Considerations for culturally inclusive diagnosis and treatment for Panjabi men who use substances

SUDs Cost Employer Health Insurance $35 Billion Per Year

Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.

Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system

Diagnosis and treatment of substance use disorder among pregnant women in three state Medicaid programs from 2013 to 2016

This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of clinical practice. This parameter considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities. (Reprinted with permission from the Journal of the American Academy of Child and Adolescent Psychiatry 2005; 44(6):609–621)

Medicolegal Issues with Reference to NDPS and MHCA in Management and Rehabilitation of Persons with Substance Use Disorders.

Introduction and Objective: Substance use (SU) and SU disorders (SUDs) adversely affect diabetes management and increase the risk of diagnosed diabetes (DM) complications. We estimated disparities in the prevalence of SU, SUDs, and SUD treatment among those with SUDs (SUDT) among US adults with DM by sociodemographic characteristics. Methods: We used 2021-2022 National Survey on Drug Use and Health self-reported data from 6,816 adults aged ≥18 years with DM. SU was defined as heavy alcohol use or binge drinking in the last 30 days or, in the past year, using any cannabis, cocaine in any form, heroin, hallucinogens, inhalants, or methamphetamine, or misusing prescription medications. A diagnosis of SUD was based on meeting criteria for use or misuse of any of these substances. Receipt of any SUDT (2022 only) was assessed among adults with any SUDs. We estimated crude prevalence (cPrev) for each outcome and adjusted prevalence ratios (aPR) using logistic regression adjusted for age, sex, race and ethnicity, education, self-rated health, family income, insurance coverage, and rurality. Results: Among those with DM, cPrev estimates (%, 95% CI) were 24.6 (23.1-26.2) for SU and 8.7 (7.8-9.8) for SUDs. Among those aged ≥65 years, cPrev estimates (%) were 14.6 (12.3-17.4) for SU, 23.3 (15.6-34.8) for SUDs, and 4.2 (1.3-13.0) for SUDT. Compared with those aged ≥65 years, aPRs (95% CI) of SU, SUDs, and SUDT were 3.4 (2.7-4.3), 2.0 (1.3-3.1), and 10.2 (2.3-46.0) for adults aged 18-34 years, and 3.0 (2.4-3.6), 1.6 (1.0-2.4), and 7.3 (1.5-36.3) for adults aged 35-49 years. Men, non-Hispanic (NH) White adults (vs. NH Asian adults), those in fair/poor health (vs. good), and those living in large metro areas (vs. nonmetro) had higher prevalence of SU. Conclusion: Among adults with DM, SU and SUDs, are common. SUDT among those with SUDs was low, especially among older adults. Addressing availability and accessibility of SUDT may improve health outcomes in adults with DM. Disclosure Y.J. Cheng: None. I. Zaganjor: None. J. Ko: None. R. Li: None. C.S. Holliday: None. K.M. Bullard: None.

BackgroundThe objective of the study was to describe the frequencies of health-care utilization by people with substance use disorder (SUD), including contacts with general practitioners (GP), psychiatrists, emergency departments (ED) and hospital admissions and to compare this frequency to the general population.MethodsData from the national register of people who were in treatment for SUD between 2011 and 2014 was linked to health care data from the Belgian health insurance (N = 30,905). Four comparators were matched on age, sex and place of residence to each subject in treatment for SUD (N = 123,620). Cases were further divided in five mutually exclusive categories based on the main SUD (opiates, crack/cocaine, stimulants, cannabis and alcohol). We calculated the average number of contacts with GP, psychiatrists and ED, and hospital admissions per person over a ten year period (2008–2017), computed descriptive statistics for each of the SUD and used negative binomial regression models to compare cases and comparators.ResultsOver the ten-year period, people in treatment for SUD overall had on average 60 GP contacts, 3.9 psychiatrist contacts, 7.8 visits to the ED, and 16 hospital admissions. Rate ratios, comparing cases and corresponding comparators, showed that people in treatment for SUD had on average 1.9 more contacts with a GP (95 % CI 1.9-2.0), 7.4 more contacts with a psychiatrist (95 % CI 7.0-7.7), 4.2 more ED visits (95 % CI 4.2–4.3), and 6.4 more hospital admissions (95 % CI 6.3–6.5).ConclusionsThe use of health services for people with SUD is between almost two (GP) and seven times (psychiatrist) higher than for comparators. People in treatment for alcohol use disorders use health care services more frequently than people in treatment for other SUD. The use of health services remained stable in the five years before and after the moment people with SUD entered into treatment for SUD. The higher use of primary health care services by people with SUD might indicate that they have higher health care needs than comparators.

To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. Cross-sectional, representative household surveys. Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. Of respondents with past-year SUD, 11.0% [standard error (SE)=0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE=1.6 versus 6.8%, SE=0.7), as was MAT (84.0%, SE=2.5 versus 68.3%, SE=3.8) and treatment by health-care professionals (88.9%, SE=1.9 versus 78.8%, SE=3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR)=2.34; 95% confidence interval (CI)=1.71-3.20], MAT among SUD cases (OR=2.75; 95% CI=1.90-3.97) and MAT among treated cases (OR=2.48; 95% CI=1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.

Several large-scale studies examining outcome predictors across various substance use treatments indicate a need to focus on psychiatric comorbidity as a very important predictor of poorer SUD treatment involvement and outcome. We have previously argued that current cognitive-behavioral treatments (CBT) approaches to SUD treatment do not focus on the necessary content in treatment in order to effectively address specific forms of psychiatric comorbidity, and thus only provide clients with generic coping strategies for managing psychiatric illness (as would be achieved in other SUD treatment approaches; Conrod et al., 2000). Furthermore, following our review of the literature on dual-focused CBT treatment programs for concurrent disorders in this article, we argue that combining CBT-oriented SUD treatments with specific CBT treatments for psychiatric disorders is not as straightforward as one would think. Rather, it requires very careful consideration of the functional relationship between specific disorders, patient reactions to specific treatment components, and certain barriers to treatment in order to achieve an integrated dual-diagnosis focus in treatment that is meaningful and to which clients can adhere. Keywords: substance abuse; cognitive-behavioral; diagnosis; psychiatric disorders; comorbidity The efficacy of cognitive-behavioral treatments (CBT) for substance use disorders (SUDs) is now indisputable. The articles presented in the current special issue on CBT approaches such as relapse prevention, guided self-change, behavioral couples therapy, and the community reinforcement approach, review evidence that clearly establishes that each produces significant improvements in SUD symptoms. The benefits of these various CBT approaches to SUD treatment are now also revealing themselves in other domains, such as in improving employment (Meyers, Villanueva, & Smith, this issue), family discord and partner aggression (Fals-Stewart et al., this issue), optimism and thought suppression (Witkiewitz, Mariait, & Walker, this issue), substance abuse in special populations (Sobell & Sobell, this issue), adaptive coping (Ouimette, Finney, & Moos, 1999), psychosocial functioning (Ouimette et al, 1999), criminal activity and use of health care services (Sacks & DeLeon, 1997), and comorbid psychiatric symptoms (Brown & Schuckit, 1988). Several large-scale studies examining outcome predictors across various substance use treatments (MacLellan et al., 1994; Ouimette, Gima, Moos, & Finney, 1999; Project MATCH, 1997) are now indicating that theoretical orientation of the treatment is not a strong determinant of SUD treatment outcome. Nonetheless, such studies have also identified a need to focus on psychiatric coniorbidity as a very important predictor of poorer SUD treatment involvement and outcome. Several reports indicate that individuals with SUDs who demonstrate psychiatric comorbidity are less likely to access addiction treatment services (Wu, Kouzis, & Leaf, 1999), demonstrate poor compliance with traditional substance use treatments (Drake, Mueser, Clark, & Wallach, 1996), and generally show a lesser response to such treatments with respect to rates of relapse to substance abuse, employment status, and psychosocial functioning (McLellan et al., 1994; Ouimette, Gima, Moos, & Finney, 1999; Project MATCH, 1997). The current article will examine the literature on the outcome of CBT approaches for the SUD client who suffers from a concurrent mental disorder. MODELS OF COMORBIDITY: How ARE SUD AND MENTAL DISORDERS RELATED? Before we examine different CBT approaches to treatment of concurrent SUD and mental disorders, it is worthwhile to consider various theoretical models of the relationship between SUDs and mental disorders. These models can inform ways of conceptualizing primary targets of therapy for dually diagnosed patients. The first model suggests that chronic and severe substance abuse is a strong contributor to the development of psychopathology and accounts for much of the co-occurrence between SUDs and other mental disorders. …

Health care cost trajectories in the year prior to and following intake into Veterans Health Administration outpatient substance use disorders treatment

DSM-5 substance use disorder: how conceptual missteps weakened the foundations of the addictive disorders field.

Women's Perspectives on the Influence of Intimate Partner Violence on Substance Use Disorder Recovery and Associated Service Needs.

Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003-2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women's perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts's deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28-1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64-1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55-0.68) and LBW (AOR 0.54, 95% CI 0.49-0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don't receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.

Transgender-related discrimination and substance use, substance use disorder diagnosis and treatment history among transgender adults