TIP 16:  Alcohol and Other Drug Screening of Hospitalized Trauma Patients: Treatment Improvement Protocol (TIP) Series 16

Disclaimer

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated.

This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, M.S., served as the CSAT Government project officer, and Roberta Messalle was the Government content advisor. Text development was provided by Carl Leukefeld, D.S.W. Writers were Carolyn Davis, Joni Eisenberg, Constance Gartner, Randi Henderson, and Deborah Shuman.

The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.

What Is a TIP?

CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources.

The dissemination of a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts. These include clinicians, researchers, and program managers, as well as professionals in such related fields as social services or criminal justice.

Once a topic has been selected, CSAT creates a Federal resource panel, with members from pertinent Federal agencies and national organizations, to review the state of the art in treatment and program management in the area selected. Recommendations from this Federal panel are then transmitted to the members of a second group, which consists of non-Federal experts who are intimately familiar with the topic. This group, known as a non-Federal consensus panel, meets in Washington for 5 days, makes recommendations, defines protocols, and arrives at agreement on protocols. Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Chair for the panel is charged with responsibility of ensuring that the resulting protocol reflects true group consensus.

The next step is a review of the proposed guidelines and protocol by a third group whose members serve as expert field reviewers. Once their recommendations and responses have been reviewed, the Chair approves the document for publication. The result is a TIP reflecting the actual state of the art of AOD abuse treatment in public and private programs recognized for their provision of high quality and innovative AOD abuse treatment.

This TIP Alcohol and Other Drug Screening of Hospitalized Trauma Patients examines the extensive role that alcohol and other drug abuse plays in traumatic injury. The costs of injury to both individuals and society are high. In financial terms, the annual direct and indirect costs of providing care for injured persons are higher than the costs of care for persons with cancer or heart disease. Persons who sustain one injury are at greatly increased risk of reinjuring themselves and others. Untreated substance use disorders are thought to be the cause of a large portion of reinjury. For these and other reasons, the consensus panel recommends universal alcohol and drug screening of injured patients ages 14 and older upon hospital admission.

The TIP provides guidelines for addressing positive results of screens. The purpose of screening is twofold: to improve the medical management of these patients during hospitalization and injury rehabilitation and to help identify a subgroup of patients with untreated AOD problems who can be referred to treatment, if appropriate. The TIP is targeted both to professionals in the treatment field, who may not be familiar with traumatic injuries, and to medical professionals, who may be considering implementing screening programs in their facilities. It is hoped that the TIP will help bring closer together two groups of care providers to improve care and more effectively address injury prevention.

This TIP represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment.

Other TIPs may be ordered by contacting The National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.