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Prevalence and Predictors of Substance-Related Emergency Psychiatry Admissions

M Scott Young and Kathleen A Moore

Background: Individuals commonly present for emergency psychiatry services for reasons related to their use of alcohol or illicit drugs. This study assessed the prevalence of these phenomena and explored characteristics distinguishing emergency psychiatry admissions with versus without presenting problems related to substance use. Methods: Data included standardized emergency psychiatry intake interviews from 2,161 consecutive admissions to three hospital-based emergency psychiatry departments in Florida’s Tampa Bay area. Admissions were classified as substanceinvolved if substance use was ascertained to be related to the presenting problem(s). Cases with only substance-related presenting problems were classified as substance-only admissions. Descriptive statistics compared substance-involved admissions to those whose presenting problems were not related to substance use. A logistic regression determined the characteristics most predictive of substance-involved admissions; similarly, a second logistic regression analysis was used to predict substance-only admissions. Findings: A substantial number of emergency psychiatry admissions (n=507; 23.5%) were identified as being substance-involved. These patients were more often male, single, and unemployed as compared to those whose presenting problems were not linked to substance use. Substance involvement was documented as the sole presenting problem for a sizable portion (n=171; 7.9%) of the emergency psychiatry department admissions. This model was similar to the previous one except that gender, employment status, and insurance type were no longer significant predictors; additionally, the second model revealed that separated or divorced participants were more than three times as likely (OR=3.30, p<0.001) as those who were single to present for services for only substance-related reasons. Conclusion: Though high costs prohibit universal implementation of biologicallybased substance use screening procedures in emergency psychiatry settings, several characteristics have consistently been shown to significantly relate to substance-involved admissions. These characteristics can be quickly and cheaply obtained during a brief interview to trigger a more thorough assessment of the patients’ substance involvement, a brief intervention in the emergency department if possible, and/or appropriate referrals for addiction and integrated Co-occurring disorders treatment service.