The available literature on the role of alcoholism as opposed to unwise drinking in injury occurrence suggests that problem drinkers and those diagnosed as alcoholics are at a greater risk of both fatal and nonfatal injuries than those in the general population who may drink prior to an accident. Alcoholics and problem drinkers are significantly more likely to be drinking and to be drinking heavily prior to an accident than others. Haberman and Baden (1978) found among fatalities from all causes that alcoholics and heavy drinkers were more than twice as likely as nonproblem drinkers to have a BAL at the legal limit. Alcoholics have also been found to experience higher rates of both fatal and nonfatal accidents, even when sober. Analysis of national mortality data found that those who died of injury drank more frequently and more heavily than those who died of disease, and that daily drinking, binge drinking (consuming 5 or more drinks per occasion), and heavier drinking (14 or more drinks per week) increased the likelihood of injury as the underlying cause of death (Li et al., 1994).
Data from the general U.S. population found the risk of injury increased with an average of one drink a day for both men and women, regardless of age. The risk of injury also increased with the frequency of consuming five or more drinks a day more often than twice a year (Cherpitel et al., 1995). This suggests that the risk for injury may be increased at relatively low levels of consumption, in which case preventive efforts aimed at more moderate drinkers, who are greater in number, may have a larger impact on the reduction of alcohol-related accidents than efforts focused on heavier drinkers, who are fewer in number.
Chronic alcohol abuse has long-term physiologic and neurological effects that may increase the risk of accidents. Chronic drinking also impairs liver function, which plays an important part in injury recovery. A damaged liver compromises the immune system, predisposing the alcoholic to bacterial infections following injury. The risk of accidental death has been estimated to be from three to sixteen times greater for alcoholics than for nonal-coholics, with the highest risk being death from fires and burns. Haberman and Baden (1978) found that among all fatalities from fires, 34 percent were alcoholics.
(SEE ALSO: Alcohol; Driving, Alcohol, and Drugs; Driving under the Influence; Industry and Workplace, Drug Use in; Social Costs of Alcohol and Drug Abuse)
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ACCIDENTS AND INJURIES FROM DRUGS Throughout history, humans have taken substances other than food into their bodies in ways that usually were socially accepted. The most common form has been as medicine, in attempts to change some feeling of ill-being or disease, such as PAIN, fatigue, or tension. Some cultures distinguish between socially approved and disapproved uses of substances by labeling those approved as ''medicine'' and those disapproved as
"drugs." Although the word medicine derives from a Latin word meaning ''of a physician,'' throughout much of recorded history and even today, "folk" medicine and ''home remedies'' are widely practiced. Early medicines were taken exclusively from nature, and PLANTS are still an important source of medicinal products (e.g., foxglove for heart problems, bread mold for penicillin).
Organic HALLUCINOGENIC substances (plants with perception-altering properties, such as peyote and mescaline, and fungi, such as psilocybin mushrooms) have been used in various cultures in the context of religious rituals, with the dramatic visual and aural hallucinations induced being interpreted in spiritual terms. Intoxicating beverages (with alcohol and/or other drugs) also have a long history of use, usually recreationally (i.e., for their relaxing and disinhibiting effects in social situations), but sometimes also for supposed medicinal purposes, as in elixirs and tonics that were marketed as patent medicines in the United States in the late 1800s and early 1900s.
With the development of modern chemistry and scientific growing methods, there has been an increase in the number, types, and strength of both organically derived (principally MARIJUANA) and chemically synthesized (laboratory-created) substances, which has prompted the implementation of measures to regulate their processing or manufacture, distribution, and dispensing (by pharmacists and physicians). In the United States, this regulatory scheme is called the Federal CONTROLLED SUBSTANCES Act (Public Law 91-513, H.R. 18583, October 27, 1970). This act, which is regularly updated, classifies substances into five categories according to the potential for abuse, accepted medical effectiveness and use, and potential for creating physiological or psychological dependence. The Controlled Substances Act is the basis for federal and state drug laws that specify the conditions making specific substances illicit (illegal) drugs and define differential criminal penalties for their manufacture, distribution, sale, and possession. Substance abuse, for the purposes of this discussion, is defined as the use of illicit drugs, the misuse of medicines (particularly those which must be prescribed by physicians but also those which are available Over THE COUNTER). Accidents and injuries from the excessive or prohibited (e.g., underage) use of other legal drugs, such as alcoholic beverages, are not included here.
An ambulance crew unloads a patient at the emergency room entrance at Beth Israel Hospital, New York City. In 1995, there were 531,800 drug-related visits to U.S. hospital emergency rooms; more than half were due to drug overdoses. (© Ed Eckstein/CORBIS)
There have been increases since the mid-1960s in both substance abuse and public awareness of it. Here the emphasis will be on an aspect of substance abuse—the unintended, negative consequences— that is relatively well known to researchers but less familiar to the general public and their representatives in government.
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