Reece Albert S
Southcity Family Medical Centre, 39 Gladstone Rd,, Highgate Hill, Queensland, Australia.
Subst Abuse Treat Prev Policy. 2008 May 3;3:10. doi: 10.1186/1747-597X-3-10.
Trauma plays an important role in the experience of many patients with substance use disorder, but is relatively under-studied particularly in Australia. The present survey examined the lifetime prevalence of various forms of trauma including driving careers in the context of relevant medical conditions.
A survey was undertaken in a family medicine practice with a special interest in addiction medicine in Brisbane, Australia.
Of 350 patients surveyed, 220 were substance dependent, and 130 were general medical patients. Addicted patients were younger (mean +/- S.D. 33.72 +/- 8.14 vs. 44.24 +/- 16.91 years, P < 0.0001) and had shorter driving histories (15.96 +/- 8.50 vs. 25.54 +/- 15.03 years, P < 0.0001). They had less driving related medical problems (vision, spectacle use, diabetes) but more fractures, surgical operations, dental trauma and assaults. Addicted patients also had significantly worse driving histories on most parameters measured including percent with driving suspensions (O.R. = 7.70, C.I. 4.38-13.63), duration of suspensions (1.71 +/- 3.60 vs. 0.11 +/- 0.31 years, P < 0.0001), number of motor vehicle collisions (2.00 +/- 3.30 vs. 1.10 +/- 1.32, P = 0.01), numbers of cars repaired (1.73 +/- 3.59 vs. 1.08 +/- 1.60, P = 0.042), rear end collisions (O.R. = 1.90, CI 1.13-3.25), running away after car crashes (O.R. = 26.37, CI 4.31-1077.48), other people hospitalized (O.R. = 2.00, C.I. 0.93-4.37, P = 0.037) and people killed (17 vs. 0 P = 0.0005). Upon multivariate analysis group membership was shown to be a significant determinant of both cars repaired and cars hit when controlled for length of driving history. Hence use of all types of drugs (O.R. = 10.07, C.I. 8.80-14.72) was more common in addicted patients as were general (O.R. = 3.64, C.I. 2.99-4.80) and road (O.R.= 2.73, C.I. 2.36-3.15) trauma.
This study shows that despite shorter driving histories, addicted patients have worse driving careers and general trauma experience than the comparison group which is not explained by associated medical conditions. Trauma is relevant to addiction management at both the patient and policy levels. Substance dependence policies which focus largely on prevention of virus transmission likely have too narrow a public health focus, and tend to engender an unrealistically simplistic and trivialized view of the addiction syndrome. Reduction of drug driving and drug related trauma likely require policies which reduce drug use per se, and are not limited to harm reduction measures alone.
创伤在许多物质使用障碍患者的经历中起着重要作用，但在澳大利亚尤其缺乏相关研究。本次调查研究了包括在相关医疗状况背景下的驾驶经历在内的各种形式创伤的终生患病率。
在澳大利亚布里斯班一家对成瘾医学有特别兴趣的家庭医学诊所进行了一项调查。
在接受调查的350名患者中，220名是物质依赖者，130名是普通内科患者。成瘾患者更年轻（平均±标准差：33.72±8.14岁对44.24±16.91岁，P<0.0001），驾驶历史更短（15.96±8.50年对25.54±15.03年，P<0.0001）。他们与驾驶相关的医疗问题（视力、眼镜使用、糖尿病）较少，但骨折、外科手术、牙齿创伤和袭击较多。成瘾患者在大多数测量参数上的驾驶历史也明显更差，包括驾驶被吊销的百分比（比值比=7.70，置信区间4.38 - 13.63）、吊销持续时间（1.71±3.60年对0.11±0.31年，P<0.0001）、机动车碰撞次数（2.00±3.30次对1.10±1.32次，P = 0.01）、维修汽车数量（1.73±3.59辆对1.08±1.60辆，P = 0.042）、追尾碰撞（比值比=1.90，置信区间1.13 - 3.25）、车祸后逃逸（比值比=26.37，置信区间4.31 - 1077.48）、他人住院（比值比=2.00，置信区间0.93 - 4.37，P = 0.037）和致人死亡（17人对0人，P = 0.0005）。多变量分析显示，在控制驾驶历史长度后，组别是维修汽车数量和汽车碰撞次数的显著决定因素。因此，各类药物的使用（比值比=10.07，置信区间8.80 - 14.72）在成瘾患者中更为常见，一般性创伤（比值比=3.64，置信区间2.99 - 4.80）和道路创伤（比值比=2.73，置信区间2.36 - 3.15）也是如此。
本研究表明，尽管成瘾患者的驾驶历史较短，但与对照组相比，他们的驾驶经历更差，且一般性创伤经历更多，这无法用相关医疗状况来解释。创伤在患者和政策层面的成瘾管理中都具有相关性。主要侧重于预防病毒传播的物质依赖政策可能在公共卫生方面的关注过于狭窄，并且往往会产生对成瘾综合征不切实际的简单化和轻视的看法。减少药物驾驶和与药物相关的创伤可能需要减少药物使用本身的政策，而不仅限于危害减少措施。
