Background: Substance use problems are overrepresented in probability samples of patients in primary care settings including the emergency room (ER) compared to the general population. While large proportions of those with alcohol or drug use disorders are most likely to obtain services for these problems outside the mental health or substance abuse treatment system, accounting, in part, for this overrepresentation, little is known about the association of alcohol misuse or drug use with health services utilization in the general population.
Methods: The prevalence and predictive value of alcohol misuse and drug use on ER and primary care use was analyzed on 6919 respondents from the 2005 National Alcohol Survey (NAS).
Results: Among those reporting an ER visit during the last year, 24% were positive for risky drinking (14+ drinks weekly for men and 7+ for females and/or 5+/4+ in a day in the last 12 months), 8% for problem drinking, 3% for alcohol dependence, and 7% for illicit drug use greater than monthly. Figures for primary care users were, respectively: 24%, 5%, 3%, and 3%. ER users were more likely to be positive for problem drinking and greater than monthly illicit drug use compared to non-ER users, while no significant differences were found in substance use for users and non-users of primary care. In logistic regression controlling for gender, age, and health insurance, problem drinkers were twice as likely as non-problem drinkers (Odds ratio, OR=1.99) (p<0.01), and those reporting greater than monthly drug use were almost twice as likely as those using drugs less frequently or not at all (OR=1.92; p=0.01) to report ER use, while those reporting alcohol dependence were 1.63 times more likely to report primary care use (p<0.05).
Conclusion: These data support the belief that both the ER and other primary care settings are important sites for identifying those with substance use problems and for initiating a brief intervention.