802 ANNALS OF EMERGENCY MEDICINE 41:6 JUNE 2003 SUBSTANCE ABUSE/ORIGINAL RESEARCH Ian R. H. Rockett, PhD, MPH Sandra L. Putnam, PhD Haomiao Jia, PhD Gordon S. Smith, MD, MPH From the Department of Community Medicine, West Virginia University, Morgan- town, WV (Rockett); Com- munity Health Research Group, University of Tennessee, Knoxville, TN (Putnam); the Department of Community Health and Social Medicine, City University of New York Medical School, New York, NY (Jia); and Liberty Mutual Research Institute for Safety, Hopkinton, MA (Smith). Copyright © 2003 by the American College of Emergency Physicians. 0196-0644/2003/$30.00 + 0 doi:10.1067/mem.2003.189 Assessing Substance Abuse Treatment Need: A Statewide Hospital Emergency Department Study See editorial, p. 814. Study objective: Health care providers in hospital emergency departments rarely take substance abuse histories or assess associated treatment need. This study compares documentation of psychoactive drug–related diagnoses for adult ED patients in medical records with treatment need assessed through self-report, toxi- cologic screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV ), criteria. Methods: A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Main outcome mea- sures were the prevalence of diagnosed substance abuse problems, positive bioas- say results, denied use, and treatment need. Sensitivity and multivariate analyses were conducted by using varied case definitions of treatment need. Results: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict defi- nition of DSM-IV current drug dependence only. Under the comprehensive case defi- nition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to the privately insured. Excess need was also exhibited by patients reporting 1 or more prior ED visits in the past year (adjusted OR 1.62; 95% CI 1.13 to 2.31) and by patients taking 2 or more hours to reach the ED after the onset of injury or illness (adjusted OR 1.54; 95% CI 1.16 to 2.04). Treatment need was inversely asso- ciated with age. Irrespective of case definition, less than 10% of ED patients who needed substance abuse treatment were receiving such treatment. Conclusion: EDs can be important venues for detecting persons in need of sub- stance abuse treatment. [Ann Emerg Med. 2003;41:802-813.]