Substance abuse policies in rehabilitation medicine departments

A 27-item substance questionnaire covering attitudes, beliefs, and policies was sent to the directors or other representatives of the 68 physical medicine and rehabilitation training programs in the United States. Anonymity of the respondents was guaranteed. Respondents representing 52 programs (76%) from 20 states participated. Almost all respondents were physicians; most were rehabilitation unit directors, directors of residency training, or department chairpersons. The average size of the rehabilitation units was 46 beds. Four important findings are emphasized. First, 73% of respondents were concerned about alcohol or drug (A/D) problems in their patients, but only 52% supported routine A/D screening for all patients. Importantly, only 25% routinely screened all patients. Second, 90% supported guidelines prohibiting A/D use in the rehabilitation unit, but only 65% had a prohibition policy and only 45% had written guidelines. More than 50% of the respondents stated that there were appropriate reasons for ordering alcohol for an inpatient. Third, 92% supported immediate intervention for inpatients found to have A/D problems, but only 55% routinely provided access to drug counselors. Fourth, 75% were in favor of drug abuse education for patients and staff, but only 29% provided education to patients and 22% to staff. The results suggest that the problems of A/D abuse in the physically disabled have yet to be adequately recognized and addressed by workers in rehabilitation medicine.