Specker Sheila, Meller William H, Thurber Steven
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
Woodland Centers, Willmar, MN, USA. Email:
Subst Abuse. 2009 Nov 27;3:93-8. doi: 10.4137/sart.s3457. eCollection 2009.
A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders.
Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants.
Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions.
These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although the results are encouraging in that individuals with SUD were identified and potentially sent for appropriate treatment, the likelihood is that many patients with SUD remain unrecognized and do not receive necessary consultative and treatment services.
综合医院中有相当数量的患者会表现出药物滥用问题，但大多数患者在转诊-会诊过程中不太可能得到充分识别。这种识别失败可能会使患者无法获得针对药物使用障碍的有效干预。
精神科会诊医生对连续一年转诊至会诊-联络精神科服务的患者（524例）进行化学相关问题审查。
在转诊患者中，176例符合药物使用障碍（SUD）标准（57%为酒精；25%为其他药物；18%为酒精和其他药物两者）。被诊断为SUD的人往往更年轻、男性、非白种人、未婚且失业。他们更有可能抑郁、有肝脏和其他胃肠道问题，并且经历过创伤事件；他们也往往目前有经济困难。大多数由普通内科和家庭医学科室的人员转诊进行SUD评估。经过精神科会诊后，被指定为SUD的患者主要被转诊至药物滥用治疗项目。与为SUD患者推荐住院还是门诊服务唯一相关的变量是功能总体评估轴（GAF），功能估计较低的人更有可能被转诊进行住院干预。
这些数据与该领域过去的研究结果相似。与以往会诊-联络精神病学领域的调查不同，数据收集纳入了经济压力源和具体的会诊医生建议。尽管结果令人鼓舞，因为识别出了SUD患者并有可能将其送去接受适当治疗，但很可能仍有许多SUD患者未被识别，无法获得必要的会诊和治疗服务。
