KAP Keys Based on TIP 16

Alcohol and Other Drug Screening of 

Hospitalized Trauma Patients

CSAT’s 

Knowledge Application Program

KAP Keys

For Clinicians

Based on TIP 16 

Alcohol and Other 

Drug Screening of 

Hospitalized 

Trauma 

Patients

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

www.samhsa.gov
KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients

Introduction

These KAP Keys were developed to accompany the Treatment 

Improvement Protocol (TIP) Series published by the Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and 

Mental Health Services Administration. These KAP Keys are 

based entirely on TIP 16 and are designed to meet the needs 

of the busy clinician for concise, easily accessed “how-to” 

information.

For more information on the topics in these KAP Keys, see TIP 16.

Other Treatment Improvement Protocols that 

are relevant to these KAP Keys:

TIP 24, Guide to Substance Abuse Services for Primary Care 

Clinicians (1997, Reprinted 2000) BKD234

TIP 31, Screening and Assessing Adolescents for Substance 

Use Disorders (1999) BKD306

TIP 34, Brief Interventions and Brief Therapies for Substance 

Abuse (1999) BKD341
KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients

Keys to Screening Trauma Patients 1 for Alcohol and Drug Use

 Screen all hospitalized trauma patients ages 14 and older.

 Screen patients at the time of admission to the emergency 

room or trauma center.

 Obtain blood alcohol concentrations (BACs) and urine-drug 

screens.

 Consider all patients with BACs above 20 mg/dl (0.02 percent) 

for further assessment of alcohol and drug use.

 The amount of alcohol that defines drunk driving differs 

from State to State; in most States the amount is 100 mg/dl 

(0.10 percent) or 80 mg/dl (0.08 percent).

 The amount known to produce impairment is about 50 

mg/dl (0.05 percent).

 Many patients with BACs above 200 mg/dl will be found to 

have a diagnosable alcohol problem on further screening 

and assessment.

Ask these two questions in combination (they have been 

shown to detect alcoholism in more than 90 percent of 

a sample):

 Have you ever had a drinking problem?

 When was your last drink?
KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients
2

KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients

Indications for Further Alcohol 

and Drug Assessments

Any of the following indicates the need for further alcohol and 

drug assessment:

 Blood alcohol concentrations greater than 20 mg/dl (0.02 

percent)

 Any urine-drug screen positive for a psychoactive substance

 Any abnormally elevated GGT (gamma-glutamyltransferase)

 More than two positive answers on a screening questionnaire such as the Short Michigan Alcoholism Screening Test 

(SMAST).
KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients
3

KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients

Short Michigan Alcoholism 

Screening Test

Score 1 point for each YES answer, except for questions 6, 10, 

and 11, which get 3 points for each YES answer. A score of 

0 to 3 indicates “nonalcoholic”; a score of 2 points equals 

“possibly alcoholic”; and a score of 3 or more indicates 

“alcoholic.”

1. Do you feel you are a normal drinker? (By normal we 

mean you drink less than or as much as most people.)

2. Does your wife, your husband, a parent, or another near 

relative ever worry or complain about your drinking?

3. Do you ever feel guilty about your drinking?

4. Do friends or relatives think you are a normal drinker?

5. Are you able to stop drinking when you want to?

6. Have you ever attended a meeting of Alcoholics 

Anonymous?

7. Has drinking ever created problems between you and your 

wife, your husband, a parent, or another near relative?

8. Have you ever gotten into trouble at work because of your 

drinking?

9. Have you ever neglected your obligations, your family, or 

your work for 2 or more days in a row because you were 

drinking?

10. Have you ever gone to anyone for help about your 

drinking?

11. Have you ever been in a hospital because of your 

drinking?

12. Have you ever been arrested for driving under the 

influence of alcoholic beverages?

13. Have you ever been arrested, even for a few hours, 

because of other drunken behavior?

Source: Selzer, M.L., Vinokur, A., and Van Rooijen, L. A self-administered Short 

Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol 

36:117–126, 1975.
KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients
Skinner Trauma History 4

KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients

To assess trauma history, ask these questions:

Since your 18th birthday, have you

1. Had any fractures or dislocations to your bones or joints?

2. Been injured in a road traffic accident?

3. Injured your head?

4. Been injured in an assault or fight (excluding injuries during 

sports)?

5. Been injured after drinking?

Yes answers to two or more questions indicate a high probability of alcohol abuse.

Source: Skinner, H.A.; Holt, S.; Schuller, R.; Roy, J.; and Israel Y. Identification of 

alcohol abuse using laboratory tests and a history of trauma. Annals of Internal 

Medicine 101(6):847-851, 1984.
KAP Keys Based on TIP 16

Alcohol and Other Drug Screening

of Hospitalized Trauma Patients

Ordering Information

TIP 16

Alcohol and Other Drug Screening 

of Hospitalized Trauma Patients

Easy Ways to Obtain Free Copies of 

All TIP Products

1. Call SAMHSA’s National Clearinghouse for Alcohol and 

Drug Information (NCADI) at 800–729–6686, TDD 

(hearing impaired) 800–487–4889

2. Visit CSAT’s Web site at www.csat.samhsa.gov

Do not reproduce or distribute this publication for a fee 

without specific, written authorization from the Office of 

Communications, Substance Abuse and Mental Health 

Services Administration, U.S. Department of Health and 

Human Services.

DHHS Publication No. (SMA) 01-3567

Printed 2001