Key study information extracted included study objective, study design, study location, eligibility criteria, the instrument by which participants were screened, presence of drug use treatment, if any, referral to specialized drug use treatment, if any, and main outcomes relevant to this study’s objective. Extensive heterogeneity of the final selected studies precluded a meta-analysis. All study information was entered in tabular format in Microsoft Excel version 16 . A flow chart of the study selection results can be seen in the Figure PRISMA diagram. The literature search resulted in 2,177 studies imported for screening. We identified 101 studies as duplicates and removed them, leaving 2,076 titles and abstracts. Of those abstracts, 1,984 studies were excluded after a title and abstract screening leaving 92 studies for full-text review. Of the 92 full-text studies, 66 studies were excluded because of wrong study design, no full-text was available , wrong patient population , wrong study setting, wrong study outcomes, or were additional duplicates. Twenty-six studies remained for the final analysis. Together, the 26 study populations spanned all ages. Fourteen studies focused on both adults and adolescents, nine on adults, and three on adolescents. The mean age of the participants ranged from 14.5-38.6 years. Thirteen studies were secondary analyses of prospective studies, which were included. None of the studies were of multiple sites.All studies screened for self-reported drug use among assault-injured participants either by computerized/written survey or in-person interview. Of the 26 studies, five studies screened for recent drug use by either survey or in-person interview without a formal screening instrument.Of the remaining 21 studies, 14 used a combination of the NIDA Quick Screen Question and Modified Alcohol, Smoking and Substance Involvement Screening Test , three used the Substance Abuse Outcomes Module ,mobile grow system two used questions from the Monitoring the Future study to detect prior-year cannabis use,one used questions from the Supporting Adolescents with Guidance and Employment survey to detect past 12-month substance use,42 and one used the Texas Christian University Drug Screen to determine past 30-day substance use.
Among all studies, drug use was found to be closely linked to assault-injury. Study results reported of this relationship were heterogenous. Four of 26 studies found a range of 25-61% of assault-injured individuals who reported drug use within the preceding 12 months.Three studies reported that previous drug use of any type was significantly associated with 1.43-7.41 greater odds of either previous or acute assault-injury.Two studies reported that assault injury was significantly associated with 1.55-1.84 greater odds of previous drug use.Overall, cannabis was the most common drug identified among assault-injured individuals. Eight studies reported cannabis use among assault-injured individuals ranged from 32.1-96.7%.Three studies found that cannabis use was significantly associated with 2.1-7.41 greater odds of assault-injury.Two studies found that cocaine use was also significantly associated with 2.7-3.1 greater odds of assault-injury.One study found prescription drug misuse was significantly associated with a 1.43 greater odds of assault-injury.In this systematic review, we identified ED-based studies that screen, treat, and/or directly refer to specialized treatment services for drug use among assault-injured individuals. Our comprehensive literature search determined that there were 26 studies that met criteria for inclusion. The studies in this review used various screening modalities to identify drug use including an in-person interview as well as computerized and written versions of validated screening instruments for drug use. None of these studies were interventional nor did they provide a direct referral to specialized treatment services. The vast majority of studies found a high prevalence of drug use within this population, with cannabis being the most common drug detected. Although study results were fairly heterogenous, the majority of them found high rates of drug use among assault injured individuals, especially when compared to those injured by other mechanisms. Previous literature demonstrates a close link between assault-injury and drug use.Several pre-existing theories have explained this relationship including the shared risk factors between assault-injury and drug use, the pharmacologic effects of drug use, and the association between assault-injury and the illegal drug trade.Evidence shows that substances such as alcohol, cocaine, amphetamine type stimulants, phencyclidine, and barbiturates cause increased aggression and impaired judgment.However, cannabis was among the most common drugs detected in our review. The evidence to support its role in causing aggressive behavior is mixed.It is more likely that the relationship between cannabis use and assault-injury is associated with the effects of withdrawal, shared risk factors of problem behavior, and facets of the illegal drug trade.
Additionally, cannabis use may also allow assault-injured individuals to mitigate aggression and cope with its negative effects.Future studies are needed to better elucidate this relationship. The practice of SBIRT to facilitate future treatment engagement for drug use in the ED setting has become increasingly common.SBIRT has shown some promise in identifying and managing unhealthy alcohol use and opioid use disorder , particularly when paired with pharmacotherapy .Studies in this review used various screening methods to identify drug use among assault-injured individuals. Several validated screening instruments for drug use exist, yet very few have been evaluated in the ED setting. Nineteen studies used one of the following formal screening instruments: the SAGE, SAOM, Texas Christian University Drug Screen, and the NIDA Quick Screen Question, and Modified ASSIST. The NIDA Quick Screen Question, “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”, is likely best suited for the ED clinical care context.1 This single question was found to be 100% sensitive for detecting drug use in the primary care setting.Among high-risk populations such as assault-injured individuals, this instrument has the potential to be the most effective in identifying drug use in the busy ED setting. Despite the ACS mandating the practice of SBIRT at all trauma centers for over two decades,our review demonstrates a marked paucity of literature that examines all aspects of SBIRT for drug use among assault-injured individuals in the ED setting. This includes the practices of brief intervention and/ or referral to specialized treatment services for drug use. This is particularly concerning because the literature supports a strong association between non-partner assault-injury and drug use. Moreover, the COVID-19 pandemic, its associated prevention efforts, and accompanying financial stress have exacerbated both substance use and assault-injury.Yet substance use is a potentially modifiable risk factor, as evidence-based behavioral and pharmacological interventions exist.This gap in literature may be explained by the challenges of engaging the intersection of two exceptionally vulnerable populations that do not often seek healthcare with regularity.Both assault-injury and drug use are sensitive topics to research likely due to a combination of stigmatization, fear of law enforcement involvement, their shared emotional impact, and a host of other shared socioeconomic factors including poverty and racism.
Furthermore, obtaining funding for assault-injury research is notoriously challenging, particularly for firearm-inflicted injuries.This may serve as an additional barrier in performing research in this vulnerable population. Other notable challenges in conducting research in this population include participant loss to follow-up by attrition , undocumented immigrant status and fear of deportation, and a lack of viable and sustained community resources where patients can be referred for counseling and treatment services.Additionally, our review highlights several knowledge gaps in the existing literature surrounding drug use in the context of non-partner assault-injury. Little is known about the mutual risk factors, notably socioecological and psychological, that may contribute to the co-occurrence of assault-injury and drug use, both considered to be problem behaviors.Further, in our review, no study evaluated the potential impact of an intervention, such as a brief behavioral intervention, to reduce drug use and subsequent injury. This is particularly compelling because previous literature has shown that a brief behavioral intervention, delivered in the ED setting, demonstrates considerable promise in reducing cannabis use and its related harm as well.Future studies may use existing theory such as the social-ecological model to inform the development of an intervention that reduces the burden of drug use and injury. 78HEAVY DRINKING AND ALCOHOL PROBLEMS are highly prevalent, chronic, mobile vertical rack and serious conditions that usually begin in the teens and persist over time, with 25% of individuals in their 50s drinking daily and/or ever consuming five or more drinks per occasion . Alcohol use disorders can decrease life spans by a decade , and two thirds of alcohol-related deaths occur between ages 45 and 60 . AUDs typically follow a course of exacerbations and remissions with complex interrelationships among risk factors that are best studied by identifying individuals before the condition develops and evaluating them repeatedly over decades. This can be challenging because research funding is usually short term, and longer follow-ups are expensive. Most longitudinal studies are 1–5 years and some cover 10–15 years , but prospective studies that began at age 20 and continued into the sixth decade of life are rare . For decades, our group has focused on predictors of AUDs and related outcomes that included demography; earlier substance use onsets, frequencies, quantities, and problems; prior treatment experiences; and genetically influenced characteristics . Although limitations in the time subjects were willing to spend during baseline evaluations for these studies and the specific interests of Prior studies indicate that remissions are likely to increase with age, European American background, having been married, and, for non-abstinent outcomes, previous lower alcohol quantities, frequencies, and alcohol problems . Abstinent outcomes are more likely in individuals with greater alcohol problems and those with experience with formal treatment or self-help groups , programs that usually emphasize non-drinking outcomes.
However, with some important exceptions , most longitudinal studies of the course of AUDs were generated from treatment samples that are often of lower socioeconomic status, and less is known about the clinical course of individuals with AUDs from higher functioning groups. Several genetically related characteristics also relate to the course of drinking and AUDs, including an endophenotype of special interest to our group. A low level of response to alcohol increases the AUD risk and might also predict higher remission rates among individuals with AUDs . The low LR is not closely linked to externalizing or internalizing characteristics, and, thus, is not related to dependence on illicit drugs or psychiatric disorders other than alcohol induced conditions . This study extracted data from the San Diego Prospective Study in which male probands entered the protocol at about age 20 as drinking, non–alcohol-dependent college students and nonacademic staff, with more than 90% of these subjects followed at age 30 and every 5 years thereafter. Half of the men had an alcohol-dependent father, and half reported no close relative with an AUD, with the two groups selected to be similar on demography and substance use histories. The selection of a sample, half of whom had an alcohol-dependent relative, resulted in a high proportion who developed an AUD. Thus, the results presented here are relatively unique among long-term studies of individuals with AUDs. Our current interest is in whether clinicians or researchers who had followed the men with AUDs from ages 20 to 50 could predict their alcohol-related outcomes. Four hypotheses guided the analyses. In Hypothesis 1, reflecting the past high education and life achievement for SDPS probands, we predicted that in their sixth decade many of these men would have developed abstinence or low-risk drinking in the absence of multiple alcohol-related problems . As a corollary, few participants will meet the criteria for AUDs between ages 50 and 55. Based on the existing literature, Hypothesis 2 predicted that low-risk drinking would be most likely for men with higher LRs to alcohol, and lower past drinking quantities, frequencies, and problems . Hypothesis 3 predicted that the more problematic outcome of high-risk drinking ages 50–55 would relate to LRs, alcohol intake patterns, and alcohol problems between the low-risk drinkers and probands who maintained abstinence during the most recent follow-up. Hypothesis 4 predicted that the probands who maintained abstinence at ages 50–55 would have the lowest LR and highest drinking quantities and report the highest rates of exposure to formal treatment and/or self-help group participation .Following approval from the University of California, San Diego , Human Subject’s Protections Committee, the SDPS began in 1978 with 18- to 25-year-old male European American and White Hispanic students and nonacademic staff selected among respondents to a randomly mailed questionnaire .