Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention.

Emergency department (ED) patients are more likely than the general population to use and misuse tobacco, alcohol, and drugs.1,2 Among ED patients, the prevalence of tobacco use has been reported to be as high as 48%.2 In 2010, almost one out of every 10 ED visits was directly or indirectly a consequence of alcohol use, a figure that has nearly doubled since 1995.1 In 2011, the Drug Abuse Warning Network (DAWN) estimated that 2.5 million ED visits (approximately 2% to 3% of all visits) were directly due to misuse or abuse of illicit and prescription drugs,3 and approximately 13% of ED patients screened positive for problematic drug use.4 Sex differences have received growing attention as being an important component in the etiology and consequences of substance abuse and dependence.5–8 One large multistate ED study demonstrated that male sex was associated with greater severity of tobacco, alcohol, and drug use, which mirrors what is known about the general population.9 Apart from this study, little is known about sex-specific differences in the patterns of substance use and need for interventions among ED patients. This knowledge deficit about substance use related to sex was highlighted as a research priority at the 2014 Academic Emergency Medicine consensus conference “Gender-Specific Research in Emergency Care.”10 Understanding sex differences may be a pivotal factor in designing effective screening, brief interventions, and referral to treatment (SBIRT) approaches to address substance use among ED patients.11 In the ED, some SBIRT models have been shown to reduce alcohol use and its associated negative consequences, using the reason for the ED visit as a “teachable moment.”12,13 In settings other than EDs, primary care-based SBIRTs have shown differential effects of these approaches between men and women.14 In addition, women generally have been underrepresented in this line of research. As research and clinical implementation of SBIRT expands, there likely will be a role for sex-specific SBIRT trials, particularly if significant differences between sexes in the prevalence, patterns, or severity of substance use exist. Substance abuse may also manifest in variable behaviors between men and women (i.e., social or financial problems), and knowledge of these behaviors might supply important content for interventions and treatment. Additional work is needed to identify sex differences and examine factors that might account for these differences in substance use among ED patients. The primary aim of this investigation was to determine if sex differences exist in the prevalence of lifetime and past 3-month use of tobacco, alcohol, and drugs among a large random sample of adult ED patients. In addition, we also examined sex differences in: 1) the frequency of tobacco, alcohol, and drug use among those who used these substances within the past 3 months; 2) the severity of substance use within each substance category; 3) the need for interventions (brief or intensive) per World Health Organization (WHO) guidelines to decrease or eliminate substance use; and 4) patterns of substance use associated with the need for intervention.