Preinjury alcohol and drug use among persons with spinal cord injury: Implications for rehabilitation

Abstract

Context/objectiveTo describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent spinal cord injury (SCI).DesignSurvey.SettingAcute inpatient rehabilitation program.ParticipantsParticipants were 118 (84.8%) of 139 consecutive admissions who met inclusion criteria and were screened for preinjury alcohol and drug use.InterventionsNone.Outcome measuresAlcohol and drug use, toxicology results, alcohol problems, readiness to change, and treatment preferences.ResultsParticipants were on average 37 years old, 84% were men, and 85% were white. Fifty-one percent of the sample was considered ‘at-risk’ drinkers. Significant lifetime alcohol-related problems were reported by 38% of the total sample. Thirty-three percent reported recent illicit drug use and 44% of the 82 cases with toxicology results were positive for illicit drugs. Seventy-one percent of at-risk drinkers reported either considering changes in alcohol use or already taking action. Forty-one percent reported interest in trying substance abuse treatment or Alcoholics Anonymous (AA). Motivation to change alcohol use was significantly and positively associated with self-reported indicators of alcohol problem severity.ConclusionPreinjury alcohol and drug abuse are common among persons with recent SCI. Substance abuse screening is feasible and detects not only salient clinical problems but also significant motivation to change and interest in AA or treatment, all of which represent an important window of opportunity for appropriate brief interventions and referrals. In contrast with the idea that alcoholism is a ‘disease of denial’, the majority of at-risk drinkers with new onset SCI indicate they are considering making changes.