency of the drinking episodes was highly correlated with the number of units of drink per occasion.

CONCLUSIONS

The study found a very high rate of binge drinking among ED visitors, and this suggests a need for large scale ED-based interventions. As binge drinkers are at elevated risk for accidents, violence and related problems, effective ED-based interventions could make an important contribution to public health. Accordingly, Israel is in the process of assessing the effectiveness of a large-scale ED-based counseling intervention.

TRIAL REGISTRATION

Trial registration number 0230-13-TLV.

Social inequality in youth violence: The role of heavy episodic drinking

INTRODUCTION AND AIMS

Alcohol use is an important risk factor for violence, and violent behaviour is more prevalent in lower socioeconomic status (SES) groups. The aim of this study was to examine whether the SES difference in youth violence can be explained by differential exposure to-and/or differential vulnerability to-heavy episodic drinking (HED). In the latter case, effect modification by impulsivity could be assumed.

DESIGN AND METHODS

We analysed cross-sectional data from a school survey of 15- to 17-year-olds in Norway (n = 9853). We employed two measures of low-SES group. Associations between SES, HED and violence were estimated by Poisson regressions, applying a residual centring procedure to test effect modification.

RESULTS

Violent behaviour frequency, HED frequency and impulsivity scores were all elevated in the low-SES group. The SES difference in violent behaviour was significantly reduced when adjusting for HED. The stronger association between HED and violence in the low, compared with the medium-SES/high-SES group, was modified when accounting for impulsivity. Sensitivity analyses suggested robust findings.

DISCUSSION AND CONCLUSIONS

The findings lend support to both the differential exposure hypothesis and to the differential vulnerability hypothesis as well as the hypothesis of an enhancing effect of impulsivity on the HED-violence association. The SES difference in youth violence can be accounted for by: (i) an elevated prevalence of HED in low-SES groups; and (ii) a stronger than average link between HED and violence in low-SES groups due to their higher than average impulsivity score. [Norström T, Rossow I, Pape H. Social inequality in youth violence: The role of heavy episodic drinking. Drug Alcohol Rev 2017;00:000-000].

Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

OBJECTIVES

Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption.

SETTING

ED of a UK tertiary referral hospital.

PARTICIPANTS

All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%).

PRIMARY OUTCOME MEASURES

Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician.

SECONDARY OUTCOME MEASURES

Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria.

RESULTS

1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with 'Severe' or 'Very Severe' acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003).

CONCLUSIONS

Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD.

Experiencing aggression in clubs: social group and individual level predictors

To examine the social drinking group's influence on the individual's experiences of physical or sexual aggression at clubs, data were collected from 368 groups (N = 986 individuals). Both group and individual level indicators were examined for impact on self-reports of physical and sexual aggression experiences while at the club. Recent aggressive experiences and perpetration, concerns for group safety, one's own plans and assessment of other group members' plans to drink to the point of intoxication, and personal characteristics were examined, using both individual and group indicators. At exit, participants reported experiencing physical aggression (12.3 %) and sexual aggression (12.6 %) at the club. Using generalized linear mixed modeling to account for nested data (club, event, and group), group level indicators predicted both the individual's physical and sexual aggression experiences. Especially for experiences of physical aggression, group effects are notable. Being in a group whose members recently experienced physical aggression increased the risk for the individual. Interestingly, groups that had higher levels of planned intoxication decreased risks of experiencing aggression, while a discrepancy in these intentions among group members increased the risks. Group effects were also noted for experiencing sexual aggression. High levels of prior experiences for sexual aggression in the group increased the risks for the individual during the event. Also, being in a group that is identified as having at least one member who is frequently drunk increases the risk for experiencing sexual aggression. These findings inform prevention strategies for young adults engaged in high-risk behaviors by targeting social drinking groups who frequent clubs.

Preventing Alcohol Abuse Through Social Networking Sites: A First Assessment of a Two-Year Ecological Approach

Background

Prevention strategies to reduce alcohol use/consumption among young people are crucial to reducing alcohol-related deaths and preventing disease. This paper focuses on the effectiveness of a social networking site (SNS) alcohol prevention program targeted toward young people.

Objective

We hypothesized that the program would diminish the relation made by participants between alcohol and festive moments, and would result in a reduction of their declared consumption of alcohol at festive moments during the program. We also explored the interaction with the prevention program that was the most efficient.

Methods

The prevention program took the form of 3 lotteries over 2 years. The participants periodically received prevention messages, particularly on alcohol and festive moments (eg, videos on Facebook and short message service [SMS] text messages on their mobile phones). For the 3 periods, the participants had to answer questions exploring the level of their belief that alcohol consumption and festive moments are highly associated. A control group that did not participate in the prevention program was asked the same questions over the same number of days for the first 2 periods. During the second period, the participants were asked to answer questions about their alcohol consumption during parties. During the third period, we explored the interaction with the prevention program on the reduction of their belief that alcohol consumption and festive moments are associated.

Results

A total of 651 participants (age: mean 22.24, SD 4.10 years; women: n=430) during the first period, 301 participants (age: mean 21.27, SD 3.07 years; women n=199) during the second period, and 305 (age: mean 22.41, SD 4.65 years; women: n=190) during the third period correctly completed the survey. For the control group, 69 students completed the survey during the first period (age: mean 18.93, SD 1.14 years; women: n=59) and 50 during the second (age: mean 20.78, SD 1.94 years; women: n=45). We observed a significant reduction in the association of alcohol with festive moments in the participants over the 2 years (period 1: z=–4.80, P<.001; period 2: z=–2.11, P=.04; period 3: z=–2.30; P=.02), but not in the controls. We also observed a reduction in the number of glasses consumed during festive moments for the participants (z=–2.36, P=.02), but not for the controls during the second period. The third period showed that only the number of days since registration in the program had an impact on the reduction of the association of festive moments and alcohol consumption (t₂₁=3.186, P=.005).

Conclusions

The findings of this study suggest that the SNS prevention program is promising in preventing the association of alcohol with festive moments and, more generally, in impacting social norms.

Alcohol and brief intervention for trauma victims

OBJECTIVE

to describe the causes and severities of trauma in patients who met the criteria for alcohol abuse or dependence according to Mini International Neuropsychiatric Interview, and to display the pattern of alcohol consumption and subsequent changes one year after trauma.

METHODS

a transversal and longitudinal quantitative study carried out between November 2012 and September 2013 in the ED. Medical and nursing students collected blood samples, applied the J section of the Mini International Neuropsychiatric Interview (MINI) and submitted alcohol abusers and dependents to BI. One year after admission, patients were contacted and asked about their patterns of alcohol use and their reasons for any changes.

RESULTS

from a sample of 507 patients admitted to the ED for trauma, 348 responded to MINI, 90 (25.9%) being abusers and 36 (10.3%) dependent on alcohol. Among the abusers, the most frequent cause of injury was motorcycle accident (35.6%) and among the dependents it was predominantly interpersonal violence (22.2%). Positive blood samples for alcohol were identified in 31.7% of the abusers and 53.1% of the dependents. One year after trauma, 66 abusers and 31 dependents were contacted, and it was ascertained that 36.4% of the abusers and 19.4% of the dependents had decreased alcohol consumption. The main reported reason for the reduction was the experienced trauma.

CONCLUSION

the motorcycle accident was the most common cause of injury. The detection of problematic alcohol use and implementation of BI are important strategies in the ED, however for alcohol abusers and dependents, BI was not the most reported reason for any changes in patterns of alcohol use.

Postdetoxification Factors Predicting Alcohol-Related Emergency Room Visits 12 to 24 Months After Discharge: Results from a Prospective Study of Patients with Alcohol Dependence

BACKGROUND

Relapse is common in patients with alcohol dependence, even after detoxification. The aims of this prospective study were to investigate changes affecting patients during the first 6 months after discharge from hospitalization for detoxification and to determine the influence of these changes on the likelihood of alcohol-related emergency room (ER) visits in the following 18-month period.

METHODS

The study included 88 patients hospitalized for participation in a detoxification program in the addiction department of a university hospital in Rennes, France. Alcohol consumption, psychiatric symptoms, and life events were investigated by addiction specialists during hospitalization and 6 months afterward. For each patient, the number of alcohol-related ER visits in the last 6 months was prospectively recorded at the hospital 12, 18, and 24 months after hospitalization. The rate ratios of ER visits as a function of sociodemographic variables and changes observed 6 months after discharge were estimated using Poisson regression with autoregressive errors.

RESULTS

Nearly half of the patients (47.7%) had ER visits in the 12- to 24-month period following discharge. The likelihood of ER visits was higher for patients living with friends/parents and for those with aggravated psychiatric symptoms, negative changes in their family life, and who had a medical follow-up in the 6 months after discharge. In contrast, the likelihood of ER visits was lower for patients living with children and those with improved psychiatric morbidity. Alcohol consumption and psychiatric symptoms at baseline had no significant effect.

CONCLUSIONS

Monitoring changes in psychiatric symptoms and family life early after a detoxification program may help identify patients who are vulnerable to relapse in the subsequent 18-month period. Systematic screening for these changes as early as possible, in combination with appropriate treatment and the establishment of a social support system, could be fundamental in avoiding further relapses and ER visits.

Comparative study of the impact of intoxication on injuries in china and Korea

OBJECTIVES

Alcohol misuse has been widely studied as a substantial contributor to injured patients' visits to emergency departments. The current research studied differences in alcohol-related injury variables in China and Korea.

METHODS

Data were collected from a sample of 4,509 patients (2,862 males and 1,667 females) reporting at emergency departments in China and Korea using the World Health Organization collaborative study on alcohol and injuries protocol.

RESULTS

More injuries were reported by men, young people aged 25-34 years, employed individuals, and persons who had at least a high-school education. The proportion of injury cases among intoxicated patients was 14% for Chinese and 20% for Koreans. The odds of intentional injuries to intoxicated patients increased significantly when the perpetrator had been drinking, especially for severely intoxicated victims in both countries. The odds of injuries for intoxicated persons in both countries were high during sports and leisure activities; odds ratio (OR) = 3.93, 95% confidence interval (CI) = 2.76-5.59 for Chinese and OR = 10.97, 95% CI = 6.06-19.85 for Koreans.

CONCLUSION

These findings are a contribution to research in the two Asian countries about the effect of intoxication on injuries especially when both victim and perpetrator are intoxicated.

[Forensic aspect of acute drunkenness]

Alcohol consumption in itself is not forbidden in France. Two situations are reprehended by the law: public drunkenness - where only the behavior is sanctioned and not the alcohol level - and driving with a level of alcohol superior to 0.5g per liter. The management of a severe state of drunkenness - even though frequent - is on the one hand poorly managed and on the other hands badly mastered by doctors. The management of drunken patients lies essentially in a strong monitoring of the possible complications. The inherent question of the returning-back-home for a drunken patient should be approached according to the state of consciousness rather than the alcohol rate in the blood. No matter what the rate is, the authorization to release a patient depends on the preservation of his judgmental capacities. If those are altered, the doctor can then decide to keep - even against his will - the patient temporarily and until he has recovered his discernment. Patients still keep their right to refuse any medical treatment. Indeed, the law does not provide any answer concerning the particular issue of the refusal of medical care by the patient, especially in case of a severe alcoholic intoxicated state that let the patient incapable to express his will and to understand the range of the given information. There is no legal measure that can able a doctor to firmly forbid a drunk patient to be released and to take the wheel. Doctors have to try to dissuade them by proposing other alternatives but they cannot physically oppose themselves to the patient decision. However, proofs that the doctor tried his best to convince the patient not to drive while under the influence of alcohol can be demanded. Doctors have the duty to inform patients on every risk that alcohol can bring while driving but do not have any measure of pressure.

The rate ratio of injury and aggressive incident for alcohol alone, cocaine alone and simultaneous use before the event: a case-crossover study

OBJECTIVES

(i) To estimate the rate ratio (RR) of use of alcohol alone, cocaine alone, and both substances simultaneously on acute injury or an aggressive incident, (ii) to compare the RRs for simultaneous use within 3 or 6h of the event; and (iii) to compare the RRs of two measures of exposure, "hours of feeling effects" vs estimates based on self-reported quantity and frequency of use.

METHODS

The study employed a case-crossover design with the frequency approach. Clients (N=616) in substance abuse treatment for alcohol or cocaine issues from 2009 to 2012 completed a self-administered questionnaire on their substance use within 3 and 6h before a recent injury or physically aggressive incident. Clients also reported detailed quantity and frequency information in relation to their typical substance use, as well as information on "feeling effects". The RR of acute harms due to substance use was estimated using the Mantel-Haenszel estimator.

RESULTS

In the 6-h window before the event, use of cocaine alone, alcohol alone and simultaneous alcohol and cocaine use were each significantly (P<0.05) related to a recent injury and aggressive incident. Simultaneous use was not significantly greater than use of either drug alone. Estimates of RR based on simultaneous use for a 3-h window before the event were consistently larger than those based on a 6-h window, and comparisons were significant (P<0.05) for an aggressive incident but not an injury. With reference to the two measures of exposure, three of eight comparisons of RRs were significantly larger for feeling the effects of the substance in comparison to quantity and frequency of substance use.

CONCLUSION

These findings are consistent with increased likelihood of harms related to the acute effects of alcohol alone, cocaine alone or simultaneous use. The results are suggestive that the acute effects of these drugs may be better measured within a 3-h time window than a 6-h window. Finally, we found that "hours of feeling effects" yielded higher estimates of RR than the quantity-frequency approach; however both measures support the overall findings.

[Alcohol use in France]

Alcohol consumption has regularly decreased in France since the 1950s, essentially in connection with the decrease of wine consumption, with disaffection for the "table wine", for the benefit of better quality wines that are drunk in lesser quantity. France is still part of the most alcohol drinking countries in the European Union but is no longer situated at the very top of the ranking. General population surveys results tend to confirm the evolution of sale of alcohol: since 1992, among 15-75 years old, alcohol daily users proportion was divided by two, from 24% in 1992 to 11% in 2010, currently replaced by a more occasional use. We indeed observe in the general population a profile of young adults having a strong and punctual consumption, and an older profile of less important but regular consumption. The proportion of problematic alcohol users remains stable, concerning approximately a person on 10 in the adult population. The part of persons who declared they have drunk six glasses or more during the same occasion at least once a month during the last twelve months increased from 15% in 2005 to 18% in 2010. Binge drinking and the frequency of drunkenness have increased among teenagers and young adults these last years. These behaviors can lead to short term risks, such as accidents, undergone violence, unwanted or unprotected sexual intercourse, even coma, whereas chronic alcohol use can lead to numerous hepatic, cardiovascular and neuropsychiatric complications, as well as cancers. With such sanitary consequences, alcohol is a major risk factor of avoidable morbidity and premature mortality. The beneficial effect that seems to have a moderate consumption of alcohol on the risk of death by cardiovascular diseases has brought about recurring scientific controversies. However, its major noxious effects in terms of non-transmitted diseases should remain the major point in public health decisions on alcoholization.

Brief interventions for hazardous and harmful alcohol consumption in accident and emergency departments

The prevalence of alcohol abuse among patients treated in accident and emergency departments (A&E) is considered as substantial. This paper is a narrative review of studies investigating the effectiveness of brief interventions (BI) for hazardous and harmful alcohol consumption in A&E. A&E departments in hospitals (and other health care infrastructures) are commonly the place where serious consequences of alcohol drinking are seen and need to be tackled, supporting the suggested theoretical usefulness of delivering BI in this environment. Available research shows that BI may be considered a valuable technique for dealing with alcohol-related problems. However, it is suggested that the usefulness of BI may depend significantly on the target population to be dealt with. BI have proved to be beneficial for male individuals and those patients who do not abuse other psychoactive substances. In contrast, evidence indicates that BI in A&E settings are not effective at all when dealing with men admitted as a consequence of a violence-related event. In addition, some studies were unable to confirm the effectiveness of BI in female population, in emergency setting. Studies investigating the association between drinking patterns and the effectiveness of BI also present inconsistent results. Most studies assessing the effectiveness of BI in A&E settings only adopted a short perspective (looking at the impact up to a maximum of 12 months after the BI was delivered). When assessing the effects of BI, both the amount of alcohol consumed and expected reductions in alcohol consequences, such as injuries, can be taken into account. Evidence on the implementation of brief intervention in emergency departments remains inconclusive as to whether there are clear benefits. A variety of outcome measures and assessing procedures were used in the different studies, which have investigated this topic.