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Patients who suffer from substance use disorders are stigmatized in the general population and even among emergency room staff and other healthcare settings (American Medical Association 2015). This chapter describes the presentation of typical patients who suffer from substance use disorders and is meant as a guide for the treatment and referral of these patients.

The Substance Use Epidemic and Treatment

The Substance Use Epidemic

The association of substance use disorders with significant morbidity and mortality is overwhelming: drug overdose remains the number one cause of accidental death in the United States and tobacco smoking remains the number one preventable risk factor for death (Yoon et al. 2014). Alcohol-related morbidity remains one of the top causes of U.S. healthcare spending (Hasin and Grant 2015). Increasingly, the emergency department (ED) has become the primary treatment entryway to the healthcare system for the uninsured and society at large; approximately half of all hospital inpatient admissions were referred from the ED setting (Weiss et al. 2014). There were approximately 2,460,000 ED visits that involved drug misuse or abuse in 2011 alone. In 2012, one-third of approximately 36 million young adults reported binge alcohol use in the past month with one-fifth of young adults reporting use of an illicit drug in the past month. The Treatment Episode Data Set (TEDS) reported that there were 403,756 admissions aged 18—25 to substance abuse treatment programs in 2011 (Batts et al. 2014). The number of young adults seen in an ED for the use of illicit drugs and the misuse or abuse of pharmaceuticals increased between 2005 and 2011 (Substance Abuse and Mental Health Services Administration 2014). Between 2006 and 2011, large central metropolitan areas experienced a 22% increase in the rate of ED visits over 5 years, from 31,900 to 39,000 visits per 100,000 population (Weiss et al. 2014). Between 2006 and 2011, the rate of ED visits for substance-related disorders (not including alcohol) increased 48% (Substance Abuse and Mental Health Services Administration 2013). Over the same period, ED visits for alcohol-related disorders increased 34%.

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