Assessing Comorbidities and service use among patients with benzodiazepine abuse

2016 ◽  
Vol 33 (S1) ◽  
pp. S294-S294 ◽  
Author(s):  
B. Cook ◽  
L. Chavez ◽  
R. Carmona ◽  
M. Alegria
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Regression Models ◽  
Service Use ◽  
Safety Net ◽  
Mental Health Disorder ◽  
Electronic Health Record Data ◽  
Competing Interest

Prior studies have identified that individuals with comorbid substance use disorder and mental health disorder are at a greater risk of benzodiazepine abuse compared to individuals that present with mental health disorder without an accompanying substance use disorder. These studies were conducted in predominantly white populations, and little is known if the same associations are seen in safety net health care networks. Also, the literature is mixed as to whether or not psychiatrists’ prescription of benzodiazepines places individuals at undue risk of benzodiazepine abuse.We use 2013–2015 electronic health record data from a Boston healthcare system. Patients with benzodiazapene abuse were identified if they had received treatment under the ICD-9 code 304.1. Benzodiazepine abuse was compared between patients with only mental illness and patients with existing comorbid substance and mental health disorder, in unadjusted comparisons and adjusted regression models. Covariates in regression models were used to identify subgroups at higher risk of benzodiazepine abuse.Individuals with benzodiazepine abuse had higher rates of emergency room and inpatient use than patients with other mental health and/or substance use disorders. Those with comorbid substance and mental disorder were significantly more likely than individuals with mental or substance use disorder alone to abuse benzodiazepines (P < .01). Among those with benzodiazepine abuse, 93.3% were diagnosed with a mental illness, 75.6% were diagnosed with a substance use disorder (other than benzodiazepine), and 64.4% had comorbid anxiety disorder and substance use disorder. These analyses suggest that patients with benzodiazepine abuse have complex presentations and intensive service use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Gender differences in medical and psychiatric comorbidities in patients with posttraumatic stress disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S213-S214
Author(s):  
L. Fortuna ◽  
Z. Ramos ◽  
I. Falgas-Bague ◽  
L. Cellerino ◽  
M. Alegria
Keyword(s):  
Substance Use ◽  
Service Use ◽  
Emergency Services ◽  
Safety Net ◽  
Psychiatric Comorbidities ◽  
Ptsd Diagnosis ◽  
The Us ◽  
Ed Visits ◽  
Competing Interest

IntroductionPTSD is associated with medical and psychiatric comorbidities. Less is known regarding differences in PTSD comorbidities and service use by gender.ObjectivesTo examine variations in comorbidities for PTSD by gender and implications for quality of care.AimsWe identify the prevalence of PTSD, medical and psychiatric comorbidities diagnosed by gender within outpatient, inpatient and emergency services.MethodsWe conducted a retrospective analysis using existing medical records from all outpatient, inpatient and emergency department (ED) encounters in 2010–2012 in a safety net health care system in the US. We identified the rates of PTSD diagnosis by gender, co-occurring diagnoses in ED and inpatient care, and rate of different comorbid diagnoses following initial PTSD diagnosis.ResultsWomen in the sample had twice the likelihood of having a diagnosis of PTSD as compared to men (1.9% vs. 3.6%, P > 0.001), the most common comorbid diagnoses for ED visits were substance use disorder (SUD), depression, anxiety and pain. Men were more likely to have pain as a diagnosis in the ED as compared to women (P > 0.001). In inpatient services, men with PTSD were more likely to be diagnosed with a SUD (35% vs. 26%, P > 0.001) and women more likely diagnosed with comorbid depression (32% vs. 43%, P > 0.001). Men were more likely to have combined medical and substance use disorders and women more likely to have combined medical and psychiatric disorders.ConclusionsGiven the different patterns of comorbidity by gender, services should focus on tailoring services early to contend with these differences.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Examination of Referral Source and Retention Among Women in Residential Substance Use Disorder Treatment: A Prospective Follow-Up Study

2020 ◽  
Author(s):  
Dean Rivera ◽  
Donna Dueker ◽  
Hortensia Amaro
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Mental Health Disorder ◽  
Treatment Retention ◽  
Future Research ◽  
Referral Source ◽  
Protective Services ◽  
Court Mandated ◽  
The Impact

Abstract Background: Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose: This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or certain mental health characteristics (increased stress, depression, anxiety, and PTSD symptomology) contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods: Multivariate regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment regardless of source (CPS or CJ) remained in treatment significantly longer (CPS: M = 116.59 days, SD = 65.59, p = .023; CJ: M = 133.86 days, SD = 79.43, p = .028), compared to women not mandated (M = 96.11 days, SD = 72.09), representing a 34.4% and 31.6% increase, respectively. Findings further revealed a corresponding 2.3% decrease in retention (p = .024) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001). Conclusions: This study highlights the importance of future research that examines the impact of referral source, co-occurring mental disorders, and stress on women’s residential SUD treatment retention.Further research is needed examining the variability in external motivation among referral sources compounded by dynamic intersections of risk associated with having a co-occurring disorder and stress on treatment retention.ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648

scholarly journals 119 Disrupting the cycle of adverse childhood experiences by supporting mothers with addiction

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e49-e49
Author(s):  
Sarah Gander ◽  
Sarah Campbell ◽  
Kathryn Flood
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Adverse Childhood Experiences ◽  
Addiction Severity Index ◽  
Assistance Program ◽  
Current Generation ◽  
Childhood Experiences ◽  
Adverse Childhood

Abstract Introduction/Background Adverse childhood experiences (ACEs), including exposure to neglect, abuse and household dysfunction, have been linked to a higher risk of addiction and mental illness. As these children grow up and start families of their own, their children are at higher risk for ACEs. Evidence has shown that interventions targeting high-risk families with young children are most effective at disrupting these cyclic mechanisms, especially where maternal addiction is present. Objectives The purpose of this study is to examine the predominance of generational addiction in a cohort of families impacted by maternal addiction, and to identify the potential risks that are present for the current generation of children, in terms of ACEs. Design/Methods The Addiction Severity Index (ASI) was administered to women who experienced alcohol- or substance-use disorder during pregnancy. Participants were asked about their family’s history of addiction and if anyone in a given category (i.e. maternal grandmother, mother’s brother) has been affected by either alcohol- or substance-use disorder. Furthermore, existing conditions that are risk factors for ACEs in the current generation were identified (i.e. addiction, incarceration of a family member, domestic violence, mental illness). Results Many participants reported that at least one of their maternal (68.9%) or fraternal (42.2%) grandparent was impacted by addiction. The subsequent generation was similarly impacted with most participants reporting the presence of addiction in their father and/or his siblings (88.9%) and their mother and/or her siblings (86.7%) Participants report that they experienced an average of seven ACEs (M = 7.13, SD = 2.501) before their 18th birthday. Of this cohort, 53.35% have been incarcerated at least once, 91.1% have been hit by a sexual partner, and 44.4% have been diagnosed with at least one mental health issue. All participants have personally experienced addiction. Conclusion The participants of this study are clients of the Parent-Child Assistance Program (PCAP), a three-year intervention that supports families impacted by maternal addiction. Given the results of the current study, it is evident that growing up in a home where addiction is present increases the risk of ACEs and future addiction and mental health issues. The PCAP intervention is designed to disrupt this cycle and help families to create a healthier family environment.

scholarly journals Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study

2021 ◽  
Author(s):  
Dean Rivera ◽  
Donna Dueker ◽  
Hortensia Amaro
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Mental Health Disorder ◽  
Treatment Retention ◽  
Service Needs ◽  
Management Support ◽  
Protective Services ◽  
Unit Increase ◽  
Court Mandated

Abstract Background: Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose: This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods: Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer ( p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention ( p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention ( p < .001). Conclusions: Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout. ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648

scholarly journals Measuring the burden of mental illness and substance use and the level and impact of health care response in patients with spinal trauma: a record linkage study.

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Lisa Sharwood ◽  
Bharat Vaikuntam ◽  
Ashley Craig ◽  
James Middleton ◽  
Jesse Young
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Social Work ◽  
Acute Care ◽  
Substance Use Disorder ◽  
Record Linkage ◽  
Recurrent Event ◽  
Self Harm ◽  
The Impact

Background with rationale Traumatic spinal injuries (TSI) include column fractures, spinal cord injury, or both. They are among the most severe injuries with potential long-term physical, psychological, and social consequences. Primary causes of TSIs are falls and motor vehicle crashes, however, mental illness and substance use are known to significantly increase all injury risk. Injury is also known to increase risks of mental deterioration and physical complications including self-harm and self-neglect. Main Aim We aimed to identify comorbid mental illness and/or substance use at incident TSI, quantifying associated costs and health service management of these inequities. Methods NSW record-linkage administrative data analyses (2013-2016) will determine accurate prevalence of mental illness and/or substance use disorder among all patients who sustained acute TSI during the study period. Using recurrent event analyses, we will estimate the contributions of mental illness and/or substance use disorder on the impact on hospital acquired complications (HAC), length of stay and costs; assessing records for social work and/or psychologist consultation. Results 13,489 individuals were hospitalised with acute TSI; 21% had either mental health and/or substance use diagnoses; 8.7% had both. These patients were more likely to have experienced falls or intentional self-harm, be male and have multiple comorbidity. Acute care stay and costs were on average twice that of patients with TSI without mental health and/or substance use diagnoses; additionally they were more than twice as likely to experience HACs. Only 56% of TSI patients with these comorbid conditions in the context of TSI, had documented social work or psychologist consultation. Conclusion Patients with mental illness and/or substance use disorder, experience significant health disparities that require concerted health system attention that should begin early in acute care.

Chronic non-malignant pain (CNMP) and substance use disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S206-S206 ◽  
Author(s):  
L. Herrera Duran ◽  
I. Falgas ◽  
B. Cook ◽  
N. Noyola ◽  
M. Toro ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Substance Use Disorder ◽  
Low Socioeconomic Status ◽  
Specialty Mental Health ◽  
Substance Disorders ◽  
Worldwide Population ◽  
Increase Risk ◽  
Competing Interest

IntroductionChronic non-malignant pain (CNMP) is defined as pain lasting a minimum of three months. In general, chronic pain affects 20% adult worldwide population. Moreover, pain is more common in patients with depression, anxiety, and substance-use disorders and with low socioeconomic status. We aimed to better understand the influence of pain on substance use and treatment use patterns of individuals who experienced clinically recognized pain and have substance use disorder.MethodsPatients with pain disturbances were identified in Electronic Health Records (EHR) through ICD-9 code 338*, medical written diagnoses, or diagnoses of fibromyalgia. A patient was considered to have a substance use disorder if he received treatment for illicit drug or alcohol abuse or dependence. We combined 2010–2012 (EHR) data from primary care and specialty mental health setting in a Boston healthcare system (n = 131,966 person-years) and a specialty mental health care setting in Madrid, Spain (n = 43,309 person-years).ResultsWe identified that 35.3% of individuals with clinically recognized pain also report substance use disorder, compared to only 10.6% of individuals without clinically recognized pain (P < 0.01). Those with co-morbid pain and substance use disorder were significantly more likely than their specialty care counterparts without co-morbid pain and substance disorders to be seen in the emergency room (56.5% vs. 36.6%, respectively, P < 0.01).ConclusionThe findings suggest that CNMP is associated with an increase risk of substance abuse disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

How the prison-to-community transition risk environment influences the experience of men with co-occurring mental health and substance use disorder

2016 ◽  
Vol 50 (1) ◽  
pp. 39-55 ◽  
Author(s):  
Michelle Denton ◽  
Michele Foster ◽  
Robert Bland
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Severe Mental Illness ◽  
Substance Use Disorder ◽  
Risk Behaviour ◽  
Individual Risk ◽  
Risk Environment ◽  
Mental Health Systems ◽  
Community Transition

Previous research has established that people with severe mental illness and co-occurring substance use disorder leaving prison have multiple and complex health, social and economic challenges. How the criminal justice and mental health systems influence the individual prison-to-community transition experience of this population is less well understood. This paper draws on unique qualitative data from a study of 18 men with co-occurring severe mental illness and substance use disorder leaving prison in Queensland, Australia. A repeat in-depth interview method was used to explore the experiences of the men in prison just prior to release and at two points post-release. Two themes are discussed from analysis of interviews: “risk behaviour and relapse” and “once a criminal always a risk”. The findings suggest that individual risk behaviour is structured within a transition risk environment that reduces individual agency, thus facilitating a vicious cycle of release, relapse and reincarceration.

scholarly journals Examination of referral source and retention among women in residential substance use disorder treatment: a prospective follow-up study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dean Rivera ◽  
Donna Dueker ◽  
Hortensia Amaro
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Mental Health Disorder ◽  
Treatment Retention ◽  
Service Needs ◽  
Management Support ◽  
Protective Services ◽  
Link Type ◽  
Court Mandated

Abstract Background Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear. Purpose This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women. Methods Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes. Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001). Conclusions Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout. Trial registration ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648.

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