29/4/2014 ALCOHOL AND DRUG USE AS PREDICTORS OF INTENTIONAL INJURIES IN TWO EMERGENCY DEPARTMENTS IN BRITISH COLUMBIA

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579212/ 1/9
ALCOHOL AND DRUG USE AS PREDICTORS OF INTENTIONAL INJURIES IN TWO EMERGENCY
DEPARTMENTS IN BRITISH COLUMBIA
Cheryl J. Cherpitel, Dr. PH, Gina Martin, MSc, [...], and Rob Stenstrom, MD, PhD
Abstract
The r isk of int ent ional injur y due t o alcohol and ot her dr ug use pr ior t o injur y is analy zed in a sample
of emer gency depar t ment pat ient s in Vancouv er , BC (n=43 6). Those r epor t ing only alcohol use wer e
close t o 4 t imes mor e likely (OR = 3 . 7 3 ) t o r epor t an int ent ional injur y , and t hose r epor t ing alcohol
combined wit h ot her dr ug(s) almost 1 8 t imes mor e likely (OR = 1 7 . 7 5 ) t han t hose r epor t ing no
subst ance use. Those r epor t ing bot h alcohol and dr ug use r epor t ed dr inking significant ly mor e alcohol
(1 5 . 7 dr inks) t han t hose r epor t ing alcohol use alone (5 dr inks). While t hese dat a suggest t hat alcohol in
combinat ion wit h ot her dr ugs may be mor e st r ongly associat ed wit h int ent ional injur y t han alcohol
alone, t his may be due t o t he incr eased amount of alcohol consumed by t hose using bot h subst ances,
and is an ar ea r equir ing mor e r esear ch wit h lar ger samples of int ent ional injur y pat ient s.
INTRODUCTION
While a subst ant ial lit er at ur e exist s demonst r at ing a st r ong associat ion of alcohol and v iolence-r elat ed
(int ent ional, not including self-inflict ed) injur y , much of which has come fr om st udies of emer gency
depar t ment (ED) pat ient s (1 , 2 l), less is known about t he associat ion of int ent ional injur y wit h
r ecr eat ional dr ug use, eit her alone, or in combinat ion wit h alcohol. Pr ev ious st udies hav e suggest ed
t hat many of t hose who hav e used alcohol hav e also used ot her dr ugs pr ior t o t he ED admission, and
t hat use of eit her alcohol or ot her dr ugs is associat ed wit h a 40% higher r at e of use of t he ot her
subst ance (3 , 4), wit h r at es for dr ug use in combinat ion wit h alcohol higher t han for dr ug use alone,
acr oss all classes of dr ugs (5 ).
Most ED st udies examining t he associat ion of dr ug use wit h injur y hav e measur ed t he pr ev alence of
posit iv e t oxicology scr eens (which may r emain posit iv e for day s t o weeks aft er t he last use, depending
on t he specific dr ug and pat t er n of use) in injur ed pat ient s at t he t ime of t he ED v isit (r ev iewed in el-
Guebaly (6)). In t hese st udies, cocaine and cannabis had t he highest pr ev alence r at es (5 , 7 9). The
major it y of t hese st udies, howev er , unlike st udies of alcohol and injur y , hav e not used r epr esent at iv e
samples of ED pat ient s, nor hav e t hey det er mined t he t iming of dr ug use r elat iv e t o injur y . These
limit at ions pr eclude est imat ion of t he pr ev alence of dr ug inv olv ement in t he injur y ev ent , or of t he
r isk of injur y associat ed wit h dr ug use.
Those few epidemiologic st udies examining t he acut e effect s of dr ug use and t he likelihood of int ent ional
injur y in t he ED hav e found t hat dr ug use may be mor e closely associat ed wit h int ent ional injur ies
t han wit h ot her t y pes of injur y (1 0), as has been found for alcohol (1 , 2 , 1 1 , 1 2 ). One st udy found t hat
pat ient s wit h int ent ional injur ies ar e mor e likely t han t hose wit h unint ent ional injur ies t o t est posit iv e
for dr ugs in combinat ion wit h alcohol, and for dr ugs alone, as well as for life-t ime and last -1 2 -mont h
dr ug dependence (3 6%) (1 3 ). An ED st udy in Mexico, howev er , found no r elat ionship bet ween dr ug use
six hour s pr ior t o t he ev ent and int ent ional injur ies (1 4), while a r ev iew of illicit dr ug use and injur ies
in ED st udies found dr ug use st r ongly associat ed wit h v iolence-r elat ed injur ies (1 5 ).
Differ ent classes of dr ugs hav e differ ent phar macological effect s, eit her alone, or in combinat ion wit h
alcohol. This may account for t he mixed findings r epor t ed. Howev er , t he small amount of av ailable
lit er at ur e suggest s t hat dr ugs may be impor t ant t o consider alongside alcohol in injur y occur r ence,
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especially for int ent ional injur ies. Cocaine, a cent r al ner v ous sy st em st imulant (1 6), has been
par t icular ly implicat ed in int ent ional injur ies (9, 1 7 1 9), and while disagr eement cont inues ov er t he
exact nat ur e of t he r elat ionship (2 0), t her e is gr owing consensus t hat acut e alcohol and cocaine effect s
ar e at least par t ially causally r elat ed t o v iolence (9, 2 1 ). A r ev iew of t he exper iment al lit er at ur e on
alcohol and cocaine concluded t hat simult aneous use of t he t wo subst ances may be sy ner gist ic in t er ms
of t he number and int ensit y of psy chomot or effect s, including agit at ion and feelings of par anoia (2 2 ,
2 3 ), and t hat t he enhanced and pr olonged euphor ia following simult aneous use of t he t wo subst ances
may incr ease t he cr av ing for bot h, r esult ing in incr eased likelihood of sev er e out comes including
int ent ional injur ies (2 4).
St udies of t he r elat ionship bet ween int ent ional injur ies and cannabis hav e also y ielded mixed r esult s
(9), and lit t le r esear ch exist s on ot her t y pes of dr ugs.
Recr eat ional dr ug use is becoming mor e pr ev alent in t he U. S. , in Canada and elsewher e, and is
especially common in heav y dr inker s (2 5 , 2 6). The 2 008 Nat ional Sur v ey on Dr ug Use and Healt h
(2 7 ) found t hat 2 9% of heav y dr inker s r epor t ed illicit dr ug use in t he last mont h (compar ed t o only 3 %
among t hose not r epor t ing alcohol use). Dat a fr om t he Nat ional Epidemiology Sur v ey on Alcohol and
Relat ed Condit ions (NESARC) found past y ear fr equency of r epor t ing 5 or mor e dr inks on an occasion
was an accur at e scr eener for past y ear cannabis or cocaine use (2 8), and a dr ug use disor der (pr imar ily
cannabis and cocaine) was mor e pr ev alent among t hose wit h a past y ear alcohol use disor der t han
among t hose wit hout (2 9). Rat es for bot h cannabis and cocaine use ar e higher in Canada t han in t he
U. S. , and in Canada ar e highest in Br it ish Columbia (BC) (3 0). Despit e t he mar ked incr ease in dr ug use
in gener al, lit t le r esear ch has examined whet her an associat ion exist s bet ween dr ug use alone, or in
combinat ion wit h alcohol, and int ent ional injur y .
To addr ess t his issue, we compar ed t he odds of subst ance use (alcohol use alone, dr ug use alone, or
alcohol combined wit h dr ug use) in int ent ionally injur ed pat ient s (not including t hose wit h self-
inflict ed injur y ) v er sus unint ent ionally injur ed pat ient s who sought t r eat ment in t wo EDs in
Vancouv er , Br it ish Columbia (BC). The t wo hospit als wer e chosen because bot h r eceiv e pat ient s fr om
t he downt own Vancouv er cat chment ar ea which includes t he ent er t ainment dist r ict s as well as dr ug
using v enues. In t his st udy , we define dr ug use as illicit dr ug use or non-pr escr ipt ion use of
psy chot r opic medicat ions such as pr escr ipt ion opioids.
METHODS
Samples
Dat a wer e collect ed ov er an 1 8-week per iod (Apr il t o August 2 009) on pr obabilit y samples of injur ed
pat ient s 1 8 y ear s and older at t he t wo Vancouv er EDs. Samples wer e dr awn fr om comput er ized
admission logs t hat r eflect ed consecut iv e ar r iv al t o t he ED, and pr ov ided equal pr opor t ional
r epr esent at ion of each shift for each day of t he week. The sampling scheme y ielded a t ot al sample of
443 int er v iewed pat ient s, which r eflect ed a 69% r esponse r at e (2 7 % r efused t o par t icipat e in t he st udy
and 4% wer e unable t o pr ov ide infor m consent due t o medical r easons). The non-int er v iewed wer e no
differ ent on gender t han t hose int er v iewed, but wer e older (ov er 65 ). Pat ient s wer e appr oached wit h
wr it t en infor med consent t o par t icipat e in t he st udy and wer e int er v iewed as soon as possible aft er
r egist r at ion. Int er v iews wer e conduct ed in a pr iv at e ar ea t o ensur e confident ialit y of r esponses. When
possible, int er v iews wer e car r ied out pr ior t o t he pat ient s examinat ion; ot her wise t he int er v iew was
complet ed aft er t he examinat ion. Pat ient s who wer e t oo sev er ely injur ed t o be int er v iewed while in t he
ED wer e int er v iewed in t he hospit al aft er t heir condit ion had st abilized.
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Instruments
A cadr e of int er v iewer s wer e t r ained by t he aut hor s and super v ised by sur v ey r esear ch st aff fr om t he
Cent r e for Addict ions Resear ch, BC t o administ er a 2 5 -minut e quest ionnair e, adapt ed fr om t he WHO
Collabor at iv e St udy on Alcohol and Injur y (3 1 ), wit h addit ional quest ions on dr ug use. The
quest ionnair e obt ained dat a, among ot her it ems, on t he t y pe and cause of injur y t hat br ought t he
pat ient t o t he ED, and whet her v iolence was inv olv ed (an int ent ional injur y ), t aken fr om t he following
quest ion: Why wer e y ou injur ed? Did y ou get int o a fight , wer e y ou beat en, at t acked or r aped? Dat a
wer e also obt ained on dr inking and dr ug use wit hin six hour s pr ior t o t he injur y , t he number of dr inks
consumed in t he six hour s, and demogr aphic char act er ist ics. Par t icipant s also pr ov ided a br eat he
sample which was analy zed for alcohol using t he Alco-Sensor IV br eat hanaly zer (Int oximet er s, Inc,
St . Louis, MO).
Dr ug dat a wer e obt ained fr om a ser ies of quest ions on use in any of t he following cat egor ies of dr ugs in
t he six hour s pr ior t o injur y : 1 ) met hamphet amines, 2 ) ot her amphet amines, 3 ) cocaine, 4) sedat iv es
including bar bit ur at es, 5 ) met hadone, 6) her oin, 7 ) ot her opiat es including codeine, 8) psy chedelics,
9) cannabis, 1 0) ot her dr ugs not including medicinal use of pr escr ipt ion or ov er t he count er
medicat ions.
Pat ient s who r epor t ed dr inking or using dr ugs pr ior t o t he injur y ev ent wer e also asked whet her t hey
believ ed t he injur y would hav e happened if t hey had not been dr inking or using dr ugs, r espect iv ely
(causal at t r ibut ion of injur y t o alcohol or dr ug use).
Data Analysis
Dat a wer e analy zed compar ing populat ion pr opor t ions for per cent s, and t -t est s for means, on
demogr aphic and subst ance char act er ist ics bet ween t hose wit h int ent ional and t hose wit h
unint ent ional injur ies (Table 1 ). Logist ic r egr ession analy sis was used t o examine t he pr edict iv e v alue
of subst ance use (alcohol only , dr ugs only , bot h alcohol and dr ugs) in t he six hour s pr ior t o injur y on
t he likelihood of r epor t ing t o t he ED wit h an int ent ional v er sus an unint ent ional injur y , cont r olling for
age and gender (Table 2 ). Odds r at ios (ORs) ar e r epor t ed for v ar iables simult aneously ent er ed in t he
model, and 95 % confidence int er v als (CIs) for t hose found t o be significant pr edict or s. For t hose
r epor t ing alcohol use in t he six hour s pr ior t o injur y , t he mean number of dr inks consumed was
compar ed bet ween t hose r epor t ing only alcohol use and t hose r epor t ing bot h alcohol and dr ug use.
Number of dr inks was calculat ed by div iding t he t ot al amount of absolut e alcohol consumed by t he
pat ient by 1 6ml (t he amount of absolut e alcohol in a nor mal beer ) (Table 3 ). For t hose r epor t ing dr ug
use in t he pr ev ious six hour s, t he mean number of dr ug cat egor ies r epor t ed was compar ed bet ween
t hose r epor t ing only dr ug use and t hose r epor t ing dr ug use combined wit h alcohol (Table 3 ).
Independent t -t est s wer e used t o examine significance differ ences in t he mean number of dr inks
r epor t ed and t he mean number of dr ug cat egor ies r epor t ed bet ween t hose using eit her subst ance alone
compar ed t o combined use of subst ances.
Tabl e 1
Char acter i sti cs of pati ents wi th i ntenti onal (i .e. v i ol ent) and uni ntenti onal i njur i es (per cent or
mean)
Tabl e 2
Odds r ati os (ORs) and 95% conf i dence i nter v al s (CIs) f or sel f -r epor ted use of al cohol and/or other dr ugs
i n the 6 hour s pr i or to the ev ent on i ntenti onal (coded 1) v er sus uni ntenti onal (coded 0) i njur i es
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Tabl e 3
Mean number of dr i nks and mean number of dr ug categor i es r epor ted i n the 6 hour s pr i or to i njur y
RESULTS
Table1 shows demogr aphic and subst ance use char act er ist ics for t hose wit h int ent ional injur ies (n=3 6)
compar ed t o t hose wit h unint ent ional injur ies (n=400). Compar ed t o pat ient s wit h unint ent ional
injur y , t hose r epor t ing int ent ional injur ies wer e significant ly mor e likely t o be male, t o r epor t alcohol
use alone (3 0. 6% v s 1 7 . 8%), and t o r epor t combined alcohol and ot her dr ug use (2 7 . 8 % v s. 3 . 3 %), but
no differ ence was found for dr ug use alone.
Table 2 shows ORs and 95 % CIs for subst ance use pr ior t o injur y for pat ient s wit h an int ent ional v s.
t hose wit h an unint ent ional injur y , cont r olling for age and gender . Bot h alcohol use alone, and alcohol
used wit h ot her dr ugs wer e significant ly pr edict iv e of an int ent ional injur y . Injur ed pat ient s r epor t ing
alcohol use alone wer e close t o 4 t imes mor e likely t o hav e a v iolence-r elat ed injur y t han t hose
r epor t ing no subst ance use, and t hose r epor t ing alcohol combined wit h ot her dr ug(s) wer e almost 1 8
t imes mor e likely t o be admit t ed for a v iolence-r elat ed injur y . When compar ed t o t he alcohol only
gr oup (not shown), t hose r epor t ing bot h alcohol and dr ug use wer e close t o 5 t imes mor e likely
(OR=4. 7 6; CI= 3 . 7 3 1 7 . 7 5 ) t o be admit t ed wit h an int ent ional injur y (Wald st at ist ic=8. 6, p=0. 003 ).
Dr ug use alone was not found t o be pr edict iv e of int ent ionalit y .
It is possible t hat t he lar ger associat ion seen in Table 2 bet ween int ent ional injur y and alcohol in
combinat ion wit h ot her dr ugs compar ed t o alcohol alone (or t o dr ug use alone), may be because
pat ient s who used bot h subst ances consumed mor e alcohol (or mor e dr ugs) t han t hose r epor t ing only
alcohol use (or only dr ug use). The mean number of dr inks r epor t ed for t he alcohol only gr oup
compar ed t o t he alcohol in combinat ion gr oup, and t he mean number of dr ug cat egor ies r epor t ed for
t he dr ug only gr oup compar ed t o t he combinat ion gr oup can be seen in Table 3 . Ov er all, t hose
r epor t ing bot h alcohol and dr ug use pr ior t o injur y r epor t ed a significant ly lar ger number of dr inks
dur ing t he six-hour per iod (mean of 1 5 . 7 ) compar ed t o t hose r epor t ing alcohol use alone (mean of 5 . 0).
The differ ence was significant (at p=. 06) for unint ent ional injur ies, but not for int ent ional injur ies
(alt hough in t he same dir ect ion), likely due t o t he small number of t hose wit h int ent ional injur ies. The
opposit e t r end was found for dr ug use, howev er , wit h t hose r epor t ing dr ug use alone r epor t ing use in
mor e dr ug cat egor ies t han t hose r epor t ing dr ug use in combinat ion wit h alcohol, alt hough t his
differ ence was not significant . Est imat ed blood alcohol cont ent (BAC) was also compar ed bet ween t hose
r epor t ing alcohol alone and t hose r epor t ing alcohol in combinat ion wit h ot her dr ug use, wit h similar
r esult s t o t hat found for self-r epor t ed consumpt ion (not shown). Ov er all, mean BAC was lower for t hose
r epor t ing only alcohol use (. 04 mg%) compar ed t o t hose r epor t ing alcohol in combinat ion wit h ot her
dr ugs (. 1 0 mg%; p=. 03 ), but t he differ ence was not significant by int ent ionalit y , most ly like due t o
small number s (. 03 9 mg% v s. . 07 7 mg%, r espect iv ely , for unint ent ional injur ies and . 05 9 mg% v s.
. 1 2 mg%, r espect iv ely , for int ent ional injur ies).
Pat ient s wer e also asked if t hey believ ed t he ev ent would st ill hav e happened had t hey not been
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dr inking or using dr ugs (causal at t r ibut ion). Among t hose wit h int ent ional injur y , a lar ger pr opor t ion
(alt hough not significant ; most likely due t o small number s at t r ibut ed a causal associat ion bet ween
t heir dr inking and t he injur y t han bet ween t heir dr ug use and injur y (2 4% v s. 8%), while lit t le
differ ence was found in casual at t r ibut ion of injur y t o alcohol compar ed t o dr ugs among t hose wit h
unint ent ional injur y (2 9% v s. 2 2 %, r espect iv ely ) (not shown).
DISCUSSION
While a subst ant ial lit er at ur e document s a st r ong associat ion of alcohol and int ent ional injur y (1 , 1 1 ),
lit t le dat a hav e been r epor t ed on t he associat ion of int ent ional injur y wit h ot her dr ug use, or wit h
alcohol in combinat ion wit h ot her dr ugs, alt hough bot h subst ances hav e been found t o be used t oget her
fr equent ly (3 , 4). To fill t his gap, t he r isk of int ent ional injur y due t o alcohol alone was compar ed t o
t hat due t o alcohol in combinat ion wit h ot her dr ug use, in a sample of ED pat ient s. While alcohol use
pr ior t o injur y was pr edict iv e of int ent ional injur y , alcohol combined wit h dr ug use was significant ly
mor e pr edict iv e of int ent ional injur y , and may be mor e at t r ibut able t o heav ier alcohol use in t he
gr oup using bot h subst ances, t han t o a sy ner gist ic effect bet ween alcohol and dr ug use. A st udy of
alcohol and v iolence-r elat ed injur ies in ED pat ient s in Mexico, Br azil and Ar gent ina found a st r onger
dose-r esponse r elat ionship (higher lev els of self-r epor t ed dr inking pr ior t o injur y associat ed wit h
gr eat er r elat iv e r isk) for v iolence-r elat ed injur ies compar e t o injur ies fr om ot her causes (3 2 ), and a six
count r y sur v ey of ED pat ient s also found a significant dose-r esponse r elat ionship bet ween BAC lev el and
int ent ional injur ies (1 1 ). These findings suggest t hat ot her mechanisms may be impor t ant for
int ent ional injur y , ov er and abov e t hose associat ed wit h impair ed psy cho-mot or coor dinat ion; for
example, alcohol r educes inhibit ions and may lead t o mor e aggr essiv e behav ior , r esult ing in incr eased
likelihood of a v iolence-r elat ed ev ent r esult ing in injur y . It is impor t ant t o not e, howev er , based on
dat a r epor t ed her e as well as t hose fr om ot her st udies, t hat it is not possible t o det er mine whet her a
pat ient s dr inking, per se, led t o t he v iolent -r elat ed injur y , or whet her ot her fact or s, such as cont ext of
dr inking and t he ev ent may hav e been r esponsible, and t his is an ar ea r equir ing fur t her r esear ch.
Addit ionally , t he magnit ude of alcohols cont r ibut ion t o int ent ional injur ies is likely an under est imat e
when based on compar ison wit h alcohol use in pat ient s sust aining unint ent ional injur ies, since t hese
lat t er pat ient s ar e mor e likely t o be alcohol inv olv ed t han bot h non-injur y cont r ol pat ient s and t hose
fr om t he gener al populat ion (3 3 ).
Dr ug use alone was not found t o pr edict int ent ional (or unint ent ional) injur y . Pat ient s also t ended t o be
mor e likely (alt hough not significant ) t o at t r ibut e a causal associat ion of int ent ional injur y t o t heir
dr inking t han t o t heir dr ug use pr ior t o t he ev ent . One possible explanat ion for lack of findings
r egar ding dr ug use is t hat not all dr ugs would be expect ed t o act in a similar manner t o one anot her , or
in combinat ion wit h alcohol, acr oss all t y pes and causes of injur y . For example, cocaine used wit h
alcohol for ms a new met abolit e, cocaet hy lene, t hat has differ ent phar macological pr oper t ies wit h
gr eat er and longer last ing behav ior al effect s t han t hose fr om eit her subst ance used alone (2 2 , 3 43 6),
pot ent iat ing an incr eased likelihood of injur y . On t he ot her hand, while cannabis use has been found t o
be pr edict iv e of injur y in an ED st udy of injur ed pr oblem dr inker s, it was not pr edict iv e of int ent ional
injur y , (2 5 ). In anot her st udy of t r eat ment client s, howev er , cocaine and alcohol, but not cannabis,
was pr edict iv e of a pr ev ious int ent ional injur y (2 1 ). While cannabis and cocaine ar e t he dr ugs most
commonly found among injur ed pat ient s in emer gency depar t ment st udies (1 5 ), some few ot her
st udies hav e implicat ed ot her dr ugs, for example benzodiazepines (3 7 ) and opium (Heber t et al. , 2 007 )
in mot or v ehicle cr ashes.
Giv en t he differ ing phar macological effect s acr oss classes of dr ugs, as well as t heir v ar y ing effect s when
combined wit h alcohol, one might expect an elev at ed r isk of injur y due t o specific dr ugs, and alcohol in
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combinat ion wit h cer t ain dr ugs (possibly a sy ner gist ic effect ) but not wit h ot her s, for specific t y pes of
injur y . Howev er , r elat iv ely small number s of pat ient s wit h int ent ional injur ies her e (n=3 6) pr ecluded
analy ses of alcohol in combinat ion wit h ot her dr ugs by specific dr ug cat egor ies. Small number s also
likely affect ed obser v ed significance in differ ences found in t he number of dr inks consumed bet ween
t hose using only alcohol compar ed t o t hose using alcohol in combinat ion wit h ot her dr ugs, and in
casual at t r ibut ion of int ent ional injur y t o alcohol compar ed t o ot her dr ugs.
Dr ug use, especially cannabis and cocaine, is becoming incr easingly mor e pr ev alent in Nor t h Amer ica
and elsewher e, and is par t icular ly common in heav y dr inker s (2 5 2 8). The debat e on whet her t he
combinat ion of alcohol and dr ugs may pr oduce a sy ner gist ic effect (incr easing t he likelihood of
v iolence) st ill r emains, due in par t t o challenges such as achiev ing sufficient st at ist ical power in
analy zing dr ug effect s, giv en t hey ar e used r elat iv ely infr equent ly in t he populat ion, and t he difficult y
of measur ing dr ug quant it y and impair ment . Nev er t heless, since injur ies, especially int ent ional
injur ies, hav e been found t o be st r ongly associat ed wit h alcohol in combinat ion wit h ot her dr ugs
(especially wit h cocaine and cannabis) (1 5 ), t his is an ar ea of impor t ant need in fut ur e r esear ch on
int ent ional injur ies, ut ilizing lar ger samples of subst ance using pat ient s.
Acknowledgments
Suppor t ed by a Canadian Inst it ut es for Healt h Resear ch, New Emer ging Team Gr ant (RAA 7 991 7 ) and
by a gr ant fr om t he U. S. Nat ional Inst it ut e on Alcohol Abuse and Alcoholism (RO1 2 AA01 3 7 5 0-04)
Footnotes
Presented at the Kettil Bruun Society for Social and Epidemiological Research on Alcohol, Melbourne, Australia, April 1115, 2011.
Contributor Information
Cher y l J. Cher pit el, Alcohol Resear ch Gr oup, Emer y v ille, CA 94608, Cent r e for Addict ions Resear ch of
BC, Univ er sit y of Vict or ia, Vict or ia, BC, Canada V8W 2 Y2 .
Gina Mar t in, Cent r e for Addict ions Resear ch of BC, Univ er sit y of Vict or ia, Vict or ia, BC, Canada V8W
2 Y2 .
Scot t Macdonald, Cent r e for Addict ions Resear ch of BC and School of Healt h Infor mat ion Science,
Univ er sit y of Vict or ia, Vict or ia, BC, Canada V8W 2 Y2 .
Jeffr ey R. Br ubacher , Depar t ment of Emer gency Medicine, Univ er sit y of Br it ish Columbia, Vancouv er ,
BC, Canada V6T 1 Z4.
Rob St enst r om, Depar t ment of Emer gency Medicine, Univ er sit y of Br it ish Columbia, Vancouv er , BC,
Canada V6T 1 Z4.
Article information
Am J Addict. Author manuscript; available in PMC Mar 1, 2014.
Published in final edited form as:
Am J Addict. Mar 2013; 22(2): 8792.
doi: 10.1111/j.1521-0391.2013.00316.x
PMCID: PMC3579212
NIHMSID: NIHMS322156
Cheryl J. Cherpitel, Dr. PH, Gina Martin, MSc, Scott Macdonald, PhD., Jeffrey R. Brubacher, MD, MSc, and Rob Stenstrom, MD, PhD
29/4/2014 ALCOHOL AND DRUG USE AS PREDICTORS OF INTENTIONAL INJURIES IN TWO EMERGENCY DEPARTMENTS IN BRITISH COLUMBIA
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579212/ 7/9
Cheryl J. Cherpitel, Alcohol Research Group, Emeryville, CA 94608, Centre for Addictions Research of BC, University of Victoria, Victoria, BC, Canada V8W 2Y2;
Contributor Information.
Corresponding Author: Cheryl J. Cherpitel, Dr. PH, Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, 510 597-3453, Fax: 510
985-6459, Email: ccherpitel/at/arg.org
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