Substance abuse, violence, and outcome after traumatic spinal cord injury

Alcohol and drug use have been shown to contribute to the onset of traumati c spinal cord injury and to be a marker for later onset substance abuse iss ues. Admission toxicology (drug and alcohol) screens were collected from 87 consecutive rehabilitation medicine patients with a diagnosis of acute tra umatic spinal cord injury. Forty-six patients (53%) presented with positive screens (44% alcohol only, 30% drug only, 26% both). Seventy-five percent of those with positive alcohol screens met state criteria for alcohol intox ication (blood alcohol level, greater than or equal to 0.08 mg/dl). Compare d with individuals with negative screens, those with positive screens were significantly (P < 0.05) younger and unmarried. Compared with nonviolence-r elated spinal cord injury, patients with violence-related spinal cores inju ry (gunshot wound and assault) were significantly (P < 0.01) more likely to have positive admission toxicology screens (76% v 41%), drug screens (62% v 14%), and intoxication screens (72% v 34%). Rehabilitation outcome compar isons between those with positive and negative screens revealed similar len gth of stay, admission and discharge Functional independence Measure (FIM(T M)) scores, FIM change scores, and FIM efficiency scores. This study has im portant implications with regard to substance abuse issues and their impact on traumatic spinal cord injury outcome, which may assist in better target ing prevention.