Aggression and recent substance abuse: Absence of association in psychiatric emergency room patients

Substance abuse has been linked to aggression in community and psychiatric samples. A retrospective chart review in 311 consecutive psychiatric emerge ncy room patients was conducted to assess the association of substance abus e and aggression in an acute psychiatric setting. Various indices of substa nce abuse, including positive urine toxicology for alcohol, cocaine, and/or cannabis, were not associated with aggressive behavior, Patients with posi tive toxicology for cocaine were less frequently aggressive than cocaine-ne gative patients. Among aggressive patients, the presence of psychotic sympt oms was the most important factor associated with admission. These findings suggest that aggression is not a common acute manifestation of recent subs tance abuse in psychiatric emergency room patients. Selection factors in th is population and the specifics of an acute psychiatric setting may obscure the association, if any. Acute psychosis seems to have a more important ro le in this setting. Future studies should focus on the prevention and early treatment of aggression in psychotic emergency room patients. Copyright (C ) 1999 by W.B. Saunders Company.