Using Machine Learning to Predict Features Within Substance Use Disorder Treatment Service Settings That Increase the Likelihood of Positive Treatment Outcomes.

Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors. Mental health nurses often describe role confusion in relation to other health professionals. Opportunities for interdisciplinary communication with other professionals may benefit health care. The current large-scale study is the first to investigate whether mental health and SUD nurses' perceptions of their opportunities to accommodate patients' needs are related to interdisciplinarity in the treatment unit and a nursing role with clearly defined responsibilities. Strong interdisciplinarity was associated with greater perceived opportunities to accommodate patients' psychosocial, somatic, and economic and legal needs, while strictly defined nursing roles/responsibilities were related to weaker opportunities to do so. The findings highlight the need to address how mental health and SUD nurses organize practice to meet patients' diverse needs Interdisciplinary teamwork could strengthen nurses' ability to address patient needs Finding the best possible balance of providing service in teams or individually could improve resource utilization at the same time as strengthening patient care, and making sure that the patients' various needs are met. INTRODUCTION: Nurses' roles in specialist mental health and substance use disorder (SUD) treatment services are multidimensional and complex. Their responsibility, autonomy and interdisciplinary collaboration may be of importance for their perceived opportunities to accommodate patients' health needs. Previous studies of interdisciplinarity and nursing responsibilities have mainly focused on outcomes such as patient safety, job satisfaction and organizational factors, and included relatively small samples. The studies have also mainly been conducted in other sectors than the mental health and SUD nursing sectors. The aim of this study is to examine the associations between nurses' roles, interdisciplinarity and their perceived opportunities to accommodate patients' psychosocial, somatic and economic/legal needs. A cross-sectional web-based questionnaire survey was conducted in a nationwide sample of Norwegian nurses in the mental health, SUD treatment and combined mental health and SUD treatment sectors. Of 5,501 contactable nurses (74% of the population), 1918 (35%) responded. The results revealed that interdisciplinarity was significantly associated with greater perceived opportunity to accommodate patient needs, whereas strictly defined nursing roles/responsibilities were associated with less opportunity to accommodate these needs. Facilitation of interdisciplinary collaboration may improve quality of care for patients in mental health and SUD treatment services.

Despite the high prevalence of tobacco use among people with substance use disorder (SUD), tobacco cessation is not a routine part of SUD treatment in South Africa. No studies have explored how people receiving SUD treatment view the effects of tobacco use on SUD treatment or their barriers to tobacco cessation. Clinicians need this information to develop locally relevant, person-centred tobacco cessation interventions. To address this gap, this study aimed to explore perceptions of tobacco use and its impact on SUD recovery among people receiving SUD treatment in South Africa. In-depth interviews were conducted with 20 participants (14 males, 6 females) recruited from five outpatient SUD treatment programmes in Cape Town, South Africa. On average, participants were 34.6 years old (SD = 10.1) and began smoking tobacco when 13.4 years old (SD = 2.6). At the time of the study, 40.0% (n = 8) had quit tobacco. Interviews explored experiences of tobacco use and its impact on SUD recovery. Data were analysed using reflexive thematic analysis. The analysis generated four themes: (1) tobacco interconnects with other substance use; (2) psychosocial functions of tobacco: identity, connection and coping; (3) detrimental impact on SUD recovery; and (4) ambivalence about tobacco cessation, despite acknowledged benefits. Participants reported that their tobacco use intertwined with and reinforced their substance use, heightening cravings and impacting efforts to remain abstinent. Participants identified barriers to cessation that included using tobacco as a coping mechanism and as a tool for social connection, difficulties managing physiological withdrawal symptoms, and limited cessation support within SUD treatment and their social environments. Findings highlight the need for tobacco cessation interventions within South Africa's SUD services. To overcome psychosocial and physiological barriers, SUD services should consider providing pharmacological interventions, psychosocial and behavioural counselling, and social support for tobacco cessation. Integrating these interventions into SUD treatment services could improve tobacco cessation rates and recovery outcomes for South Africans with SUDs.

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.

There has been an increase in problematic substance use among women, yet little is known about their access to substance use disorder (SUD) treatment services. This qualitative study employed an exploratory-descriptive research design to examine the availability and scope of treatment services for women in the Limpopo Province of South Africa. Data was collected through telephonic interviews with 20 social workers employed by the Department of Social Development in Limpopo Province and analyzed using thematic content analysis. Findings revealed that there is no standardized treatment specifically for women, and the available government treatment facility in Limpopo Province is not sufficient for the demand that arises from women in need of SUD treatment services. The study suggests that increased government investment in SUD treatment facilities and services is essential to improve treatment access for women in need of these services.

Substance use disorder treatment carve outs in Medicaid managed care

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

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

IntroductionPatient-centered treatment and care is a key quality standard within substance use disorder (SUD) treatment services. Patient-Reported Outcome and Experience Measures (PROMs and PREMs) allow us to collect direct feedback from patients on how they perceive health outcomes and quality of care in a systematic way.ObjectivesTo identify current practices regarding the use of PROMs and PREMs in clinical practice in SUD treatment services and to develop an electronic self-report tool for routine assessment of PROMs and PREMs in SUD treatment services in Belgium.MethodsWe present results from a scoping review, identifying studies reporting on the use and routine implementation of PROMs and PREMs in SUD services. Additionally, preliminary results from a naturalistic longitudinal multicenter study assessing self-reported sociodemographic characteristics, clinical factors, PROMs, and PREMs in N=189 adults who recently started treatment for SUD in various treatment modalities are presented: the OMER-BE study (Outcome Measurement and Evaluation as a Routine practice in alcohol and other drug services in Belgium).ResultsThere is an increasing use of patient-reported measures in SUD services. However, there is large variation in the patient-reported measures that are used, how they are developed, and how and when patient-reported data are collected. The most important barriers and facilitators to the implementation of PROMs and PREMs in clinical practice include burden to and involvement of staff, and leadership and technical support. Alcohol and cocaine were the most commonly used substances among participants of the OMER-BE study, with 59.7% of participants reporting polysubstance use. The 45-, 90-, and 180-day follow-up assessments were completed by 64%, 59% and 54% of participants respectively. At 180-day follow-up, 56% of respondents were still in treatment for SUD.ConclusionsGuidance is needed to support clinicians in selecting and implementing valid, meaningful, and comparable patient-reported measures to understand and benefit from the impact that PROMs and PREMs can have on treatment quality and outcome. The OMER-BE study provides an example of the insights that can be gained into patient needs through the use of an electronic self-report tool assessing PROMs and PREMs.Disclosure of InterestC. Migchels: None Declared, W. van den Brink Consultant of: Wim van den Brink reports a consulting/advisory relationship with Takeda Pharmaceutical Company Limited, Camurus AB, and Clearmind Medicine., A. Zerrouk: None Declared, W. Vanderplasschen: None Declared, C. Crunelle: None Declared

BackgroundInterventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives.MethodWe analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment.ResultsOverall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes.ConclusionThis study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance.

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. …

Prescription drug monitoring programs increase racial/ethnic inequities in unmet demand for substance use disorder treatment among people who inject drugs. A repeated cross-sectional analysis of people who inject drugs in 13 states in 2012, 2015, 2018, and 2022.

Patient-centred care (PCC) is considered crucial for high-quality substance use disorder (SUD) treatment and care, but it is unclear whether PCC is associated with enhanced outcomes. This review aimed to map available evidence of the relationship between PCC and outcomes across the SUD treatment continuum. We conducted a scoping review of the literature on the relationship between PCC for SUD and service outcomes in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Six electronic databases were searched for peer-reviewed articles published in English between January 1994 and June 2024. After screening 5268 titles and abstracts and 186 full texts in duplicate, data were extracted from 135 articles and narratively synthesized according to six PCC dimensions (therapeutic alliance, shared decision-making, personalised supports, integrated care for co-occurring disorders, trauma-informed and culturally-informed care). The findings from this review suggest largely positive associations between these PCC components and the outcomes of generalist and specialist SUD services. Few studies (<1 %) assessed more than one PCC dimension. The therapeutic alliance was the most frequently assessed dimension (35.6 %, 48/135 articles), followed by shared decision-making (16.3 %, 22/135 articles), trauma-informed care (14.8 %, 20/135 articles), integrated care (13.3 %, 18/135 articles), and personalised services (13.3 %, 18/135 articles). PCC in generalist services was associated with greater SUD treatment utilization and fewer adverse events. PCC in specialist SUD treatment was largely associated with better SUD outcomes. This review highlighted evidence gaps on the relationship between PCC and SUD service outcomes, with literature scant for some PCC dimensions and studies typically examining a single dimension of PCC. More research is needed to understand the relative importance of each PCC dimension for predicting SUD service outcomes, how these dimensions interact to influence outcomes, and to develop and evaluate interventions for enhancing PCC.

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.

Aims:We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services’ utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year.Methods:We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed.Results:CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = −1518, −391) and reduced days of detox utilization by about 1.0 days (95% CI = −1.9, −0.1) among HFS.Conclusion:Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.

An ever-increasing cultural diversification within American society has resulted in variegated dialogues involving different cultural backgrounds, beliefs, values, practices, behaviors, and/or languages. These demographic changes combined with the complexities of contemporary racism, racial prejudice, and/or cultural miscommunication have impacted the level of addiction treatment needs for communities of color, in particular, African American and Hispanic communities. This lack of recognition of cultural differences has often led to the development and implementation of ineffective, inefficient, and inequitable substance use disorder (SUD) treatment services. Cultural competency is necessary for the effectiveness of delivery and the quality of services; however, studies have shown that some SUD treatment organizations have failed to adequately understand African American and Hispanic clients with regard to their treatment needs. To facilitate in the process of improving SUD treatment services for African American and Hispanic communities, this chapter will discuss challenges associated with SUDs by gender via the identified groups. The chapter will also explore risk factors, cultural issues, and complexities in diagnosing SUDs and co-occurring disorders (i.e., alcohol or drugs and mental health). Finally, treatment recommendations and service models that have shown to be effective when working with these two communities of color will also be presented.