“ Alcohol and Substance Use in the Emergency Department: A Mexico–US Collaboration ” .

1. “Alcohol and Substance Use in the Emergency Department: A Mexico–US Collaboration”. Dr. Guilherme L.G. Borges 1 & Dr. Cheryl Cherpitel 2 1 Instituto Nacional de Psiquiatria & Universidad Autonoma Metropolitana-Xochimilco (Mexico City) 2Alcohol Research Group (Berkeley, CA) International Pre-conference of the National Hispanic Science Network on Drug Abuse next October 11th

2. Goals • This presentation describes the process, nuances and results of a long lasting collaborative effort between two researches: Dr. Cheryl Cherpitel from the US (Alcohol Research Group), and Dr. Guilherme Borges from Mexico (Instituto Nacional de Psiquiatría).

3. History • Our collaboration started around 1990 with advice from Dr. Cherpitel on Emergency Department (ED) studies in Mexico and manuscript collaboration (2 years). • After a period of informal meetings and collaboration, we move to an NIAAA grant supplement (together with CONACyT grant support- 1996), followed by an NIAAA R21 award (1997-2000).

4. History • Another CONACyT, WHO and NIAAA center grant and a Consultant agreement followed this collaboration. (year 2000, present). • Dr. Borges has visited ARG 3 times and Dr. Cherpitel visited the INP 2 times, and we both made one site visit (El Paso-Juarez) since 1996.

5. Some results • At the present, we have published together about 22 papers in peer review journals. Dr. Borges was the first author in 8 of these papers, Dr. Cherpitel in 10 and another 4 papers were first authored by another collaborator. Papers were published in English (most) and Spanish.

6. Some results • We have together about 26 presentations in several national and international meetings. • Currently we are collaborating in two NIAAA multicenter studies. The first one includes over 20,000 injured and non-injured ED patients from Argentina, Australia, Canada, Italy, Mexico, Poland, Spain, U.S. The second one includes about 5,000 injured patients from Argentina, Belarus, Brazil, Canada, China, Czech Republic, India, Mexico, Mozambique, South Africa, Sweden, New Zealand.

7. Research goals and some results • In addition to the general goal of international collaboration and personal training in Mexico, our studies have had two main foci: epidemiological estimation of the association between alcohol, substance use and injuries and the development of screening measures for the ED and minorities groups.

8. SOME RESULTS

9. Sex Female 8 331 3.05 (1.73 - 5.37) Male 90 630 4.52 (3.66 - 5.58) Age 18-29 44 482 6.04 (4.51 - 8.10) >=30 54 533 3.48 (2.66 - 4.55) Race-Ethnicity/Acculturation Santa Clara (all race/ethnicity) 24 272 1.7 (1.13 - 2.54) Pachuca 74 686 7.37 (5.81 - 9.36) White (Santa Clara) 12 109 2.47 (1.37 - 4.44) Blacks (Santa Clara) 5 70 2.76 (1.14 - 6.68) Hispanics (Santa Clara and Mexico) 81 779 5.02 (4.04 - 6.23) RELATIVE RISK OF INJURY DUE TO ALCOHOL CONSUMPTION ONE HOUR PRIOR TO THE INJURY BY PATIENTS CHARACTERISTICS (common RR=4.33 CI= 3.55-5.27) Exp Sub RR CI

11. The Rapid Alcohol Problems Screen (RAPS4) 1.During the last year, have you had a feeling of guilt or remorse after drinking? (Remorse) 2. During the last year has a friend or a family member ever told you about things you said or did while you were drinking that you could not remember? (Amnesia) 3.During the last year have you failed to do what was normally expected from you because of drinking? (Perform) 4. Do you sometimes take a drink when you first get up in the morning? (Starter)

12. RAPS4: Sensitivity and Specificity for Alcohol Dependence (ICD-10 & DSM IV) in Santa Clara Total Males Females Black Hispanic White/Other Sensitivity Specificity

13. Sensitivity and Specificity of Screening Instruments for Alcohol Dependence by Gender in Pachuca, Mexico

14. The Rapid Alcohol Problems Screen- Quantity Frequency (RAPS4-QF) • During the last year, have you had a feeling of guilt or remorse after drinking? (Remorse) • During the last year has a friend or a family member ever told you about things you said or did while you were drinking that you could not remember? (Amnesia) • During the last year have you failed to do what was normally expected from you because of drinking? (Perform) • Do you sometimes take a drink when you first get up in the morning? (Starter) • During the last year do you drink as often as once a month? (Frequency) and 6. During the last year have you had 5 or more drinks on at least one occasion? (Quantity)

15. Sensitivity & Specificity of the AUDIT, RAPS4, and RAPS4-QF for Alcohol Abuse by Ethnicity African American Hispanics

16. Sensitivity and Specificity of the RDPS for Drug Dependence and for Drug Dependence or Drug Abuse in the ER in Mexico City

17. Future Collaborations between ARG and INP • Under Alcohol Research Group’s National Alcohol Research Center grant, we will collect data on alcohol and alcohol in combination with other substance use at border ERs in El Paso and Cd. Juarez. • Data includes breathalyzing patients and saliva testing for drugs across six categories. • Can analyze the added risk for injury of alcohol use in combination with other drugs, compared to alcohol use alone. • Data can be compared to general population data from respective regions in each country. • We plan to write an RO1 grant to build on Center work for funding data collection at two interior ER sites in Mexico City and Santa Clara, CA.