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In an effort to define the role that substance abuse has to play in head injuries, a prospective study of 204 patients presenting to the Accident and Emergency (A&E) Department over a 10-week period was carried out. Urine samples were collected and assayed for the presence of common drugs of abuse and alcohol. One or other substance (drugs or alcohol) was detected in 43% of patients. The association between alcohol and head injuries has been confirmed and the importance of drugs in this area has been addressed and found to be of some significance. More rapid and accurate methods of assaying these substances may improve our management of head injury patients.