Search

Se estudió la prevalencia del consumo y el abuso en la ingestión de alcohol entre los casos de urgencias médicas, accidentes y violencias atendidaos en las salas de urgencias de tres hospitales del sector salud de la ciudad de Pachuca, Hidalgo. Material y métodos. Se aplicó un cuestionario y se hizo una medición de alcohol en sangre a las personas que solicitaron atención por primera vez en estos servicios de urgencias. El cuestionario recabó datos demográficos, patrones de consumo de alcohol, escalas para medir la dependencia y el consumo riesgoso de alcohol, tales como el CAGE y el Alcohol Use Disorders Identification Test (AUDIT). Se comparó, por medio de la prueba ji², el consumo de alcohol entre los pacientes que ingresaron por un accidente o acto de violencia y aquellos que ingresaron debido a una urgencia médica. Resultados. Se evaluaron 1 511 pacientes. El consumo fue mayor y más frecuente en los pacientes que ingresaron por un accidente o porque fueron víctimas de la violencia, en comparación con las urgencias médicas. De los pacientes con accidentes o víctimas de la violencia, 17.7% fueron positivos al alcosensor y 15.8% notificaron consumo de alcohol en las seis horas previas al accidente. El CAGE detectó como dependiente a 9.2% de los casos, y 10.9% calificaron como bebedores riesgosos según el AUDIT. Conclusiones. El consumo de bebidas alcohólicas, especialmente en los pacientes atendidos en los servicios de urgencias debido a un accidente o acto de violencia, es elevado. Son indispensables las medidas preventivas para disminuir el costo individual y social del abuso en el consumo de alcohol en esta población.

WORK IS CURRENTLY UNDER WAY by the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) Substance-Related Disorders Work Group to inform the Fifth Revision (DSM-V) of [...], Objective: Adding a craving criterion presently in the International Classification of Diseases, 10th Revision, diagnosis of alcohol dependence--has been under consideration as one possible improvement to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and was recently proposed for inclusion by the DSM Substance-Related Disorders Work Group in the Fifth Revision of diagnostic criteria for alcohol use disorders. To inform cross-cultural applicability of this modification, performance of a craving criterion was examined in emergency departments in four countries manifesting distinctly different culturally based drinking patterns (Mexico, Poland, Argentina, United States). Method: Exploratory factor analysis and item response theory were used to examine psychometric properties and individual item characteristics of the 11 DSM-IV abuse and dependence criteria with and without craving for each country separately. Differential item functioning analysis was performed to examine differences in the difficulty of endorsement (severity) and discrimination of craving across countries. Results: Exploratory factor analysis found craving fit well within a one-dimensional solution, and factor loadings were high across all countries. Results from item-response theory analyses indicated that both discrimination and difficulty estimates for the craving item were located in the middle of the corresponding discrimination and difficulty ranges for the other 11 items for each country but did not substantially increase the efficiency (or information) of the overall diagnostic scheme. Across the four countries, no differential item functioning was found for difficulty, but significant differential item functioning was found for discrimination (similar to other DSM-IV criteria). Conclusions: Findings suggest that, although craving performed similarly across emergency departments in the four countries, it does not add much in identification of individuals with alcohol use disorders.

MOST INDIVIDUALS, MEETING CRITERIA for heavy/problem 'at risk' drinking or those with alcohol-use disorders do not seek specialized treatment for their drinking problems (Reid et al., 1999). Brief interventions have [...], Objective: A randomized, controlled trial of screening, brief intervention, and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers was conducted in an emergency department (ED) in Sosnowiec, Poland, among patients ages 18 years and older. Method: Data were collected over a 23-week period, from 4:00 PM to midnight, and resulted in 446 patients being recruited into the study (90% of those who screened positive) and randomized to three conditions following a two-stage process: screened only (n 147), assessed (n = 152), and received intervention (n = 147). Patients in the assessment (85%) and intervention (83%) conditions were blindly reassessed at 3 months via a telephone interview. Results: At 3-month follow-up, both groups showed significant decreases in the proportion who were positive for at-risk drinking, the primary outcome variable. Both groups also showed significant decreases in drinking days per week, drinks per drinking day, maximum drinks per occasion, and negative consequences of drinking. Using analysis of covariance to control for baseline measures and demographic characteristics, no difference in outcome measures was found between intervention and assessment conditions. Subgroup analysis found some significant interactions between intervention and secondary outcomes. Conclusions: Although the main findings were similar to those from other brief-intervention studies in Western cultures, findings here also suggest that intervention may have differential benefits for specific subgroups of patients in the ED, an area of research that may warrant additional study of brief intervention in the ED setting.

ALTHOUGH EMERGENCY DEPARTMENT (ED) studies have documented a strong association of alcohol with nonfatal injury (Cherpitel, 2007; Romelsjo, 1995), less is known about the attributable risk or fraction of injury [...], Objective: Although studies of patients seen in emergency department (ED) settings have documented a strong association of alcohol with injury, such patients are not necessarily representative of the larger population, and less is known of alcohol's association with risk of injury in patient samples outside the ED. Method: Drinking before injury was analyzed in the 2005 National Alcohol Survey among the 1,149 respondents (18.5%, weighted) who reported an injury during the past year; analysis was by injury treatment type (ED-treated, 29.2%; other-treated, 47.8%; and nontreated, 22.9%). Results: Based on case-crossover analysis, the relative risk of injury from drinking was 1.85 (p < .01) for those with an ED-treated injury, 1.42 (NS) for those with an other-treated injury, and 1.43 (NS) for those with a nontreated injury. Alcohol-attributable fractions based on these relative risk estimates were 2.96% for an ED-treated injury, 1.59% for an other-treated injury, and 1.89% for a nontreated injury. Comparative attributable fractions based on the person's causal attribution of injury to his or her drinking were 3.06%, 1.61%, and 1.47%, respectively. Although these attributable fractions based on case-crossover analysis and subjective evaluation of causal attribution were not greatly different, all estimates were considerably smaller than those found in studies of ED patients. Conclusions: The data suggest that alcohol plays a larger role in those injuries for which treatment is sought in EDs, and this may be related to the severity of the injury. Additional studies of alcohol and injury in general populations that take into account the intensity of exposure to alcohol before the event, as well as recall bias by eliciting data on the proximity of the event to the time of the respondent interview, are necessary for determining unbiased estimates of the attributable fraction of alcohol in injury morbidity.

CONSISTENT EVIDENCE HAS SHOWN THAT a pattern of heavy drinking, alcohol use before injury, and positive and high blood alcohol concentrations (BAC) (i.e., exceeding .08, or 8 mg of alcohol/100 [...], Objective: The objectives of the present study were twofold: (1) to determine whether gender differences exist in the roles of drinking in the event (i.e., self-reported drinking before the injury and estimated blood alcohol concentration [BAC] captured after injury) and drinking pattern (i.e., heavy episodic drinking) in explaining violent versus nonviolent injuries and (2) to assess whether these gender differences vary by country. Method: Emergency department data were analyzed from 30 hospitals in 15 countries, as part of the Emergency Room Collaborative Alcohol Analysis Project and the World Health Organization Collaborative Study of Alcohol and Injuries. Interaction effects between gender and alcohol were tested in the prediction of violent versus nonviolent injury for each country. Results: The bivariate analyses revealed significantly larger effects of drinking-in-the-event variables for men than for women in three countries (i.e., 6 hours before the injury in Argentina and having a positive BAC in Belarus and Spain). In the multivariate analyses, restricted to countries with sufficient sample sizes (i.e., Mexico, South Africa, and the United States), no significant gender differences were found between the drinking-in-the-event variables and violent injury. In the bivariate and multivariate analyses, a significant interaction effect between gender and heavy episodic drinking was found in the United States, indicating that heavy episodic drinking predicted violent injury for women but not for men. Conclusions: Although the results are preliminary, treatment and prevention programs may need to target both genders equally or perhaps even focus more on heavy-drinking women, particularly in the United States. (J. Stud. Alcohol Drugs 68: 824-833, 2007)

ALTHOUGH MANY STUDIES CARRIED OUT in the emergency department (ED) have relied on patient self-reports of alcohol consumption before the injury event to identify those injuries that may be considered [...], Objective: Self-reports of alcohol consumption among patients visiting an emergency department (ED) have been used extensively in the investigation of the relationship between drinking and injury. Little is known, however, about the associations between validity of self-reports with patient and injury characteristics and whether these relationships vary across regions or countries. Both of these issues are explored in this article. Method: In the construct of a multilevel logistical model, validity of self-reports was estimated as the probability of a positive self-report given a positive blood alcohol concentration (BAC). The setting included 44 EDs across 28 studies in 16 countries. Participants included 10,741 injury patients from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study of Alcohol and Injuries. Data were analyzed on self reported drinking within 6 hours before injury compared with BAC results obtained from breath-analyzer readings in all but two studies, which used urine screens. Covariates included demographic, drinking, and injury characteristics and aggregate-level contextual variables. Results: At the individual level, a higher BAC measurement was associated with a higher probability of reporting drinking, as was heavy drinking and sustaining injuries in traffic accidents or violence-related events. At the study level, neither aggregate BAC nor other sociocultural variables affected the validity of self-reported drinking. Conclusions: This study provides further evidence of the validity of self-reported drinking measures in crossnational ED studies based on the objective criterion of BAC estimates.

EMERGENCY DEPARTMENT (ED) STUDIES in the United States have found that substantial proportions of both injured and noninjured patients report frequent use of the ED. One study found more than [...], Objective: Although injured patients in the emergency department (ED) report more frequent use of the ED compared with the general population, and alcohol-related admissions and chronic alcohol misuse have been found to be predictive of future ED admissions, these data are based on only a few U.S. studies. The purpose of this article was to explore the association of alcohol use and ED services use among injured patients cross-nationally. Method: Binary and multinomial logistic regression were used to analyze the association of alcohol consumption with prior ED visits among 9,743 injured patients surveyed in 37 EDs in 14 countries and reported in 23 studies from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and World Health Organization Collaborative Study of Alcohol and Injuries. Results: Drinking within 6 hours before injury was associated with prior ED visits during the last 12 months (odds ratio = 1.25, p < .05), with a positive dose-response relationship. Heavy drinkers and those drinkers who were alcohol-dependent were also significantly more likely to report multiple prior ED visits, reflecting an elevated burden of services use. At the ED level, stigmatization of alcohol use was the only significant contextual variable that consistently predicted cross-ED variation in the relationship between drinking and ED use, in which the association was weaker in areas where alcohol use is less accepted. Conclusions: This study lends additional support to the potential effectiveness of screening for acute and chronic alcohol use among ED injured patients to reduce ED services use and associated costs.

[TEXT NOT REPRODUCIBLE IN ASCII] Introduction Reports of alcohol use that used the case-crossover design have shown that alcohol use is a strong risk factor for all causes of non-fatal [...], Objectives To study the risk of non-fatal injury at low levels and moderate levels of alcohol consumption as well as the differences in risk across modes of injury and differences among alcoholics. Methods Data are from patients aged 18 years and older collected in 2001-02 by the WHO collaborative study on alcohol and injuries from 10 emergency departments around the world (n = 4320). We used a case-crossover method to compare the use of alcohol during the 6 hours prior to the injury with the use of alcohol during same day of the week in the previous week. Findings The risk of injury increased with consumption of a single drink (odds ratio (OR) = 3.3; 95% confidence interval = 1.9-5.7), and there was a 10-fold increase for participants who had consumed six or more drinks during the previous 6 hours. Participants who had sustained intentional injuries were at a higher risk than participants who had sustained unintentional injuries. Patients who had no symptoms of alcohol dependence had a higher OR. Conclusion Since low levels of drinking were associated with an increased risk of sustaining a non-fatal injury, and patients who are not dependent on alcohol may be at higher risk of becoming injured, comprehensive strategies for reducing harm should be implemented for all drinkers seen in emergency departments. Resume Etude multicentrique de la relation entre abus d'alcool et traumatismes non mortels : donnees fournies par une etude collective menee par l'OMS sur le theme alcools et traumatismes Objectits Etudier le risque de traumatisme non mortel associe a une consommation faible ou moderee d'alcool, ainsi que les variations de ce risque en fonction du type de traumatismes et de la consommation alcoolique. Methodes Les donnees concernent des individus de plus de 18 ans et ont ete recueillies sur la periode 2001-2002 dans le cadre d'une etude collective organisee par l'OMS sur la relation entre alcool et traumatismes dans 10 service d'urgence repartis dans le monde (n = 4320). Ces donnees ont ete soumises a une analyse de type case crossover pour comparer la consommation d'alcool pendant les 6 jours precedant le traumatisme a celle des memes jours de la semaine precedente. Resultats Le risque de traumatisme augmente des la premiere consommation (odds ratio = 3,3; intervalle de confiance 95 % = 1,9-5,7) et s'accroit d'un facteur 10 pour les sujets ayant pris six consommations et plus pendant les 6 jours precedents. Pour les sujets, le risque de traumatisme intentionnel est plus grand que celui de traumatisme involontaire. L'odds ratio (OR) est plus eleve pour les sujets ne presentant aucun symptome de dependance alcoolique. Conclusion Une association etant Constatee entre la consommation de faibles quantites d'alcool et l'augmentation du risque de traumatisme non mortel et les individus non dependants a l'egard de l'alcool pouvant etre exposes a un plus grand risque de traumatisme, des strategies completes de limitation des dommages doivent etre mises en place a l'intention de tous les buveurs accueillis dans les services d'urgence. Resumen Estudio multicentrico sobre consumo agudo de alcohol y traumatismos no mortales: datos de un estudio en colaboracion de la OMS sobre el alcohol y los traumatismos Objetivos Estudiar el riesgo de traumatismo no mortal a niveles moderados y bajos de consumo de alcohol, asi como el distinto riesgo asociado a cada tipo de traumatismo y las diferencias segun el grado de dependencia del alcohol. Metodos En 2001-2002, como parte del estudio en colaboracion de la OMS sobre el alcohol y los traumatismos, se reunieron datos sobre pacientes de 18 anos o mas atendidos en 10 departamentos de urgencias en todo el mundo (n = 4320). Utilizamos un metodo de casos cruzados para comparar el consumo de alcohol durante las 6 horas anteriores al traumatismo y el consumo de alcohol durante el mismo dia de la semana anterior. Resultados El riesgo de traumatismo aumentaba tras consumir una sola bebida (razon de posibilidades (OR) = 3,3; intervalo de confianza del 95% = 1,9-5,7), y se multiplicaba pot 10 entre quienes habian tomado seis o mas bebidas durante las 6 horas precedentes. Los participantes que habian sufrido traumatismos intencionales presentaban un riesgo mayor que el de los participantes que habian sufrido traumatismos no intencionales. Los pacientes sin sintomas de dependencia del alcohol presentaban una OR mas elevada. Conclusion Considerando que los niveles bajos de consumo de alcohol se asociaban ya a un mayor riesgo de traumatismo no mortal, y que los pacientes sin dependencia del alcohol presentan quiza un mayor riesgo de sufrir traumatismos, convendria aplicar estrategias integrales de reduccion de danos con todas las personas que sean atendidas en departamentos de urgencias y hayan bebido.

A NUMBER OF BRIEF SCREENING INSTRUMENTS have been developed for identifying alcohol-use disorders in clinical settings (Bradley et al., 1998). These instruments, however, have not been evaluated cross-nationally, with the [...], Objective: There are little data available on the performance of brief screening instruments for alcohol-use disorders cross-nationally; therefore, we analyzed the performance of one such instrument in a number of countries. Method: Performance of the RAPS4 for tolerance and the RAPS4-QF for heavy drinking are analyzed from emergency room data across 13 countries included in the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study on Alcohol and Injuries. Results: The RAPS4 showed good sensitivity and specificity for tolerance across most of the countries, but was higher in countries that were higher on societal-level detrimental drinking patterns. Prevalence of tolerance was also higher in those countries with high detrimental drinking pattern scores. Sensitivity of the RAPS4-QF for heavy drinking was uniformly high across countries, while maintaining good specificity, and did not vary by detrimental drinking patterns. Conclusions: Findings suggest the RAPS4 and RAPS4-QF may hold promise cross-nationally. Future research should more fully address the performance of brief screening instruments for alcohol-use disorders (using standard diagnostic criteria) cross-nationally, with consideration of the impact of societal drinking patterns.

Objectives. We sought to determine gender- and age-specific attributable risks of all-cause and violence-related injuries associated with alcohol use. Methods. We used meta-analytic techniques to estimate attributable risks observed in emergency room studies conducted in 7 countries (n = 17 708). Results. In the case of both alcohol consumption before the injury event and individual drinking patterns, pooled attributable risk effect sizes for all-cause injuries were significant but minimal (2% to 6%). Effect sizes for violence-related in juries were 43% for drinking before an injury event and 27%, for individual drinking pattern. Risks were greater for men, but no age-specific differences were found. Conclusions. This meta-analysis showed that attributable risk of injury is greater for drinking before the injury event than for drinking pattern; in addition, risks were more pronounced for violence-related injuries. Differences in risk were explained by variables related to sociocultural contexts. (Am J Public Health. 2005;95: 266-272. doi: 10.2105/AJPH.2003.031179)

An analysis was conducted by comparing various measures of alcohol involvement in violent versus accidental injuries to determine whether alcohol is a likely cause of violence. The odd ratios of violent versus accidental injury for a blood alcohol concentration (BAC) over 80 mg% were significant for each country.

IT IS WELL ACCEPTED that both chronic and acute alcohol use are associated with suicidal behavior (Berghmd and Ojehagen, 1998; Brismar and Bergman, 1998). However, the mechanisms and magnitude of [...], Objective: Several studies have shown that acute alcohol use is associated with suicidal behavior, but the magnitude and nature of the relationship remain unclear. We report a study on the impact of acute alcohol use on suicide attempts treated in the emergency room (ER) using the case-crossover design. Method: Seven ER studies carried out in the United States, Canada, Mexico and Australia from 1984 to 1996 with probability samples and similar methodology were merged yielding a total of 102 suicide attempters (overall 52% were male and 59% under 30 years of age). Results: Thirty-six patients reported alcohol use within 6 hours prior to the suicide attempt. When usual alcohol consumption during the past 12 months served as the control value, the estimated relative risk (RR) for patients who reported alcohol use within 6 hours prior to the suicide attempt was 9.6 (95% confidence interval: 5.7-16.3). Although the prevalence of alcohol use differed by sex, there was no statistically significant difference in the estimated RRs (RR = 13.6 men and RR = 5.3 women, p = 0.11 for the heterogeneity test). Conclusions: A positive association was found between alcohol use 6 hours prior and suicide attempts in 102 ER cases in four countries. The case-crossover methodology is well suited to studies for which an external control group is not easily obtainable.

A SUBSTANTIAL PROPORTION of alcohol-related morbidity and mortality is related to the short-term effects of heavy episodic alcohol use. In Australia it has been estimated that 68% of episodes of [...], Objective: This study describes and examines the development of surrogate measures of acute alcohol-related injury for use in the evaluation of community-based prevention initiatives. Method: An international collaborative study of alcohol and injury, the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), provided a subset of data on 8,580 emergency room (ER) presentations from five countries and 28 ER facilities. Results: Presentations most likely to be alcohol related were those made between 12:00 AM and 4:59 AM (56%), on Fridays, Saturdays or Sundays (26%); and those among injured persons who were male (28%), who were aged between 18 and 45 years (24%) or who were unmarried (24%). Multilevel logistic regression models confirmed the significance of the above variables as predictors of alcohol involvement prior to the injury event. The strongest predictor variable was presentation between 12 midnight and 4:59 AM with an odds ratio of 4.92 (Wald Test [chi square] = 397.6, p < .001). Being male had an odds ratio of 3.01 (Wald Test [chi square] = 247.25, p < .001), and presenting on a Friday, Saturday or Sunday night had an odds ratio of 1.50 (Wald Test [chi square] = 49.6, p < .001), whereas being under 45 (odds ratio [OR] = 1.20, p < .05) and being unmarried (OR = 1.2, p < .01) were less strong predictors. Combining all these values for variables raised the probability of prior alcohol involvement in such injury presentations to 0.65, although only 3.37% of all cases met these criteria, limiting applicability of this combined variable as a surrogate measure for intervention studies. Probabilities of prior alcohol involvement are presented with other combinations of values for the predictor variables. Conclusions: Frequency of nighttime injury presentations to ER facilities, particularly by men, can be used as a reliable surrogate measure of alcohol-related injuries for various epidemiological and evaluation purposes.

This paper reports a case-crossover analysis in a sample of 961 patients who consulted the emergency department (ED) due to an injury in Santa Clara, California, and in Pachuca, Mexico. In the analysis in which usual alcohol consumption during the last 12 months served as the control value, the estimated relative risk of injury in the hour after alcohol consumption, as compared with no alcohol consumption during that time, was 4.33 (CI, 3.55-5.27). After controlling for alcohol use in the l-h period before injury, the relative risks for consecutive l-h periods (2-6h) before the injury were not significantly greater than one, indicating that the induction time was less than 1 h. The relative risk varied greatly depending on race-ethnicity and acculturation among the Hispanics in Santa Clara, with Mexicans in Pachuca showing the highest risk and the high acculturation group in Santa Clara showing the lowest risk. Violence-related injuries were associated with higher relative risk. Relative risk also varied depending on the presence of alcohol dependence and usual frequency of drunkenness: patients with alcohol dependence and patients with high frequency of usual drunkenness had lower risks than patients without alcohol dependence and with lower self-reported episodes of drunkenness in the last year. When blood alcohol content at ED admission was used instead of self-reported alcohol consumption, similar results were obtained. These findings have important public health consequences. Each episode of alcohol consumption results in an increase in the short-term risk for an injury, especially for a violence-related injury. Patients with the lowest usual involvement with alcohol are subject to a higher elevation in their risk for an injury immediately after alcohol consumption compared to patients who drink more heavily. [c] 2003 Elsevier Ltd. All rights reserved. Keywords: Injury; Alcohol; Case-crossover; Epidemiology; Acculturation; Hispanics

TRAUMA IS a significant problem in many countries and a substantial literature exists, a great deal of which is from emergency room (ER) studies, implicating alcohol as a major risk [...], Objective: To examine the impact of usual drinking patterns and related problems on the acute use of alcohol in injury. Method: The impact of quantity and frequency of drinking, alcohol problems and dependence symptoms on admission to the emergency room (ER) for an alcohol-related injury (based, separately, on a positive blood alcohol concentration [BAC] and self-reported drinking within 6 hours prior to injury), compared with a nonalcohol related injury, was examined using meta-analysis, across 15 ER studies covering seven countries. Results: Pooled effect size for consuming five or more drinks on an occasion at least monthly was significant but not homogeneous, with odds ratios (ORs) of 4.16 for BAC and 3.92 for self-report. Frequency of drinking among nonheavy drinkers was found to have the largest effect size (5.93 for BAC and 4.93 for self-report). Heavy drinking, controlling for frequency, was also significant (ORs of 2.08 for BAC and 1.86 for self-report), but effect size was homogeneous only for self-report. Effect sizes for consequences of drinking and dependence symptoms were also significant and homogeneous, with ORs of 4.29 and 3.55, respectively, for BAC, and 3.84 and 3.94, respectively, for self-report. In meta-regression analysis, among contextual variables the level to which alcohol use is stigmatized in the culture was most consistently predictive of heavy-drinking effect size on an alcohol-related injury, with larger effect sizes found in those studies reporting a lower level of stigmatization. Conclusions: Whereas quantity and frequency of drinking were both found to be highly predictive of an alcohol-related injury, sociocultural variables may affect observed associations of heavy drinking with an alcohol-related injury.

INJURIES are major sources of morbidity and mortality (McCaig and Burt, 2001), and many are associated with alcohol use (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2000a). Case-control and [...], Objective: Alcohol is associated with intentional injury, but most studies have operationalized it as alcoholism and have not examined acute exposure. The study aimed to clarify the relative contributions of drinking over a few hours and of alcohol use disorders to the risk of intentional injury inflicted by another person. Method: The study used a case-control design with two control groups: (1) Community controls matched to cases, and (2) the cases themselves, comparing consumption on the day of injury with consumption on previous days, in a case-crossover comparison. Cases were patients with an acute injury presenting to any of the three emergency departments in one county; 102 had an intentional injury. Community controls (N = 1,856) were recruited by random-digit dialing. Recent alcohol consumption was recorded in self-reported standard drinks. Current alcohol use disorders were defined using DSM-IV criteria. Results: In the case-control analysis, drinking in a 6-hour window was associated with risk of intentional injury (odds ratio [OR] = 10, 95% confidence interval [CI]: 4.7-22). In case-crossover comparison of the cases' own drinking in the 6 hours prior to injury with their own drinking the day before, the OR was 34 (95% CI: 4.7-250). In case-control analyses, alcohol dependence was associated with intentional injury (OR = 6.0, 95% CI: 3.5-10), but alcohol abuse was not (OR = 0.7, 95% CI: 0.4-1.3). Conclusions: Drinking over a few hours is strongly associated with intentional injury. Current alcohol dependence is also, but with a lower OR. The findings may have implications for efforts to prevent intentional injury. (J Stud. Alcohol 64: 350-357, 2003)