A comparative study of Arab and Jewish patients admitted for psychiatric hospitalization in Jerusalem: the demographic, psychopathologic aspects, and the drug abuse comorbidity.

BACKGROUND: The influence of ethnicity on different aspects of psychiatric hospitalization is far from clear. THE AIM OF THE STUDY: The main aim of the study was to compare the Arab and the Jewish inpatients, at the time of admission, for the demographic factors, severity of psychotic, and affective psychopathology and comorbid drug abuse rate. POPULATION, METHOD, AND TOOLS: Among 250 consecutively admitted patients in the Jerusalem Mental Health Center-Kfar Shaul Hospital, 202 Jews and 42 Arabs (aged 18-65 years) were examined within 48 hours after admission. The psychiatric diagnoses were made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. For the differential measurement of psychopathologic severity, the following rating scales were used: 21-item Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale. Urine tests for Δ9-tetrahydrocannabinol (THC), cocaine, opiates, amphetamines, and methamphetamine were performed using the Sure Step TM kits (Applied Biotech, Inc, San Diego, CA, USA). The Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for drug abuse were applied based on self-report and results of urine analysis. RESULTS: The comparison of the 2 population showed that among the Arab inpatients, there were more males (81% vs 67.4%; P < .005). No significant difference in psychiatric diagnosis was observed. The overall severity of positive symptoms (PANSS positive) in Arab group was higher, but only slightly so (P = .05). No significant difference was observed for total rates of PANSS negative subscale. The rates of PANSS-general were also similar. The Arab patients were significantly less depressive according to 21-item Hamilton Depression Rating Scale (P = .032), and the total score of Hamilton Anxiety Rating Scale for the Jewish group was significantly higher (P = .001). No significant difference in general severity of manic symptoms for 2 groups was detected according to Young Mania Rating Scale. The rate of comorbid drug abuse for Jewish inpatients was borderline higher (P = .068). CONCLUSIONS: The issue of referral to psychiatric hospitalization could be culturally influenced; it may be the result of disparities in demographic, psychopathologic, and drug abuse comorbid presenting symptoms, which are demonstrated upon admission by patients of different ethnic origins.

Volatile substance misuse among youth in Israel: results of a national school survey.

Volatile substance misuse (VSM) among Israeli youth has been identified as widespread and growing. Using data from the 2009 National School Survey of 12-18 year olds (N = 7,166), this study describes VSM prevalence among Jews and Arabs, examining relationships between past-month VSM and sociodemographic, behavioral, psychological, and interpersonal characteristics. Past-month VSM, reported by 7.5% of respondents, was significantly associated with other risky behaviors including past-month illicit drug use (Adjusted odds ratios (AOR) = 5.41, 95% CI: 3.5-8.1), Internet gambling (AOR = 2.12, 95% CI: 1.5-3.1), smoking, binge drinking, and truancy. National drug policy must address VSM and develop strategies to reduce demand and supply. Potential study limitations are noted.

Alcohol consumption during pregnancy among women in Israel.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a range of disabilities caused by gestational exposure of the fetus to alcohol. Alcohol consumption in Israel has increased dramatically in the last decades. Our previous study revealed limited knowledge among Israeli medical professionals of the risks and potential long-term effects of FASD. OBJECTIVES: To evaluate the awareness and knowledge of women regarding the current recommendations on alcohol consumption during pregnancy, evaluate how many of the women received information regarding alcohol consumption during pregnancy from medical professionals, and their personal drinking habits during pregnancy. METHODS: A cross-sectional sample of new mothers in 3 large hospitals in Israel were asked to complete an ad hoc questionnaire on aspects of alcohol consumption during pregnancy. RESULTS: A total of 3815 women of mean age 30.4 years participated in the study; 82% were Jewish. Alcohol consumption during pregnancy was reported by 14.1%, including more than 17% of the Jewish women, 11.1% of the Christian women, and none of the Muslim women. Rates were higher among nonsecular and younger women and first-time mothers. 71.6% of the sample claimed that women should not drink alcohol at all during pregnancy, and 21.4% thought that it was permissible if limited to 2 drinks per week. Seventy-five percent had received no formal information from medical professionals regarding alcohol consumption during pregnancy. CONCLUSIONS: Alcohol consumption is frequent among pregnant women in Israel, especially young secular Jewish women with first pregnancies. Improved educational programs on the dangers of FASD are needed for both professionals and the general public.

The effect of alcohol, THC and their combination on perceived effects, willingness to drive and performance of driving and non-driving tasks.

BACKGROUND: Driving under the influence of drugs (DUID) is one of the main causes of car accidents. Alcohol and marijuana are the most popular drugs among recreational users. Many classify these drugs as "Light" drugs and therefore allow themselves to drive after consuming them. OBJECTIVE: The study had two main objectives: 1) to investigate the effect of alcohol (BAC=0.05%), THC (13 mg) and their combination on driving and non-driving tasks. 2) to investigate the extent to which people are willing to drive based on their subjective sensations and their perceived effects of the drugs. METHOD: 7 healthy men and 5 healthy women, ages 24-29, all recreational users of alcohol and marijuana, completed 5 experimental sessions. Sessions included: drinking and smoking placebo, drinking alcohol and smoking placebo, drinking placebo and smoking THC, drinking alcohol and smoking THC, drinking placebo and smoking placebo 24 hours after drinking alcohol and smoking THC. Three types of measures were used: subjective perceptions (with questionnaires), performance parameters of the driving and non-driving tasks (arithmetic task and a secondary target detection task) and physiological changes (heart rate). RESULTS: Overall, the combination of alcohol and THC had the most intense effect after intake. This effect was reflected in performance impairments observed in the driving and non-driving tasks, in the subjective sensations after intake, and in the physiological measures. Despite significant differences in the size of the effects after the various treatments, there were no differences in the distances subjects were willing to drive while under the influence on each of the treatments.

Druze adolescent dropouts in Israel and their use of psychoactive substances.

The current study examines rates of psychoactive substance use among Druze adolescent dropouts and links between use rates and socio-demographic, interpersonal, cognitive, and personality characteristics. 204 adolescents took part in the study in late 2004. Approximately 21% had consumed tobacco 10 times or more in the last year, 25% reported consuming alcohol in the same timeframe, and nearly 6% used an illegal substance at least once in the last year. Boys had significantly higher rates of alcohol and tobacco use than girls. Religiosity, attitudes and behavioral intentions regarding use were also linked with consumption of the three substances.

Neurodevelopmental and psychological assessment of adolescents born to drug-addicted parents: effects of SES and adoption.

OBJECTIVES: Prenatal exposure to heroin may have long-term consequences for development during early and middle childhood. The present research studied the cognitive, social, and emotional functioning of adolescents exposed to drugs prenatally, and investigated the extent to which the early adoption of children exposed prenatally to drugs would alleviate the possible effects of exposure. METHODS: The study included 191 adolescents (12-16 years of age) and their parents in Israel, who had or had not been exposed prenatally to drugs and differing in socio-economic status (SES), and in adoptive status. They were administered five subtests of the Wechsler Intelligence Scale for Children (WISC-III), and the Youth Self-Report Form for assessing behavior problems that measures problems associated with attention deficit, self-esteem and risk-taking. Parents were administered the Child Behavior Checklist (CBCL) for assessing behavior problems, the Conners Rating Scale (CRS) for assessing attention deficit problems in their children and the Wender Utah Rating Scale (WURS), a self-report measure of ADHD-related problems. RESULTS: Adolescents exposed to at least one risk factor (exposure to drugs, low SES, or adoption) performed more poorly than those exposed to none of these risk factors on the WISC-III subtests, the CBCL and the CRS. The effects of risk factors did not cumulate. Contrary to our hypothesis, adoption did not mitigate the effects of prenatal exposure to drugs: for cognitive functioning exposure to drugs was associated with poorer performance among the exposed High SES Adopted versus non-exposed High SES non-adopted children on three of the WISC-III subtests. Exposed low SES children living with their parents performed at the same relatively low level as non-exposed low SES controls. Exposure to drugs was associated with adult ADHD-related problems assessed by the WURS. There were no direct or interaction effects of exposure on neurological functioning, self-competence, behavior problems on the CBCL or risk-taking. CONCLUSIONS: Children exposed to drugs of abuse prenatally, including those adopted away, and children who grow up in low SES backgrounds, may be at risk of relatively reduced cognitive functioning (though still within the normal range) in adolescence. Children exposed to drugs, who are from low SES backgrounds, or who are adopted, may be at risk for lower cognitive or social functioning than children who have not experienced such risks. PRACTICE IMPLICATIONS: There is a need for implementing early monitoring and long-term intervention programs featuring encouragement of cognitive and social skills for children prenatally exposed to drugs in order to alleviate the possible long-term effects of exposure to risk.

Cannabis abuse and severity of psychotic and affective disorders in Israeli psychiatric inpatients.

The influence of cannabis abuse on the severity of existing psychotic and affective symptoms is still unclear. Among 470 consecutively admitted psychotic or affective patients, 54 active (in the previous month) cannabis abusers were detected via urine tests (Sure Step TM kits; Applied Biotech Inc, San Diego, Calif) and Structured Clinical Interview for DSM-IV (SCID- IV) questionnaire. In 24 cases, substances other than cannabis were abused; 392 patients were nonabusers. All patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The following rating scales were used: Hamilton Depression Rating Scale (HAM-D-21), Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale (YMRS). Cannabis abusers (n = 54) were significantly younger and more frequently males than nonuser patients. In this group, there were more schizophrenic patients and fewer affective and anxiety patients (chi(2) = 11.76; P < .01). The double-diagnosed patients had more prominent psychotic symptoms than the nonusers (n = 392)-PANSS positive: 19.056 +/- 8.30 vs 16.128 +/- 8.031 (P < .02; t(446) = 2.510). The difference was statistically significant for hallucinatory behavior, excitement, grandiosity, and hostility. General PANSS scale rate of abusers was lower: 33.012 +/- 9.317 vs 37.3575 +/- 11.196 (P < .01; t = 2.727), especially for depression, anxiety, somatic concern, guilt feelings, tension, motor retardation, and volition disturbances. Rates of PANSS negative scale of abusers and nonusers were not significantly different (13.815 +/- 6.868 vs 14.983 +/- 6.446) except for lower rates of social withdrawal and stereotyped thinking for abusers. No significant difference in general level of manic symptoms (YMRS) between abusers and nonusers was observed (6.778 +/- 10.826 vs 4.910 +/- 7.754), but severity of thought/language disturbances and poor insight was found significantly higher in the abusers. Cannabis abusers are obviously less depressive (HAM-D): 5.944 +/- 10.291 vs 12.896 +/- 13.946 (P < .0005, t = 3.535). Such differences were observed in the high number of the subscales. Abusers' rates were higher (although not significantly) for paranoid symptoms and general somatic symptoms. Cannabis possibly produces some antidepressive and anxiolytic effect on psychotic and affective inpatients. The "price" of this effect is often an exacerbation of psychotic and some manic symptoms.

Knowledge about Hepatitis-C among methadone maintenance treatment patients in Israel.

Ignorance about Hepatitis-C (HCV) among drug users, treatment staff, and policy makers thwarts treatment uptake and facilitates virus transmission. We assessed knowledge about HCV among methadone patients in Israel, where effective HCV-treatment is provided at low-cost within the national health insurance framework, yet few infected methadone patients are treated. In 2006, 512 patients in two methadone clinics in Israel were interviewed, of whom 53% were HCV-positive. The clinics were purposively selected from the 11 methadone clinics in the country. Respondents exhibited poor knowledge about HCV, particularly about diagnosis and treatment. Lesser-educated respondents were three times more likely to score low on HCV-knowledge compared to those with 12+ years of schooling (AOR = 2.97, 95% CI = 1.5-5.7. HCV-negative patients were also three-times more likely than HCV-positive patients to score low on the HCV-knowledge scale (Adjusted Odds Ratio = 3.0, 95% Confidence Interval = 1.9-4.7). Enhancing HCV-knowledge may help patients avoid becoming infected and infecting others, allay exaggerated fears about hepatitis, and facilitate HCV-treatment initiation among those infected.

Psychoactive substance use among Arab adolescent school dropouts in Israel: a phenomenon and its implications.

This comprehensive study is the first to examine rates of legal and illegal psychoactive substance use and their predictors specifically among Arab adolescent school dropouts. It investigates the links between sociodemographic, interpersonal, cognitive and personality characteristics and use rates. Four hundred and seventy-six Arab adolescents aged 12-18 from throughout Israel, who had dropped out of school, participated in the study in late 2004. Sampling was done using a cluster method in order to choose specific localities. Participants completed self-report questionnaires assessing substance use and other variables. Legal substances--alcohol and tobacco--were used by 36% and 30% of the respondents, respectively, in the previous year. Being male, non-religious and having higher behavioural intentions and positive attitudes regarding use increased the odds of substance use. The best predictors of alcohol use were gender and religiosity, each raising the odds of use by 3.5. The best predictor of tobacco use was gender, raising the odds by 12.7. The best predictors of illegal use, behavioural intentions and risk perception, each doubled the odds of use. These and other results facilitate a better understanding of substance use among Arab adolescent dropouts and can foster the development of appropriate prevention and intervention programmes for this underserved population.

Illicit drug and alcohol users admitted to the pediatric emergency department.

BACKGROUND: Clinicians' impression of adolescents' alcohol or drug involvement may underestimate substance-related pathology. OBJECTIVES: To describe the characteristics of adolescents presenting to the pediatric emergency department due to substance abuse and to determine whether physicians can reliably identify these patients. METHODS: We conducted a prospective cohort study of all patients aged 12-18 years presenting to a pediatric emergency department between 1 January 2005 and 31 December 2006 for whom a urine drug screen or ethanol blood levels was ordered. According to departmental protocol, urine drug screen and ethanol levels are taken for specific indications. Based on the history and clinical findings the pediatrician in the ED assessed on a 5-point likelihood scale the possibility that the patients' symptoms were related to substance abuse. RESULTS: Of the 139 patients in the study group 40 (30%) tested positive for ethanol or drugs of abuse. The median age was 16. Compared with patients who tested negative, there were more patients with decreased level of consciousness among patients who tested positive for ethanol or drugs (5% vs. 33% respectively, P < 0.001). The median physician estimate for the likelihood of substance abuse was 5 in patients who tested positive and 2 in patients who tested negative (P< 0.001). The likelihood of a positive drug/ethanol test was not affected by age or gender. CONCLUSIONS: The likelihood of substance abuse is higher in patients presenting with a low level of consciousness, Physicians may accurately assess the likelihood of substance abuse in these patients.

Substance abuse in hospitalized psychiatric patients.

BACKGROUND: The co-morbidity rate of illicit substance abuse and major mental problems in Israel is far from clear. OBJECTIVES: To investigate the extent of drug abuse in a sample of psychiatric patients hospitalized in a psychiatric hospital and in the psychiatric department of a general hospital in Israel, to compare demographic and other background factors in dual-diagnosis patients with those of abuse-free mental inpatients, and to examine the time correlation between drug abuse and the appearance of major mental problems. METHODS: Our data were derived from self-report and urine tests. The study population comprised 470 consecutively admitted patients--250 patients in the mental health center and 220 patients in the psychiatric department of the general hospital. RESULTS: The lifetime prevalence of drug abuse was 24%; cannabis abuse was found in 19.7%, opiates in 5.7%, cocaine in 2.7%, amphetamines in 3.4% and methamphetamine in 1.1%. Active abuse of drugs (during the last month) was registered in 17.3%, cannabis in 11.5%, opiates in 4.9%, amphetamine in 3.8%, cocaine in 1.3% and methamphetamine in 1.1%. We also found that 28.2% of active abusers used two or more substances. In 41.6% the drug abuse appeared prior to symptoms of the mental disorder; in 37.1% the duration of the mental disorders and the drug abuse was relatively similar, and in 21.3% of cases the duration of mental problems was longer than the duration of drug abuse. Dual-diagnosis patients were younger than non-abusers, more often male, unmarried, and of western origin. CONCLUSIONS: Substance abuse (especially cannabis) among hospitalized psychiatric patients in Israel is a growing problem.

Substance use among Druze adolescent students in Israel: identifying predictors and patterns of use.

OBJECTIVE: The current study examines the rates of legal and illegal psychoactive substance use among Druze secondary school students, as well as the correlations between use rates and sociodemographic, interpersonal, cognitive, and personality characteristics. This is the fi rst comprehensive study to focus exclusively on substance use in the Druze population. METHOD: Druze secondary school students (n = 519), Grades 7-12, participated in the study in late 2004. Participants were sampled using a cluster method from 15 schools in northern Israel and completed self-report questionnaires assessing substance use and other variables. RESULTS: The results indicate that 20% of the Druze students consumed alcohol in the past year, and 10% used illegal substances of various types. Also, male students had much higher use rates than female students; low religiosity was related to higher levels of use, and positive attitudes and behavioral intentions were both linked to higher levels of substance use. CONCLUSIONS: These findings provide an indication of the extent of substance use among Druze students and enable us to identify unique characteristics and patterns as well as similarities to the other populations, particularly Arab students in Israel.

Patterns of psychoactive substance use among Arab secondary school students in Israel.

The current study examines patterns and trends in the use of psychoactive substances among Arab secondary school students throughout Israel. Data were collected in late 2004 using self-report questionnaires. The sample consisted of 2,944 students, Grades 7 through 12. Participants were sampled using a cluster method from schools throughout Israel. Results indicate higher use rates among males and among low-religiosity adolescents, as well as a strong link among attitudes, risk perception, behavioral intentions, and substance use. The study's implications and limitations, as well as possibilities for future research, are discussed. This study was funded by the Israel Anti-Drug Authority.

Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol.

BACKGROUND: The effects of marijuana or THC on driving has been tested in several studies, but usually not in conjunction with physiological and subjective responses and not in comparison to alcohol effects on all three types of measures. OBJECTIVE: To assess the effects of two dosages of THC relative to alcohol on driving performance, physiological strain, and subjective feelings. METHOD: We tested the subjective feelings and driving abilities after placebo, smoking two dosages of THC (13 mg and 17 mg), drinking (0.05% BAC) and 24 h after smoking the high dose THC cigarette, while monitoring physiological activity of the drugs by heart rate. Fourteen healthy students, all recreational marijuana users, participated in the study. RESULTS: Both levels of THC cigarettes significantly affected the subjects in a dose-dependent manner. The moderate dose of alcohol and the low THC dose were equally detrimental to some of the driving abilities, with some differences between the two drugs. THC primarily caused elevation in physical effort and physical discomfort during the drive while alcohol tended to affect sleepiness level. After THC administration, subjects drove significantly slower than in the control condition, while after alcohol ingestion, subjects drove significantly faster than in the control condition. No THC effects were observed after 24 h on any of the measures.

Drug and alcohol use among the Bedouin of the Negev: prevalence and psychosocial correlates.

The primary aim of this study was to estimate the prevalence of drug and alcohol use among the Bedouin of the Negev. A representative sample of 821 adults and 440 adolescents were surveyed using the Arabic version of the Israeli National Epidemiological Questionnaire. Almost 14% of adult Bedouins used alcohol and 11.1% used illicit drugs during the past year, with rates higher among individuals living in government settlements than those living in unrecognized traditional villages. Among adolescents, 21.9% used alcohol and 20.4% used drugs over the past year, with rates higher for high school students than for school attritters. Drug use was positively associated with being male, having a tolerant attitude toward drug use, the perception that drugs were not dangerous, being secular, low family cohesion and either low or high family adaptability. These data suggest that drug use is prevalent among the Bedouin of the Negev, particularly among adolescents, who report using drugs such as narcotics, cocaine, and hallucinogens at rates 3 to 8 times greater than Israeli Jewish secular students. School-based and family-based prevention and treatment programs may be most effective for this population.

Brain imaging study of the acute effects of Delta9-tetrahydrocannabinol (THC) on attention and motor coordination in regular users of marijuana.

PROCEDURE: Twelve regular users of marijuana underwent two positron emission tomography (PET) scans using [18F] Fluorodeoxyglucose (FDG), one while subject to the effects of 17 mg THC, the other without THC. In both sessions, a virtual reality maze task was performed during the FDG uptake period. RESULTS: When subject to the effects of 17 mg THC, regular marijuana smokers hit the walls more often on the virtual maze task than without THC. Compared to results without THC, 17 mg THC increased brain metabolism during task performance in areas that are associated with motor coordination and attention in the middle and medial frontal cortices and anterior cingulate, and reduced metabolism in areas that are related to visual integration of motion in the occipital lobes. CONCLUSION: These findings suggest that in regular marijuana users, the immediate effects of marijuana may impact on cognitive-motor skills and brain mechanisms that modulate coordinated movement and driving.

Melatonin for perceived sleep disturbances associated with benzodiazepine withdrawal among patients in methadone maintenance treatment: a double-blind randomized clinical trial.

AIMS: To evaluate the effectiveness of melatonin in attenuating sleep difficulties during benzodiazepine (BDZ) withdrawal. DESIGN: Double-blind cross-over control study. SETTING: Methadone maintenance treatment clinic. PARTICIPANTS: Eighty patients enrolled at a community methadone maintenance clinic recruited to a BDZ withdrawal programme. INTERVENTION: Melatonin (5 mg/day) or placebo: 6 weeks one arm, 1 week washout, 6 weeks other arm. MEASUREMENTS: Urine BDZ; self-reported Pittsburgh Sleep Quality Index (PSQI) and the Center for Epidemiologic Studies Depression (CES-D) questionnaires administered at baseline, and at 6, 7 and 13 weeks. FINDINGS: Sixty-one patients (77.5% in the 'melatonin first' condition and 75% in the 'placebo first' condition) completed 6 weeks of treatment, showing a similar BDZ discontinuation rate of 11/31 and 11/30, respectively. PSQI scores were significantly lower (indicating better sleep quality) in the 22 patients who discontinued BDZ (8.9 +/- 0.9) than in 39 with urine BDZ (11.2 +/- 0.7, P = 0.04). Sleep quality in patients who continued abusing BDZ improved more in the 'melatonin first' group than in the 'placebo first' group, with no differences in sleep quality improvement in patients who stopped BDZ. CONCLUSION Most improvement in sleep quality was attributed to BDZ discontinuation. Although melatonin did not enhance BDZ discontinuation, it improved sleep quality, especially in patients who did not stop BDZ.

Family history and other characteristics of heroin-dependent Jewish males in Israel: results of a case-control study.

BACKGROUND: Various studies support the concept of an inherited vulnerability to drug dependency, while emphasizing the importance of social and environmental influences and their interactions. OBJECTIVES: To compare the characteristics of heroin-dependent Jewish men in Israel with those of the general population, focusing on the nature of family history of substance abuse. METHOD: This case-control study compares 64 heroin-dependent Jewish male residents of Jerusalem with a community sample of 131 randomly selected Jerusalem residents with no drug use disorder. Univariate and multivariate models were employed to appraise the independent associations between heroin dependence and exposure variables such as family history of substance misuse and exposure to legal psychoactive substances. RESULTS: The case group is characterized by heavy tobacco and alcohol involvement. Nearly 70% of the cases report an alcohol and/or drug problem in at least one first-degree relative compared with 10% of controls (odds ratio 14.5, adjusted for sociodemographic and other potential confounders). Cases with a positive family history have, on average, higher alcohol consumption levels and higher heroin-use severity scores, as compared with cases with no such history. CONCLUSIONS: Familial aggregation of drug and alcohol problems, along with smoking at a young age, is the strongest predictor of heroin dependence in this population. Better understanding of the components underlying this familial aggregation can lead to improved prevention and treatment strategies.

Drug and alcohol-related emergency department visits: results of a pilot survey in two hospitals in Israel.

There is no system for reporting drug and alcohol-related emergency department (ED) visits in Israel. This pilot survey was aimed at examining the feasibility of establishing an ED surveillance system in a general hospital and a psychiatric hospital. We describe the design and preliminary results of a pilot-survey conducted in the emergency departments of two hospitals in Northern Israel. Active and passive case identification was conducted in Rambam Hospital and Tirat Carmel Psychiatric Hospital, from August, 1999-January, 2000. A total of 160 ED patients were identified, 64% as drug-related, with heroin being the most common drug. The majority of cases were identified through self-reports. Overdose and IVDU complications accounted for 20% of drug cases identified at Rambam Hospital, and injury and motor vehicle accidents accounted for 12% of all visits at this hospital. We did not attempt to estimate the proportion of all ED visits that are associated with drugs and/or alcohol. Under-ascertainment of cases and incomplete data recording remain major concerns for a survey of this nature. Results of this pilot survey indicate that with proper training of ED nurses a national ED surveillance system can be successfully and efficiently established in general hospitals and psychiatric hospitals in Israel.