Approximately 4.4 million Americans require admission to an intensive care unit (ICU) every year for treatment of a life-threatening illness. Many who survive are at increased risk for major depression and posttraumatic stress disorder (PTSD). Although we know that mental health problems are associated with an increased risk for alcohol use disorders, and critical medical illness survivors are at increased risk for symptoms of depression and PTSD, little is known about whether these patients are at increased risk for alcohol use problems, and what factors would increase this risk in critical illness survivors.
The aims of the Substance Abuse and Psychiatric Disorders in Intensive Care Unit Survivors (SAPD- ICUS) study are to describe the amount of non-injured ICU survivors'alcohol use over the year post-ICU, as well as to examine whether patient-specific vulnerabilities, and certain ICU exposures, predict who may go on to develop alcohol use problems after an ICU stay. Study subjects will be ICU survivors from Harborview Medical Center, a large hospital in Seattle, WA. We will interview enrolled patients after they are transferred out of the ICU to learn about their alcohol and drug use in the month pre-ICU, lifetime histories of major depression and PTSD, and prior exposure to traumatic events. We will also obtain a saliva sample to test for the presence of two specific gene variations that may increase risk for alcohol use problems. In addition, we will review medical records to obtain information about medication and procedure exposures while in the ICU. We will interview patients again three and twelve months after they leave the hospital to learn if they are experiencing alcohol use problems, as well as depression and/or PTSD symptoms. Through our study, we hope to increase understanding of alcohol use disorders in critical medical illness survivors. We hypothesize that we will observe a reduction in drinking in the months immediately post- ICU, followed by a recurrence in drinking over the course of the year post-ICU. We also hope to identify what patient-specific vulnerabilities and critical illness/ICU-related exposures increase the risk of alcohol and other substance use problems. With this information, physicians can identify patients at risk for problem drinking early, perhaps even before they leave the hospital, so that these patients can receive brief interventions and referrals. Early identification of symptoms of alcohol and other drug use problems could lead to earlier treatment, and a better recovery and quality of life for patients surviving critical illnesses.
The Substance Abuse and Psychiatric Disorders in Intensive Care Unit Survivors (SAPD-ICUS) investigation will attempt to examine the burden of, as well as identify what patient-related and critical illness- related factors may increase the risk of, alcohol use problems in patients surviving critical medical illnesses. There is currently no systematic screening for problem drinking in non-injured critical medical illness survivors, and since millions of Americans require ICU admissions annually, the lack of screening represents a potential gap in quality of care and a major public health problem. The SAPD-ICUS study seeks to provide a basis for systematic screening for alcohol use problems in critical medical illness survivors as well as to identify new avenues for interventions that may prevent problem drinking after patients leave the hospital.
