Abstract 228: National Prevalence of Substance Use Disorders Among Hospitalized Heart Failure Patients

Background: Several cardiotoxic substances contribute to the development of heart failure (HF). The burden of comorbid substance use disorders (SUD) among patients with HF is under-characterized. Objectives: To describe the national burden of comorbid SUD (tobacco, alcohol, or drug use disorders) among hospitalized HF patients in the U.S. Methods: We used data from the 2014 National Inpatient Sample to calculate the proportion of hospitalizations for a primary HF admission with tobacco, alcohol, or drug use disorder diagnoses, accounting for demographic factors. Drug use disorder analysis was further sub-divided into specific illicit substance categories. Results: There were a total of 989,080 HF hospitalizations of which 35.3% (n=348,995) had a documented SUD. Tobacco use disorder (TUD) was most common (n= 327,220, 33.1%) followed by drug use disorder (DUD) (n=34,600, 3.5%) and alcohol use disorder (AUD) (n=34,285, 3.5%). Female sex was associated with less TUD (OR 0.59; 95% CI, 0.58-0.60), AUD (OR 0.23; 95% CI, 0.22-0.25) or DUD (OR 0.58; 95% CI 0.55-0.62). Tobacco, alcohol, cocaine, and opioid use disorders were highest among HF patients age 45 to 55, while cannabis and amphetamine use was highest in those <45 years. Native American race (versus White) was associated with increased risk of AUD (OR 1.67; 95% CI 1.27-2.20). Black race was associated with increased risk of AUD (OR 1.09; 95% CI 1.02-1.16) or DUD (OR 1.63; 95% CI 1.53-1.74). Medicaid insurance (versus Medicare) was associated with greater TUD (OR 1.27; 95% CI 1.23-1.32), AUD (OR 1.74; 95% CI 1.62-1.87), and DUD (OR 2.15; 95% CI 2.01-2.30). Decreasing quartiles of median household income were associated with increasing SUD. Conclusions: Comorbid SUD disproportionately affects certain HF populations, including men, younger age groups, lower SES patients, and race/ethnic minorities. Further research on interventions to improve prevention and treatment of SUD among hospitalized HF patients are needed given the high rates of SUD in this population. Systematically screening hospitalized HF patients for SUD may reveal opportunities for treatment and secondary prevention.

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Suicide among people treated for drug use disorders: a Danish national record-linkage study

10.21203/rs.2.18295/v1 ◽

2019 ◽

Author(s):

Morten Hesse ◽

Birgitte Thylstrup ◽

Abdu Kedir Seid ◽

Jens Christoffer Skogen

Keyword(s):

Risk Factors ◽

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Psychiatric Care ◽

Psychiatric History ◽

Completed Suicide ◽

Drug Use Disorders ◽

History Of ◽

Drug Use Disorder

Abstract Background Substance use disorders are a major risk factor for suicide. However, less is known about specific risk factors for suicide in people with substance use disorders. Methods This population cohort study assessed suicide among people treated for drug use disorders in Denmark 2000-2010, and described risk factors for completed suicide. Data from 27,942 individuals enrolled in treatment were linked to national registers and matched with controls. Competing risk regression was used to identify risk factors of completed suicide. Results There were 163 suicides among patients with a history of drug treatment (0.6% of patients). Increased risk was associated with younger age at enrolment (hazard ratio [HR] = 0.97, 95% CI: 0.95, 0.98), history of psychiatric care (HR=1.96, CI 95%: 1.39, 2.77), opioid use (HR=1.81, 95% CI: 1.23, 2.68) and alcohol use (HR=1.56, 95% CI: 1.09, 2.23). Lower risk was associated with cannabis use (HR=0.69, 95% CI: 0.50, 0.96). The standard mortality ratio was 7.13 for people with drug use disorder without a history of psychiatric care (95% CI: 5.81, 8.44), 13.48 for people with drug use disorder and psychiatric history (95% CI: 9.75, 17.22), and 13.61 for people with psychiatric history only (95% CI: 6.72, 20.50) Conclusions Risk of suicide is increased among people with drug use disorders. Access to treatment for co-morbid mental health problems for people with drug use disorders could potentially reduce risk of suicide.

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Suicide among people treated for drug use disorders: a Danish national record-linkage study

10.21203/rs.2.18295/v2 ◽

2019 ◽

Author(s):

Morten Hesse ◽

Birgitte Thylstrup ◽

Abdu Kedir Seid ◽

Jens Christoffer Skogen

Keyword(s):

Risk Factors ◽

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Psychiatric Care ◽

Psychiatric History ◽

Completed Suicide ◽

Drug Use Disorders ◽

History Of ◽

Drug Use Disorder

Abstract Background: Substance use disorders are a major risk factor for suicide. However, less is known about specific risk factors for suicide in people with substance use disorders. Methods: This population cohort study assessed suicide among people treated for drug use disorders in Denmark 2000-2010, and described risk factors for completed suicide. Data from 27,942 individuals enrolled in treatment were linked to national registers and matched with controls without drug use disorder and with (n=138,136) or without psychiatric history (n=1,574). Competing risk regression was used to identify risk factors of completed suicide. Results: There were 163 suicides among patients with a history of drug treatment (0.6% of patients). Increased risk was associated with younger age at enrolment (hazard ratio [HR] = 0.97, 95% confidence interval (CI): 0.95, 0.98), history of psychiatric care (HR=1.96, CI 95%: 1.39, 2.77), opioid use (HR=1.81, 95% CI: 1.23, 2.68), and alcohol use (HR=1.56, 95% CI: 1.09, 2.23). Lower risk was associated with cannabis use (HR=0.69, 95% CI: 0.50, 0.96). Compared with age- and gender-matched controls without a history of treatment for substance use disorders or recent psychiatric care, the standardized mortality ratio due to suicide was 7.13 for people with drug use disorder without a history of psychiatric care (95% CI: 5.81, 8.44), 13.48 for people with drug use disorder and psychiatric history (95% CI: 9.75, 17.22), and 13.61 for people with psychiatric history only (95% CI: 6.72, 20.50). Conclusions: Risk of suicide is increased among people with drug use disorders. Access to treatment for co-morbid mental health problems for people with drug use disorders could potentially reduce risk of suicide.

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Suicide among people treated for drug use disorders: a Danish national record-linkage study

10.21203/rs.2.18295/v3 ◽

2020 ◽

Author(s):

Morten Hesse ◽

Birgitte Thylstrup ◽

Abdu Kedir Seid ◽

Jens Christoffer Skogen

Keyword(s):

Risk Factors ◽

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Psychiatric Care ◽

Psychiatric History ◽

Completed Suicide ◽

Drug Use Disorders ◽

History Of ◽

Drug Use Disorder

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Psychosocial Treatments for Substance Use Disorders

A Guide to Treatments that Work ◽

10.1093/med:psych/9780195304145.003.0006 ◽

2007 ◽

pp. 179-202 ◽

Cited By ~ 17

Author(s):

John W. Finney ◽

Paula L. Wilbourne ◽

Rudolf H. Moos

Keyword(s):

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Sense Of Self ◽

Contingency Management ◽

Treatment Modalities ◽

Therapeutic Alliances ◽

Drug Use Disorders ◽

Management Approaches ◽

Use Behavior

Our review of the literature indicates that among the most effective treatments for alcohol and illicit drug use disorders are cognitive-behavioral treatments, community reinforcement and contingency management approaches, 12-step facilitation and 12-step treatment, behavioral couples and family treatment, and motivational enhancement interventions. Most of these treatment modalities address not only drinking and/or drug use behavior but also patients’ life contexts, sense of self-efficacy, and coping skills; motivational interventions focus primarily on attempts to enhance individuals’ commitment to behavior change. Consistent with motivational interviewing principles, therapists who are interpersonally skilled, empathic, and less confrontational produce better patient outcomes, probably because they establish better therapeutic alliances with their patients. An effective strategy for many patients may be to provide lower intensity treatment for a longer duration—that is, treatment sessions spread at a lower rate over a longer period to match better the chronic, relapsing nature of many individuals’ substance use disorders. At this point, it seems wise to restrict brief interventions as a stand-alone treatment to patients with mild to moderate disorders. Longer term interventions and treatment in inpatient or residential settings should be reserved for patients with more severe, treatment-resistant substance use disorders, fewer social resources, more concomitant medical/psychiatric disorders, and a desire for longer term and/or residential treatment.

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Personality and substance use disorders: II. Alcoholism versus drug use disorders.

Journal of Consulting and Clinical Psychology ◽

10.1037/0022-006x.67.3.394 ◽

1999 ◽

Vol 67 (3) ◽

pp. 394-404 ◽

Cited By ~ 98

Author(s):

Matt McGue ◽

Wendy Slutske ◽

William G. Iacono

Keyword(s):

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Drug Use Disorders

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Medical Care for Patients with Substance Use Disorders

ASAM Handbook of Addiction Medicine ◽

10.1093/med/9780197506172.003.0014 ◽

2020 ◽

pp. 313-348

Author(s):

Megan Buresh ◽

Darius A. Rastegar

Keyword(s):

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Methadone Maintenance ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Agonist ◽

Reduction Strategies ◽

Primary Care Clinicians ◽

Prolonged Qt Syndrome

Primary care clinicians commonly encounter patients with substance use disorders and can provide effective treatment for their problems. Many of the medical complications associated with drug use are due to the use of needles; these include transmission of HIV and hepatitis C, soft tissue infections, and endocarditis. Harm reduction strategies reduce the harms associated with drug use without targeting use itself; these include syringe distribution, safe consumption facilities, naloxone distribution, and pre-exposure HIV prophylaxis. Patients on opioid agonist treatment may develop a number of problems, including hypogonadism, constipation, and psychomotor impairment; those on methadone may develop prolonged QT syndrome. Other issues include drug interactions, treatment of acute pain, and perioperative care. Treating pain in patients with substance use disorder can be complicated; for many, especially those with opioid use disorder, treatment with buprenorphine or enrollment in methadone maintenance is the best option.

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A review of research-supported group treatments for drug use disorders

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00371-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Gabriela López ◽

Lindsay M. Orchowski ◽

Madhavi K. Reddy ◽

Jessica Nargiso ◽

Jennifer E. Johnson

Keyword(s):

Substance Use ◽

Drug Use ◽

Support Groups ◽

Substance Use Disorder ◽

Group Treatment ◽

Behavioral Therapy ◽

Opioid Use ◽

Drug Use Disorders ◽

Group Treatments ◽

Group Cbt

AbstractThis paper reviews methodologically rigorous studies examining group treatments for interview-diagnosed drug use disorders. A total of 50 studies reporting on the efficacy of group drug use disorder treatments for adults met inclusion criteria. Studies examining group treatment for cocaine, methamphetamine, marijuana, opioid, mixed substance, and substance use disorder with co-occurring psychiatric conditions are discussed. The current review showed that cognitive behavioral therapy (CBT) group therapy and contingency management (CM) groups appear to be more effective at reducing cocaine use than treatment as usual (TAU) groups. CM also appeared to be effective at reducing methamphetamine use relative to standard group treatment. Relapse prevention support groups, motivational interviewing, and social support groups were all effective at reducing marijuana use relative to a delayed treatment control. Group therapy or group CBT plus pharmacotherapy are more effective at decreasing opioid use than pharmacotherapy alone. An HIV harm reduction program has also been shown to be effective for reducing illicit opioid use. Effective treatments for mixed substance use disorder include group CBT, CM, and women’s recovery group. Behavioral skills group, group behavioral therapy plus CM, Seeking Safety, Dialectical behavior therapy groups, and CM were more effective at decreasing substance use and psychiatric symptoms relative to TAU, but group psychoeducation and group CBT were not. Given how often group formats are utilized to treat drug use disorders, the present review underscores the need to understand the extent to which evidence-based group therapies for drug use disorders are applied in treatment settings.

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Developmental cascades: Linking adolescent substance use, affiliation with substance use promoting peers, and academic achievement to adult substance use disorders

Development and Psychopathology ◽

10.1017/s0954579410000532 ◽

2010 ◽

Vol 22 (4) ◽

pp. 899-916 ◽

Cited By ~ 46

Author(s):

Moira Haller ◽

Elizabeth Handley ◽

Laurie Chassin ◽

Kaitlin Bountress

Keyword(s):

Academic Achievement ◽

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Community Sample ◽

Parental Alcoholism ◽

Alcohol Disorders ◽

Alcohol And Drug Use ◽

Drug Use Disorders ◽

Adolescent Risk

AbstractUsing a high-risk community sample (N = 405), the current study examined developmental cascades among substance use, affiliation with substance use promoting peers, and academic achievement over an 18-year period and tested whether these pathways mediated the influence of parental alcoholism on adult alcohol and drug use disorders. Results showed that the influence of parental alcoholism on adult drug disorders was mediated by developmental cascades across all three domains, whereas the influence of parental alcoholism on adult alcohol disorders was mediated through affiliation with substance use promoting peers and persistence in binge drinking. Adolescent drug use had more implications for adult outcomes than did adolescent alcohol use, which was less likely to spill over into other domains of functioning. Findings indicated that adolescent risk factors had indirect rather than unique effects on adult substance use disorders, suggesting that adolescent risk is not immutable and is largely mediated by later influences.

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Burden of Mental, Neurological, Substance Use Disorders and Self-Harm in North America: A Comparative Epidemiology of Canada, Mexico, and the United States

The Canadian Journal of Psychiatry ◽

10.1177/0706743719890169 ◽

2019 ◽

pp. 070674371989016 ◽

Cited By ~ 2

Author(s):

Daniel Vigo ◽

Laura Jones ◽

Graham Thornicroft ◽

Rifat Atun

Keyword(s):

United States ◽

Substance Use ◽

Alcohol Use ◽

Drug Use ◽

Substance Use Disorders ◽

The United States ◽

Conduct Disorders ◽

Distinct Pattern ◽

Drug Use Disorders ◽

Self Harm

Objective: To estimate the burden of mental, neurological, substance use disorders and self-harm (MNSS) in Canada, Mexico, and the United States. Method: We extracted 2017 data from the Global Burden of Disease online database. Based on a previously developed framework to classify and aggregate the burden of specific disorders and symptoms, we reestimated the MNSS burden to include suicide, alcohol use, drug use, specific neurological, and painful somatic symptom disorders. We analyzed age–sex-specific patterns within and between countries. Results: The MNSS burden is the largest of all disorder groupings. It is lowest in Mexico, intermediate in Canada, and highest in the United States. Exceptions are alcohol use, bipolar, conduct disorders, and epilepsy, which are highest in Mexico; and painful somatic syndromes and headaches, which are highest in Canada. The burden of drug use disorders in the United States is twice the burden in Canada, and 7 times the burden in Mexico. MNSS become the most burdensome of all disorder groups by age 10, staying at the top until age 60, and show a distinct pattern across the lifetime. The top three MNSS disorders for men are a combination of substance use disorders and self-harm (United States), with the addition of painful somatic syndromes (Canada), and headaches (Mexico). For women, the top three are headaches and depression (all countries), drug use (United States), neurocognitive disorders (Mexico), and painful somatic syndromes (Canada). Conclusion: MNSS are the most burdensome disease grouping and should be prioritized for funding in Canada, Mexico, and the United States.

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Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djab082 ◽

2021 ◽

Author(s):

Devon K Check ◽

Christopher D Bagett ◽

KyungSu Kim ◽

Andrew W Roberts ◽

Megan C Roberts ◽

...

Keyword(s):

North Carolina ◽

Substance Use ◽

Cancer Survivors ◽

Low Income ◽

Opioid Therapy ◽

Adjusted Relative Risk ◽

Opioid Use ◽

Chronic Opioid Therapy ◽

Increased Risk ◽

Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

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