Financial capability: Standardizing assessment for adult beneficiaries with co-occurring disorders

Abstract

s / Drug and Alcohol Dependence 140 (2014) e2–e85 e15 14–15, respectively, had used marijuana prior to opioids. Regardless of age of opioid initiation, alcohol and tobacco use tended to precede opioids and cocaine and heroin to come after opioids. Conclusions: By early adulthood (20–21 yo), most who started NMP opioid use had already started use of marijuana, but opioid use tended to precede marijuana use in early adolescence (12-15 years). These findings point to changing patterns of onset across developmental stages that should be addressed in prevention and intervention strategies. Financial support: Funded by Purdue Pharma, L.P. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.061 Financial capability: Standardizing assessment for adult beneficiaries with co-occurring disorders Anne C. Black1,2, T.J. McMahon1, R.A. Rosenheck1,2, M.I. Rosen1,2 1 Psychiatry, Yale University, New Haven, CT, United States 2 Psychiatry, VA Connecticut Healthcare System, West Haven, CT, United States Aims: In 2011, 6.5 million adults with psychiatric disorders received Social Security benefits to provide for basic needs. Payments typicallymade directly to the beneficiarymay be assigned to a representative payee if the beneficiary is determined not capable to manage funds. SSA assesses capability as “the ability to understand and act on the ordinary affairs of life, such as providing for own adequate food, housing, clothing, etc., and the ability, in spite of physical impairments, to manage funds or direct others how to manage them” (SSA, 2010). The breadth of the current definition poses the risk that bias and subjectivity may influence conclusions on this high-stakes assessment. The aim of this study was to develop an instrument to further standardize clinician assessment of financial capability for adults with co-occurring disorders. Methods: A 58-item questionnaire was pilot-tested with clinicians of 122 adult beneficiaries with substance abuse/dependence receiving intensive psychiatric care. Items were based on expert consensus about manifestations, correlates, and consequences of financial incapability. Data analyses explored response distributions, tested factorial validity, item reliability, and compared assessment-based capabilitydeterminations togold-standardfindings. Items were trimmed based on a priori item function criteria. Results: Clinicians lacked specific information about patients’ financial management; “don’t know” responses created high rates of missing data. Items involving gambling problems generally were not endorsed. One-week test-retest reliability ranged from r= .18–.98; item-total correlations were r= .06–.85. CFA-confirmed subscalesof spendingonnon-essentials, failing tomeetbasicneeds, spending on harmful things, and future likelihood of misspending led to capability determinations thatmatched the gold standard for 75% of cases. Conclusions: The questionnaire was reduced to 27most salient and reliable items. The next phase will validate the reduced questionnaire. Financial support: NIDA; 1R01DA025613 (M.I. Rosen). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.062 Chronic methamphetamine use heightens concurrent risk of functional dependence in persons living with HIV infection Kaitlin Blackstone1, J.E. Iudicello2, E.E. Morgan2, E. Weber1, D.J. Moore2, R.J. Ellis2, I. Grant2, S.P. Woods2 1 SDSU/UCSD Joint Doctoral Program, San Diego, CA, United States 2 Psychiatry, UCSD, San Diego, CA, United States Aims: Disability among chronic methamphetamine (MA) users is multifactorial. We examined the additive adverse impact of HIV infection, a common comorbidity in MA users, on functional dependence. Methods: Participants (N=798) were stratified by lifetime MA dependence diagnoses (i.e., MA+ or MA−) and HIV serostatus (i.e., HIV+ or HIV−) and underwent comprehensive neuromedical, neuropsychiatric, and functional research evaluations, including assessment of neurocognitive symptoms in daily life, instrumental and basic activities of daily living, and employment status. Results: A logistic regression revealed additive effects of HIV and MA across all measures of functional dependence, independent of other demographic, psychiatric, and substance use factors. The prevalence of global functional dependence increased in the expected stepwise fashion, with the lowest rates in the HIV/MA-group (29%) and the highest rates in the HIV+/MA+ sample (69%). Post-hoc ANOVAs indicated that the impact of HIV on MAassociated functional dependence was moderated by nadir CD4 (i.e., historic immunosuppression), such that MA use was associated with greater disability among HIV+ persons with higher, but not lower nadir CD4. A logistic regression within the HIV+/MA+ cohort illustrated that functional dependence was reliably associated with neurocognitive impairment, lower cognitive reserve, polysubstance use, and major depressive disorder. Conclusions: HIV infection confers an increased risk of MA-associated disability, particularly among HIV+ persons without histories of immune compromise. Standard MA treatment approaches may benefit from compensatory strategies aimed at counteracting the effects of low cognitive reserve, neurocognitive impairment, and psychiatric comorbidities for functional dependence in the context of HIV. Financial support: The authors report no conflicts of interest. This researchwas supported byNational Institutes of Health grants T32-DA31098, P01-DA12065, P50-DA026306, L30-DA032120, L30DA034362, F31-DA034510, and P30-MH62512. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.063 Factors associated with time to injection initiation among drug injectors Ricky Bluthenthal1, L. Wenger2, J. Thing1, S. Arreola2, D. Chu1, Martin Y. Iguchi3, P. Bourgois4, A. Kral2 1 University of Southern California, Los Angeles, CA, United States 2 RTI International, San Francisco, CA, United States 3 Georgetown University, Washington, DC, United States 4 University of Pennsylvania, Philadelphia, PA,