Alcohol and Trauma

A Commentary by NIAAA Director Enoch Gordis, M.D.

In managing traumatic injury, it is essential to obtain accurate information on patient alcohol use and to refer alcohol abusers for appropriate treatment.

Although extensive evaluation of alcohol abuse, especially in busier emergency rooms, may not always be feasible, at a minimum, screening of blood alcohol levels must be done routinely. Doing so provides a quick picture of alcohol as a factor in managing the trauma without compromising emergency room functioning. It also reduces risk for errors that can result from basing diagnoses solely on external signs, such as inebriated behavior or the smell of alcoholic beverages on a patient's breath, rather than basing diagnoses on appropriate medical evaluation.

Bias against treating an inebriated patient who is uncooperative and disruptive may lead to quick disposition of that case in order to free up time for more "deserving" patients. Or, stupor in a patient smelling of alcoholic beverages might be assumed to result only from heavy drinking. In either instance, appropriate medical evaluation could uncover head injuries, such as subdural or epidural hematoma, or other problems that often coexist with alcoholism, such as hypoglycemia, use of drugs other than alcohol, bacterial infections, or meningitis.

Alcoholics who incur trauma but, because of well developed tolerance, show no evidence of intoxication, present a special dilemma due to a variety of unexpected alcohol-related complications that may arise during trauma management. For example, depending on the recency of their drinking, many alcoholics vary in their response to therapeutic drugs, including anesthetics, a critical factor if an operation is required. An alcoholic patient also may enter withdrawal, further complicating management of the traumatic event.

Once patients have been stabilized, practitioners have another responsibility that is all too often ignored--referring alcohol abusers for appropriate alcohol treatment. Doing so is just as medically necessary as managing the traumatic event. In general, patients who should be referred include reasonably coherent persons with a high concentration of alcohol or other drugs of abuse in their body fluids; persons who are inebriated; persons who are in withdrawal; or persons in whom there is evidence of repeated trauma. Treatment needs will vary among victims of alcohol-related trauma, ranging from minimal intervention for episodic abuse to more intensive treatment for alcohol dependency.

Through referral, emergency medical personnel can help alcohol abusers and dependent patients reduce their risk for life-threatening health consequences, including future episodes of alcohol-related injury. Referral is especially critical for the many young victims of alcohol-related trauma for whom early intervention has a great payoff in terms of years of potential life saved.

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