Problems of drug and alcohol abuse are ubiquitous in hospitalized patient populations. A prevalence study at Johns Hopkins Hospital in 1986 demonstrated active alcoholism in 23% of surgical patients, with subgroup rates ranging from 14% in patients on the urology service, 28% in those on the orthopedic service, to 43% in those on the otorhinolaryngology service [1]. Although this study did not evaluate the prevalence of drug abuse, consideration of the abuse of drugs other than alcohol could only increase the overall rate of affected patients on surgical services. Detection rates by physician staff of patients with substance abuse problems are low in general and lowest on surgery and obstetrics-gynecology services. Data indicate that under 25% of affected patients are identified on these specialty services. In addition, less than half the substance-abusing patients who are identified receive any form of intervention, counseling, or even a medical treatment plan that addresses the substance abuse issues. Therefore, only about 10% of surgical patients with substance abuse problems have their abuse addressed in any way by their physicians or other members of the surgical team.

In a few special populations of surgical patients, problems of substance abuse are of even greater magnitude. Trauma service data indicate that between 30% and 75% of all injured patients have positive results on toxicology testing for legal levels of alcohol intoxication or for drugs of abuse at the time of hospital admission [2–6]. Our experience after a year of testing each consecutive level 1 trauma admission indicated an alcohol intoxication rate of 63%, an illicit drug use rate of 48%, and a combined rate of 78%. Follow-up interviews with these patients revealed that most (92%) had serious drug and alcohol abuse or dependence, with only 8% being substance users who happened to suffer a major trauma [7].