Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

No consensus exists on the use of psychiatric medication among patients with co-occurring mental health and alcohol disorders. The authors investigated patterns of use of psychiatric medication and perceived effectiveness of mental health treatment among users of mental health care with and without alcohol dependence. Data were obtained from the 2001 to 2003 National Survey on Drug Use and Health. The sample consisted of respondents who reported receiving mental health treatment in the past year (N=11,872). Rates of psychiatric medication use were compared between mental health care patients who were alcohol dependent and those who were not. Patient-reported effectiveness of mental health treatment was examined among alcohol-dependent and non-alcohol dependent patients who did and did not receive psychiatric medication. No statistically significant differences in rates of use of psychiatric medication were found between those with and without alcohol dependence (76.2 percent and 75.9 percent, respectively). Among alcohol-dependent patients, those who received psychiatric medication were significantly more likely than those who did not receive such medication to report that treatment helped a lot or a great deal (OR=2.87, 95 percent CI=1.57 to 2.56, p<.001). Among those who received psychiatric medication, no statistically significant differences were found between alcohol-dependent and nondependent respondents in patients' ratings of treatment effectiveness. Most alcohol-dependent individuals in mental health treatment received psychiatric medication, despite the lack of guideline support in this area. A large majority of those with alcohol dependence who received psychiatric medication reported that mental health treatment was effective.

OBJECTIVES: This study examined the utilization of and the perceived need for alcohol treatment services among college-age young adults (18–22 years) according to their educational status: full-time college students, part-time college students, noncollege students (currently in school with the highest grade level below college), and nonstudents (N=11,337). This breakdown of young adults had not been addressed previously. METHODS: Secondary analyses were conducted on data from the 2002 National Survey on Drug Use and Health. RESULTS: Full-time college students (21%) were as likely to have an alcohol use disorder as nonstudents (19%), but were more likely than part-time college students (15%) and noncollege students (12%). Only 4% of full-time college students with an alcohol use disorder received any alcohol services in the past year. Of those with an alcohol use disorder who did not receive treatment services, only 2% of full-time college students, close to 1% of part-time college students, and approximately 3% of young adults who were not in college reported a perceived need for alcohol treatment. Full-time college students were less likely than noncollege students to receive treatment for alcohol use disorders. All young adults with an alcohol use disorder were very unlikely to perceive a need for alcohol treatment or counseling. CONCLUSIONS: College-age adults have a high prevalence of alcohol use disorders, yet they are very unlikely to receive alcohol treatment or early intervention services or to perceive a need for such services. Underutilization of alcohol-related services among college-age young adults deserves greater research attention.

Impact of Intimate Partner Violence on Unmet Need for Mental Health Care: Results From the NSDUH

Cross-sectional studies show a robust association between anxiety disorders and alcohol use disorders (comorbidity); however, this methodology does not allow for the testing of causal models. The authors attempted to overcome this limitation by examining comorbid relationships prospectively. Male and female college students were assessed as freshmen (year 1), and then again at years 4 and 7, for selected 12-month anxiety disorders (generalized anxiety disorder, agoraphobia, and social phobia or panic) diagnosed according to the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and DSM-III and for 12-month DIS/DSM-III alcohol use disorders (alcohol dependence alone and alcohol abuse or dependence). Cross-sectionally, the odds of having either an anxiety disorder or an alcohol use disorder were two- to fivefold greater when the other condition was present. Prospectively, the odds of developing a new alcohol dependence diagnosis at year 7 increased from 3.5 to five times for those diagnosed with an anxiety disorder at years 1 or 4. Conversely, the odds of developing a new anxiety disorder at year 7 increased by about four times for those diagnosed with alcohol dependence at years 1 or 4. When alcohol abuse and dependence were combined, the pattern of findings was similar, albeit weaker. Multivariate path models provide similar results and highlight the reciprocal influence of alcohol use disorders and anxiety disorders. Alcohol use disorders (especially alcohol dependence) and anxiety disorders demonstrate a reciprocal causal relationship over time, with anxiety disorders leading to alcohol dependence and vice versa.

OBJECTIVE: Although studies have shown disparities between black and white populations in service utilization for mental disorders, little information exists on whether such disparities apply equally across disorders. The objective of this study was to examine racial differences in lifetime prevalence of service utilization for mood and anxiety disorders and for alcohol and drug use disorders, with controls for predisposing, enabling, and need-for-service variables unequally distributed between racial-ethnic groups. METHODS: Data were from a face-to-face epidemiologic survey of 32,752 non-Hispanic white or black adults ages 18 and older residing in households and group quarters in the United States. Main outcome measures were treatment for mood, anxiety, and alcohol and drug use disorders. RESULTS: White adults were consistently more likely than black adults to have had treatment for mood disorders (odds ratio [OR]=2.16, 95% confidence interval [CI]=1.80–2.59) and anxiety disorders (OR=1.77, 95% CI=1.43–2.19) after adjustment for predisposing and enabling factors and need for service (severity of disorder). In contrast no evidence of lower service utilization for treatment of alcohol use disorders emerged among black respondents (OR=.87, 95% CI .69–1.10). Moreover, white respondents with drug use disorders were significantly less likely than black respondents to receive treatment for a drug problem (OR=.64, 95% CI=.47–.88). CONCLUSIONS: Differences in treatment between black and white adults depended on the specific disorder and type of treatment considered. Prevention and intervention strategies should address disorder-specific disparities in services received.

Substance Abuse-Related Mortality Among Middle-Aged Male VA Psychiatric Patients

The purposes of this dissertation were to examine trends from 2008 to 2014 in mental health and substance use disorders and treatment receipt, and explore factors associated with treatment receipt in pregnant women aged 18-44 years in the United States. A systematic review showed that illicit drug use disorder increased in pregnant women over the past decade. Despite the increase in treatment admissions for these disorders from 1992 to 2012, the overall treatment admission rate for pregnant women remained relatively stable (4%). In a trend study, compared mental health and substance use disorders and treatment receipt across Matched groups of pregnant (n = 5,520) and non-pregnant women (n = 11,040) who participated in the 2008-2014 National Survey on Drug Use and Health (NSDUH) did not differ on mental health and substance use disorders and treatment receipt. Past-year anxiety disorder, past-month psychological distress, and illicit drug use disorder increased in the total sample from 2008 to 2014, whereas trends in treatment receipt did not change over time. Secondary analysis of data from the same survey was conducted with data from pregnant women (1,106 with mental health problems and 521 with substance use disorders). Predictors of mental health treatment receipt included: mental health problems, college education, health insurance, and White ethnicity. Predictors of substance use treatment receipt were: illicit drug abuse/dependence, alcohol dependence, comorbid anxiety/depression, White ethnicity, and urban residency. Compared to Whites, nonWhite pregnant women with mental health and/or substance use disorders had lower odds of receiving mental health treatment.

Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

1. Ximena Sanchez-Samper, MD* 2. John R. Knight, MD* 1. *Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, Mass After completing this article, readers should be able to: 1. Discuss current trends in adolescent substance use and the specific substances used most commonly among 8th, 10th, and 12th graders. 2. Identify risk and protective factors, including genetic and environmental correlates, for the initiation of substance use in adolescents. 3. Discuss the most common concomitant mental health disorders and how they can affect the course of diagnosis and treatment for substance abuse. 4. Delineate the variety of treatment options available. 5. Describe the role of the pediatrician in educating patients and families on substance abuse prevention; performing screening and initial assessments; and providing support, brief counseling, or referrals for in-depth treatment. Adolescence is a time of physical, emotional, and psychological maturation as well as a period of searching for independence and experimentation. One area of experimentation associated with adolescence is substance use. (1) Although many adolescents experiment with drugs and alcohol from time to time without enduring problems, those who develop the disorders of substance abuse and dependence make substance use a major public health concern. The Monitoring the Future Study (MTFS) is a nationwide survey measuring smoking, drinking, and illicit drug use among nearly 50,000 8th, 10th, and 12th graders in more than 400 secondary schools in the United States each year. (2)(3) According to the 2006 overview of findings from the MTFS, approximately one fifth (21%) of today's 8th graders, more than one third (36%) of 10th graders, and nearly half (48%) of all 12th graders reported using an illicit drug at least once during their lifetimes. Despite a minimum legal age requirement to purchase alcohol, 6% of 8th graders, 19% of the 10th graders, and 30% of the 12th graders self-reported drunkenness during the month prior to being interviewed. (2)(3) Among the problems experienced by adolescents who use alcohol and drugs are …

Alcohol Use and Anxiety: Diagnostic and Management Issues

This study estimated how patterns of substance use are related to work status, public program use, and well-being among a sample of female caregivers and children. This study assessed work, public program use, and well-being measures as a function of substance use among 1,623 female caregivers of children aged zero to four or ten to 14 who participated in the Welfare of Children and Families study and lived in low- and moderate-income neighborhoods in Boston, Chicago, and San Antonio. Data were analyzed from baseline interviews that were conducted from March through December 1999 and from follow-up interviews that were conducted 11 to 26 months after baseline (average of 16 months). Substance use patterns were placed into three categories: light or no substance use reported in both interviews, moderate or heavy substance use (that is, moderate or heavy use in both interviews or increased substance use during the study period), and reduced substance use during the study period. Among caregivers who reduced their substance use, measures of work status, receipt of income assistance, mental health symptoms, and reports of child behavior problems were not significantly different at follow-up from those of caregivers with light or no substance use. At follow-up, compared with caregivers with light or no substance use, those with moderate or heavy substance use were significantly less likely to experience improvements in mental health symptoms and to see improvements in their children's behavioral problems. Caregivers with moderate or heavy substance use were more likely to be "detached" (p=.051)--that is, neither working nor collecting income assistance--although this difference was only marginally significant. Caregivers with increased substance use fared poorly on measures of well-being and work. Policies that promote, rather than impede, reductions in substance use are more likely to promote self-sufficiency and well-being.

Objective-This retrospective cohort study examined the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice, the nation's largest state prison system. Methods-The study population included all 8,149 inmates who were released under parole supervision between September 1, 2006, and November 31, 2006.An electronic database was used to identify inmates whose parole was revoked within 12 months of their release.The independent risk of parole revocation attributable to psychiatric disorders, substance use disorders, and other covariates was assessed with logistic regression analysis.Results-Parolees with a dual diagnosis of a major psychiatric disorder (major depressive disorder, bipolar disorder, schizophrenia, or other psychotic disorder) and a substance use disorder had a substantially increased risk of having their parole revoked because of either a technical violation (adjusted odds ratio [OR]=1.7,95% confidence interval [CI]=1.4-2.4) or commission of a new criminal offense (OR=2.8,95% CI=1.7-4.5) in the 12 months after their release.However, parolees with a diagnosis of either a major psychiatric disorder alone or a substance use disorder alone demonstrated no such increased risk.Conclusions-These findings highlight the need for future investigations of specific social, behavioral, and other factors that underlie higher rates of parole revocation among individuals with co-occurring serious mental illness and substance use disorders.Over the past four decades the widespread deinstitutionalization of persons with serious mental illness (1-3), the increase in drug-related arrests (4,5), and the reduction of community-based mental health care (1,2) have resulted in a substantial overrepresentation of persons with serious mental illness in the U.S. correctional system (1,2,6).Approximately 10% to 20% of U.S. prison inmates are estimated to have an axis I major mental disorder of thought or mood, such as major depressive disorder, bipolar disorder, or schizophrenia (7-12).Moreover, a majority of inmates with serious mental illness have a comorbid substance use disorder (7,(12)(13)(14)(15).A number of investigations have examined predictors of recidivism among released inmates (16)(17)(18)(19).Although results of these studies-conducted throughout a variety of criminal justice

Following efforts made in recent years to provide effective mental health treatments based on evidence-based guidelines, a working definition was developed in the literature detailing a minimum level of "adequate mental health care" for serious mental illness. However, little is known about racial or ethnic disparities in receipt of adequate mental health care for individuals affected with serious mental illness. The objective of this study was to examine disparities among Caucasian and Hispanic youths in receipt of adequate mental health care for past-year major depressive episodes. Data for this study were drawn from the 2005 National Survey on Drug Use and Health. The study sample was composed of 1,169 Caucasian youths and 316 Hispanic youths aged 12 to 17 with past-year major depressive episodes. The percentages of youths in the sample who received adequate mental health care for past-year major depressive episodes were estimated, and the correlates of receipt of adequate mental health care were examined. Thirty-four percent of the full sample received adequate mental health care for past-year major depressive episodes, but separate analyses indicated that adequate mental health care was received by a significantly higher proportion of Caucasian youths (36%) than Hispanic youths (27%). The odds of receiving adequate mental health care for past-year major depressive episodes for Caucasians were 1.55 times that of Hispanics (p=.01). Having Medicaid or coverage via the State Children's Health Insurance Program significantly increased the odds of receiving adequate mental care for past-year major depressive episodes for both Hispanics and Caucasians. As mental health problems of adolescents from diverse racial or ethnic backgrounds become more easily identified and a larger proportion of these groups is referred to mental health treatment services, it is important to examine the degree to which treatment should be tailored to engage and retain specific racial or ethnic groups so that they will receive the minimum of adequate mental health care.