Substance abuse among first admissions to the psychiatric unit of a general hospital in Trinidad.

Admissions for first episode of psychiatric illness provide information on service utilization which can be used to improve service delivery. The present study reviews the use of in-patient general psychiatric services in southern Trinidad using data from first admissions in one year, specifically to determine service utilization by substance-abusing patients. Case files of all admissions to the psychiatric unit of the San Fernando General Hospital in one year were reviewed and analyzed for demographic data, substance abuse, diagnosis and associated features of the admission. Significant rates of substance abuse were found among first admissions. Of 123 new patients, 43.1% were diagnosed with a substance abuse disorder, 56.6% of whom had a comorbid psychiatric disorder. Patients with substance abuse problems tended to be young males. The substance most commonly abused was alcohol (26.8%) and alcohol abusers were more likely to be of East Indian descent. Management within this mental health catchment area needs to address identification, early intervention and prevention of substance abuse among psychiatric patients. It is proposed that both hospital and community-based substance abuse interventions should be employed in the management of acute psychiatric patients.