Treatment for mental health and substance use

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

Understanding predictors of mental health and substance use treatment utilization among US adults: A repeated cross-sectional study

To explore predictors of mental health and substance use treatment receipt in pregnant women in the USA. Secondary analysis of data from the 2008–2014 National Survey on Drug Use and Health was conducted. Two logistic regression models were run to identify predictors of mental health treatment receipt among pregnant women aged 18–44 years with mental health problems (N = 1106) and predictors of substance use treatment among pregnant women with substance use disorders (N = 521). Forty four percent of pregnant women with mental health problems received mental health treatment, and only 13% of pregnant women with substance use disorders received substance use treatment. Women with anxiety disorder (vs. no disorder) (adjusted odds ratio (AOR): 17.3, 95% Confidence Interval (CI): 8.6–34.8), major depression (vs. no depression) (AOR: 2.48, 95% CI: 1.44–4.27), higher level of serious psychological distress (AOR: 1.06, 95% CI: 1.003–1.12), college (vs. less than high school) education (AOR: 2.84, 95 %CI: 1.36–5.91), and health insurance coverage (vs. no coverage) (AOR: 2.34, 95% CI: 1.16–4.71) had higher odds of mental health treatment receipt. African American (AOR: .38, 95% CI: .20–.74) and Hispanic women (AOR: .17, 95% CI: .05–.59) had lower odds for mental health treatment relative to Whites. The best set of predictors of substance use treatment receipt included NonWhite (vs. White ethnicity) (AOR: .39, 95% CI: .19–.80), large (vs. small urban) residency (AOR: 4.38, 95% CI: 1.84–10.45), alcohol and illicit drug use disorders (vs. no disorder) (AOR: 2.92, 95% CI: 1.48–5.78; AOR: 8.70, 95% CI: 3.32–22.76; respectively), and comorbid anxiety/depression disorder (vs. no disorder) (AOR: 3.13, 95% CI: 1.40–7.02). The common barriers reported by pregnant women who perceived unmet need for mental health treatment included perceived cost, opposition to treatment, and stigma, regardless of their disorder. The majority of pregnant with mental health/substance use disorders do not receive treatment. More policy and treatment initiatives that address barriers to and predictors of treatment receipt are needed to help this vulnerable population of pregnant women to gain access to mental health and substance use treatment.

Veterans diagnosed with mental health and/or substance use disorders (SUD) often face significant barriers to employment and reintegration into civilian society. In the current study, we investigated whether how the VA healthcare system for mental health and/or SUD treatment predicted program enrollment into vocational rehabilitation, simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation predicted employment at discharge, and mental health and/or SUD treatment continues and employment remain 60-days-post-vocational-rehabilitation discharge. An outcome-based, summative program evaluation design to measure quality assurance of vocational rehabilitation services provided to 402 veteran patients enrolled in a VA healthcare located within the Great Lakes Health Care System - Veterans Integrated Services Network. Multivariable logistic regression analyses showed psychological empowerment (confidence in one's ability to work or find work) is a significant factor determining whether a veteran is enrolled in the vocational rehabilitation program, prior mental health treatment (yes/no) and frequency of mental health treatment did not predict program enrollment, and frequency of SUD VA system treatment 60 days prior did not predict program enrollment. Other findings showed that simultaneous mental health and/or SUD treatment while enrolled in vocational rehabilitation did not predict employment at discharge, and employment at discharge did not predict continued mental health and/or SUD treatment post-discharge from vocational rehabilitation. However, veterans with both SUD and mental health and continued mental health treatment were less likely to be employed. Utilization of real-world program evaluation data from an actual VHA vocational rehabilitation program enhances the study's ecological validity, offering practical implications for policymakers and practitioners in the field. The findings support the importance of veterans enrolling in mental health and/or SUD treatment simultaneously while enrolled in vocational rehabilitation services, as integrating vocational rehabilitation with mental health and SUD treatment services can lead to improved vocational and health outcomes for veterans (eg, development of targeted interventions to support veterans' successful reintegration into the workforce and society).

Purpose To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014. Methods Using data from the 2008–2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared. Results There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts. Conclusions There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.

Trends in Behavioral Health Care Service Provision by Community Health Centers, 1998–2007

Parole Revocation Among Prison Inmates With Psychiatric and Substance Use Disorders

Background: Persons using substances, living in rural communities, tend to underutilize mental health (MH) and substance use disorder (SUD) treatment compared with their urban peers. However, no studies have examined longitudinal predictors of MH and SUD treatment use among rural persons using stimulants. Methods: Data were collected through interviews conducted between 2002 and 2008 from a natural history study of 710 adults using stimulants and living in rural counties of Arkansas, Kentucky, and Ohio. Each study site recruited participants using respondent-driven sampling (RDS). Participants were adults, not in drug treatment, and reporting past-30-day use of methamphetamine, crack cocaine, or powder cocaine. Study participants completed face-to-face baseline assessments and follow-up interviews using computer-assisted personal interviews. Follow-up interviews were conducted at 6-month intervals for 3 years. Results: Our results show that being male, nonwhite, and having a prior lifetime history of MH or SUD treatment use were associated with lower odds of using MH and SUD treatment over time; having medical insurance and living in a state with potentially greater availability of MH and SUD treatment were associated with higher odds of using MH and SUD treatment over the 3-year period. Further, reporting greater legal problems and alcohol severity were associated with greater odds of using MH and SUD care, whereas greater employment problems was associated with higher odds of SUD but not MH treatment use. Conclusions: Findings from this study could be used to inform clinical and public health strategies for improving linkage to MH and SUD care in this population. Our findings also highlight the importance of having medical insurance as a potential facilitator to utilizing SUD care in this population and support the need for health care policies that increase the ability of rural adults who use stimulants to pay for such services.

Although monitoring of treatment response is standard practice for many medical conditions, practitioners in mental health treatments, and substance abuse treatment in particular, have been slow to adopt these practices. Progress monitoring (PM), consisting of measurement and feedback, has the potential to significantly improve treatment outcomes. This paper reviews the existing literature on the effects of PM in mental health and substance use disorder (SUD) treatment. Whereas previous reviews have examined aspects of PM in mental health treatment, this is the first such review to cover monitoring efforts in substance abuse treatment, conceptualized here as diverse forms of measurement-based care. To address drug use, monitoring in SUD treatment has typically relied on treatment attendance and urine screens as indicators of treatment progress. However, some research has shown that other means of PM can significantly improve SUD treatment effectiveness. Previous meta-analyses show that PM significantly improves outcomes in mental health treatment. More extensive research on three particular measures, demonstrate the effectiveness of PM in mental health treatment. With the growing focus on quality improvement in medical care, there is need for further research and adoption of progress monitoring methods in mental health and SUD treatment.

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009-2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.

Adults with mental health conditions are more likely than those without to receive long-term opioid therapy. Less is known about opioid therapy among adolescents, especially those with mental health conditions. To examine associations between preexisting mental health conditions and treatments and initiation of any opioid and long-term opioid therapy among adolescents. A cohort of 1 224 520 incident opioid recipients without cancer diagnoses aged 14 to 18 years at first receipt was extracted from nationwide commercial health care claims data from January 1, 2003, to December 31, 2014. Analysis was conducted from August 19, 2016, to November 16, 2017. Associations between preexisting mental health conditions and treatments and any opioid receipt were examined by comparing recipients with nonrecipients matched on sex, calendar year and years of age of first enrollment, and months of enrollment (prior to the index month for recipients, ever for nonrecipients). Associations between preexisting mental health conditions and treatments and subsequent long-term opioid therapy were examined among recipients with at least 6 months' follow-up using Cox proportional hazards regressions adjusted for demographics. Mental health condition diagnoses and treatments recorded in inpatient, outpatient, and filled-prescription claims prior to opioid receipt. Opioid receipt, defined as any opioid analgesic prescription claim, and long-term opioid therapy, defined as more than 90 days' supply within a 6-month window having no gaps in supply of more than 32 days. Of the 1 224 520 new opioid recipients included, the median age at first receipt was 17 years (interquartile range, 16-18 years), and 51.1% were female. Median follow-up after first receipt was 625 days (interquartile range, 255-1268 days). Adolescents with anxiety, mood, neurodevelopmental, sleep, and nonopioid substance use disorders and most mental health treatments were significantly more likely to receive any opioid (odds ratios from 1.13 [95% CI, 1.10-1.16] for nonopioid substance use disorders to 1.69 [95% CI, 1.58-1.81] for nonbenzodiazepine hypnotics). Among the 1 000 453 opioid recipients (81.7%) who had at least 6 months' follow-up, the cumulative incidence of long-term opioid therapy was 3.0 (95% CI, 2.8-3.1) per 1000 recipients within 3 years after first opioid receipt. All preexisting mental health conditions and treatments were strongly associated with higher rates of long-term opioid therapy (adjusted hazard ratios from 1.73 [95% CI 1.54-1.95] for attention-deficit/hyperactivity disorder to 8.90 [95% CI, 5.85-13.54] for opioid use disorder). Commercially insured adolescents with many types of preexisting mental health conditions and treatments were modestly more likely to receive any opioid and were substantially more likely to subsequently transition to long-term opioid therapy relative to those without, although overall rates of long-term opioid therapy were low.

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.

BackgroundMaternal mental health conditions are associated with unmet Social Determinants of Health (SDOH) needs and can impede access to mental health and substance use disorder (SUD) treatment, leading to poor maternal and newborn health outcomes. A text/phone-based maternal mental health screening and referral to treatment intervention, Listening to Women and Pregnant and Postpartum People (LTWP), has demonstrated improved rates of screening, screening positive for mental health concerns, referral to and attendance of mental health and SUD treatment compared to usual care (i.e., in-person screening and referral). It is unknown, however, if LTWP improves identification of individuals with unmet SDOH needs. This study examines rates of screening, screening positive, referral and attendance to mental health treatment among those with unmet SDOH needs compared to those not experiencing unmet SDOH needs.MethodsThis secondary analysis includes participants randomized to LTWP and endorsing one or more unmet SDOH need (n = 78) or no unmet SDOH need (n = 103) measured by the Accountable Health Communities Health-Related Social Needs Screening Tool via an online survey. Differences in groups' rates of completing a screening, screening positive, being referred to treatment and attending treatment were compared between groups using chi-square tests and relative risk as a measure of association. Adjustments for missing SDOH data via multiple imputations were performed for analysis of the full cohort of LTWP endorsing at least one unmet SDOH need (n = 106) or no unmet SDOH need (n = 118).ResultsAmong LTWP participants, 43.0% (78/181) reported at least one unmet SDOH need with financial strain (55.1% (43/78)), disabilities (34.6% (27/78)), and food insecurity (33.3% (26/78)) being the most frequently reported SDOH. On average, participants with SDOH needs were significantly younger (29.0 vs. 32.0 years), more likely to self-identify as non-Hispanic Black (42.3% vs 13.6%), and report a lower household annual income (33.3% vs 1.9% under $25,000), compared to those without SDOH needs. Those with SDOH needs were more likely to screen positive for mental health concerns (RR: 1.59; 95% CI: 1.21–2.09), be referred to (RR: 2.97; 95% CI: 1.36–6.48), and attend mental health treatment (RR: 2.64; 95% CI 1.04–2.73) compared to those without SDOH needs.ConclusionsThe LTWP intervention, a simple text- and phone-based screening approach with referral to care as needed, shows promise in increasing access to mental health and substance use treatment for individuals with unmet social determinants of health needs and demonstrates potential to enhance screening, identification, and treatment attendance rates for perinatal mental health disorders and substance use disorders compared to traditional in-person systems.

Mental Health and Substance Use Problems of Parents Involved With Child Welfare: Are Services Offered and Provided?

1. Sofya Maslyanskaya, MD* 2. Elizabeth M. Alderman, MD* 1. *Division of Adolescent Medicine, Children's Hospital at Montefiore, and Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY * Abbreviations: CDC: : Centers for Disease Control and Prevention EHR: : electronic health record EOB: : explanation of benefits HIPAA: : Health Insurance Portability and Privacy Act HIV: : human immunodeficiency virus SAHM: : Society for Adolescent Health and Medicine STD: : sexually transmitted disease Confidentiality protections are critical in the provision of comprehensive primary care of adolescent patients. The protections differ based on state laws and are limited by electronic health record documentation and billing operations of individual physician practices. Physicians need to strive to increase their knowledge regarding confidentiality protections for their adolescent patients. Moreover, physicians should understand their role in preventing possible confidentiality breaches. After completing this article, readers should be able to: 1. Define confidentiality, its limitations, and reasons for developmentally appropriate confidentiality protections for adolescents. 2. Recognize confidentiality protections for adolescents provided by state and federal laws, including the Health Insurance Portability and Privacy Act privacy rule. 3. Explain minor consent laws. 4. Describe the limitations and advantages of the electronic health record in providing confidentiality protections. 5. Identify concerns and solutions related to billing for confidential services. A 16-year-old girl who has been your patient since birth presents to an appointment alone and requests testing for sexually transmitted diseases (STDs). She also does not want her parents to find out about this visit. How would you proceed? ### Confidentiality and Autonomy The provision of confidentiality and the ability of adolescents to consent for certain health concerns are the cornerstone of optimal adolescent health-care. (1) According to this tenet, information about an adolescent’s health-care is not disclosed without his or her permission. Assurance of confidentiality is important to protect the adolescent’s health and to safeguard public health. The major causes of morbidity and mortality in adolescents are due to risky behaviors such as sexual activity and alcohol and substance use, as well as unmet mental health needs. During the past 3 decades, research has supported the importance of the …