Abuse Treatment Need Research Articles

Utilization of Pastoral Care Services for a Screening, Brief Intervention, and Referral-to-Treatment Program at an Urban Level I Trauma Center

Excessive alcohol consumption is currently the third leading cause of preventable death within the United States, accounting for roughly 80,000 deaths each year. 1 Maier RV Controlling alcohol problems among hospitalized trauma patients. J Trauma. 2005; 50: S1-S2 Crossref Scopus (19) Google Scholar Excessive alcohol consumption also takes a toll on hospitals and health care centers, specifically emergency departments and trauma units. Each year, over 20 million adults in the United States sustain injuries requiring emergency care, and 15% to 20% screen positive for alcohol. 2 Rockett IH Putnam SL Jia H et al. Assessing substance abuse treatment need: a statewide hospital emergency department study. Ann Emerg Med. 2003; 41: 802-813 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar , 3 Teplin LA Abram KM Michaels SL Blood alcohol level among emergency room patients: a multivariant analysis. J Stud Alcohol. 1989; 50: 441-447 PubMed Google Scholar , 4 Soderstrom CA Session 2: substance-abuse interventions—setting the stage for discussion. J Trauma. 2005; 59: S77-S79 Crossref PubMed Scopus (8) Google Scholar , 5 Hungerford DW Recommendations for trauma centers to improve screening, brief intervention, and referral to treatment for substance abuse disorders. J Trauma. 2005; 59: 537-542 Google Scholar These figures increase further within the trauma department, where up to half of all trauma accidents are linked to alcohol use (25%-50%). 4 Soderstrom CA Session 2: substance-abuse interventions—setting the stage for discussion. J Trauma. 2005; 59: S77-S79 Crossref PubMed Scopus (8) Google Scholar , 5 Hungerford DW Recommendations for trauma centers to improve screening, brief intervention, and referral to treatment for substance abuse disorders. J Trauma. 2005; 59: 537-542 Google Scholar , 6 Babor TF McRee BG Kassebaum PA Grimaldi PL Ahmed K Bray J Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28: 7-30 Crossref PubMed Scopus (673) Google Scholar Tiffany L. Overton is Trauma Research Associate, JPS Health Network, Fort Worth, TX. Gary Williams is SBIRT Program Coordinator, JPS Health Network, Fort Worth, TX. Shahid Shafi is Consultant, JPS Health Network, Fort Worth, TX. Rajesh R. Gandhi is Trauma Medical Director, JPS Health Network, Fort Worth, TX.

Using the Massachusetts Youth Screening Instrument–Version 2 on a Community Sample of African American and Latino/a Juvenile Offenders to Identify Mental Health and Substance Abuse Treatment Needs

The Massachusetts Youth Screening Instrument–Version 2 (MAYSI-2) is a brief screening tool used to identify youth in the juvenile justice system who are at-risk of mental-health-related difficulties. The MAYSI-2 was administered to 5,205 African American and Latino/a youth throughout Chicago, Illinois, who were on probation and residing in the community. This study investigated differences (i.e., legal status, gender, age, race/ethnicity) in reporting of mental health symptoms and substance use on the MAYSI-2. Females scored above the clinical cutoffs more frequently than males, and there were few differences found between diverted and adjudicated youth. Age comparisons revealed mixed results. Overall, youth in the current sample scored above the clinical cutoffs less often than youth in the MAYSI-2 norm reference groups. Nonetheless, during the first phase of this study, the MAYSI-2 demonstrated effectiveness by accurately identifying a substantial portion of youth in need of mental health and/or substance abuse treatment.

Moving toward Trauma-Informed Practice in Addiction Treatment: A Collaborative Model of Agency Assessment

Clients in substance abuse treatment need, in addition to evidence-based and sensitive treatment services in general, a system of care that takes into account the impact of trauma and violence in so many of their lives. In addition, services need to be delivered in a way that avoids triggering trauma memories or causing unintentional re-traumatization. To that end, this article describes an agency self-assessment process that combines a trauma-informed assessment, a NIATx process of “walking-through” and use of the Institute of Healthcare Improvement's Plan-Do-Study-Act (PDSA) cycles, and a user-friendly format. The trauma-informed assessment is designed to address issues of safety of clients and staff members, reduction of re-traumatization, consistency in practice, and client empowerment. It brings a non-judgmental, collaborative approach to process and practice improvement. The article describes how the assessment process can be—and has been—used to develop an Action Plan, including trainings and the identification of “trauma champions”; i.e., staff who will continue to spread trauma-informed changes and new evidence-based practices throughout the agency. As we enter a period of healthcare reform, addressing trauma as an integral part of addiction treatment also allows us to better deal with the totality of our clients’ health problems.

Unmet Mental Health and Substance Abuse Treatment Needs of Sexual Minority Elders

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55–64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Predictors of substance abuse treatment need and receipt among homeless women

Many homeless women do not receive needed treatment for substance abuse. This study identified social network and other predisposing factors associated with perceived need for and receipt of substance abuse treatment among 273 homeless women who screened positive for past-year substance abuse. Perceived treatment need was more likely among women with drug-using sex partners, a denser network, and an arrest history but less likely for those with a minor child and a longer history of homelessness. Receiving treatment was more likely among women who received informational support from their sex partners and who had an arrest history but less likely among those who had a more street-based social network, had a minor child, considered themselves homeless, and recently needed mental health treatment. Treatment services researchers should attend more closely to social contextual factors, as well as the more traditional individual factors, to understand access and barriers to treatment.

A influência da comorbidade com transtornos alimentares na apresentação de mulheres dependentes de substâncias psicoativas

A associação entre transtornos alimentares e dependência de substâncias é freqüente na prática clínica. Apesar de já existirem dados sugestivos de que essa associação possa sinalizar maior severidade nos distúrbios psiquiátricos e clínicos das pacientes, poucas pesquisas avaliaram sua influência no tratamento. Oitenta mulheres dependentes de álcool e drogas que procuraram tratamento em um programa exclusivo para mulheres foram avaliadas por meio da Entrevista Clínica Estruturada para o DSM-IV (SCID), do ASI, e de um questionário padronizado para a coleta de dados sociodemográficos e relativos ao uso de substâncias psicoativas. As 27 (33,75%) pacientes que tinham transtornos alimentares presentes (grupo com TA) foram comparadas com as 53 (66,25%) que não tinham essa comorbidade (grupo sem TA). Os resultados mostraram que o grupo com TA teve problemas com drogas de maneira mais precoce, era significativamente mais jovem e tinha maior severidade no uso destas que o grupo sem TA. As diferenças encontradas, bem como a alta prevalência dos transtornos alimentares não formais, enfatizam a importância de uma avaliação detalhada dos transtornos alimentares em pacientes dependentes de substâncias psicoativas que buscam tratamento. A fim de planejar abordagens terapêuticas efetivas, essas diferenças e, principalmente, a influência da comorbidade entre transtornos alimentares e dependência de substâncias psicoativas no tratamento da dependência química precisam ser investigadas no futuro.

The Substance Abuse Treatment Needs of Prisoners

Studies have demonstrated that treatment for drug-involved offenders can reduce relapse and recidivism. However, few institutions utilize validated assessments of drug dependence, limiting the ability to determine and prioritize services. Toward this goal, we explain an assessment method implemented statewide using a sample of 22,069 prisoners. Our purpose is to demonstrate best practice standards for screening and placement, and to disseminate information on the implementation process and data from the statewide screening, so that others may adapt similar procedures in their institutional environments. Six steps in the process are detailed with a brief summary of the efficacy of the new procedure.

Unmet substance abuse treatment need, health services utilization, and cost: A population-based emergency department study

There is a high prevalence of unmet substance abuse treatment need among adult hospital emergency department (ED) patients. We examine the association between this unmet need and excess utilization of health services and estimate costs. A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Toxicologic screening augmented in-person interviews. Main outcome measures were ED case disposition; frequency of physician office visits, ED visits, and hospitalizations in the past 12 months; and costs of excess service utilization. Covariates in the multivariate model were substance abuse treatment need status, age, sex, main reason for ED visit, perceived previous health status, history of tobacco use, and health care coverage. Unmet substance abuse treatment need was assessed using 13 overlapping criteria that incorporated use, dependence, denial, and treatment history. Target substances included ethanol and selected illegal and prescription drugs but not nicotine. Compared with patients without substance abuse treatment need (n=1,073), patients with unmet need (n=415) were 81% more likely to be admitted to the hospital during their current ED visit (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.27 to 2.64) and 46% more likely to have reported making at least 1 ED visit in the previous 12 months (OR 1.46; 95% CI 1.12 to 1.84). Their utilization patterns accounted for an estimated 777.2 million US dollars in extra hospital charges for Tennessee in 2000 dollars, representing an additional 1,568 US dollars per ED patient with unmet substance abuse treatment need. ED patients with unmet substance abuse treatment need generated much higher hospital and ED charges than patients without such need. Given potential savings from avoidable health care costs, the future burden of substance-associated ED visits and hospitalizations may be reduced through programs that screen and, as appropriate, provide brief interventions or treatment options to these patients.

Substance abuse treatment needs and access in the USA: interstate variations.

This study investigated interstate substance abuse treatment needs and access in the USA. After assessing the validity of recently developed survey and indicator measures, the study analysed the geographic distribution and nature of state substance abuse treatment needs. Substance abuse treatment utilization index scores were regressed on the need measurements to identify differences among state populations in treatment access. The interstate substance abuse treatment need measures had evidence of reliability and construct validity. Treatment needs clustered in stable, distinct geographic patterns. The most severe problems, primarily reflecting alcoholism, were in the west. Drug and alcohol substance use disorders and related problems were not significantly correlated at this level of aggregation. There was evidence of regionalization of the drug-of-choice mix in treatment admissions. Only 21% of the variations in state treatment utilization rates stemmed from the prevalence of substance use disorders and related problems. The biggest treatment gaps were in the south and south-west, regions with large minority populations. Development of interstate survey and indicator measures of treatment needs has created new opportunities to broaden our understanding of substance abuse epidemiology and treatment access in the USA. The nature and severity of drug and alcohol problems vary from state to state, but the interstate disparities in treatment services remain even after variations in treatment need have been discounted. Further research is needed to understand the causes of these differences in treatment access.

Treatment need and utilization among youth entering the juvenile corrections system

Relatively little is known about the substance abuse treatment need patterns and experiences of youth incarcerated in the United States juvenile justice system. To address this issue, four analytic questions concerned with understanding the predictors of treatment need and utilization patterns among adolescents entering the juvenile corrections system are examined. Data analyzed were collected as part of a face-to-face survey of 401 youth who entered the Illinois juvenile correctional system in mid-2000. Overall, need for treatment and treatment utilization each were predicted by sets of social environmental and personal characteristics, in addition to several sociodemographic variables. Less than half of youth with an identified need for treatment reported receiving treatment. Considerable variability in the effects of demographic and social environmental indicators on treatment need and utilization across race groups also was observed. These findings underscore the need for the continual development of the cultural competence of treatment providers and the expansion of onsite provision of substance abuse treatment services to incarcerated juveniles.

Assessing substance abuse treatment need: A statewide hospital emergency department study

Study objective: Health care providers in hospital emergency departments rarely take substance abuse histories or assess associated treatment need. This study compares documentation of psychoactive drug-related diagnoses for adult ED patients in medical records with treatment need assessed through self-report, toxicologic screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) , criteria. Methods: A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Main outcome measures were the prevalence of diagnosed substance abuse problems, positive bioassay results, denied use, and treatment need. Sensitivity and multivariate analyses were conducted by using varied case definitions of treatment need. Results: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of screened ED patients (n=1,330) had positive test results for substance use. Their prevalence of denial of use in the 30 days before the survey ranged from 10% for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast, as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse treatment on the basis of a comprehensive case definition that accounted for denial and positive test results. A sensitivity analysis using other case definitions is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the very strict definition of DSM-IV current drug dependence only. Under the comprehensive case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30 to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed excess treatment need relative to the privately insured. Excess need was also exhibited by patients reporting 1 or more prior ED visits in the past year (adjusted OR 1.62; 95% CI 1.13 to 2.31) and by patients taking 2 or more hours to reach the ED after the onset of injury or illness (adjusted OR 1.54; 95% CI 1.16 to 2.04). Treatment need was inversely associated with age. Irrespective of case definition, less than 10% of ED patients who needed substance abuse treatment were receiving such treatment. Conclusion: EDs can be important venues for detecting persons in need of substance abuse treatment. [Ann Emerg Med. 2003;41:802-813.]

Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort

Background: There is concern that as the baby boom population ages in the US, there will be a substantial increase in the number of older adults needing treatment for substance abuse problems. To address this concern, projections of future treatment need for older adults (defined as age 50 and older) were made. Methods: Using data from the National Household Survey on Drug Abuse, regression models including predictors of treatment need in 2000 and 2001 were developed. Treatment need was defined as having a DSM-IV alcohol or illicit drug use disorder in the past year. Regression parameters from these models were applied to the projected 2020 population to obtain estimates of the number of older adults needing treatment in 2020. Results: The number of older adults in need of substance abuse treatment is estimated to increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020. This is due to a 50 percent increase in the number of older adults and a 70 percent increase in the rate of treatment need among older adults. Conclusions: The aging baby boom cohort will place increasing demands on the substance abuse treatment system in the next two decades, requiring a shift in focus to address the special needs of an older population of substance abusers. There is also a need to develop improved tools for measuring substance use and abuse among older adults.

Measuring Substance Abuse Treatment Need Among Adults in Florida: A Social Indicators Approach

Determining the size and demographiccharacteristics of substance abuse populationsis extremely important for implementing publicpolicies aimed at the control of substanceabuse. Such information not only assists in theallocation of limited treatment resources bythe state, but also in the monitoring ofsubstance abuse trends over time and in theevaluation of innovative policy initiatives. Inthis study, we develop three composite measuresof treatment need. We then use these measuresto estimate treatment need for alcohol abuseand for controlled substance abuse within eachof Florida's 67 counties. This study providesan important empirical component of communityplanning, quantifying and, to a limited degree,specifying the level of need for the substanceabuse treatment of community residents. Anadditional benefit is the development of a costeffective and unobtrusive methodology fordetermining empirically when levels of need arechanging so that treatment levels can beadjusted accordingly. With proper use,policymakers can readily employ the methodologydeveloped in this study in Florida andelsewhere to make better-informed decisions inthe allocation of finite substance abusetreatment resources.

A new brief screen for adolescent substance abuse.

To develop a brief alcohol and other drug (AOD) screening test for adolescents. A 9-item test was constructed by combining and modifying items from several AOD assessments, and administered concurrently with the Personal Involvement With Chemicals Scale (PICS), the criterion standard. A hospital-based adolescent clinic. Fourteen- to 18-year-old patients consecutively arriving for routine medical care who were known to have used AOD. Internal consistency of the 9 items was calculated using the Cronbach alpha. The relationship between the brief screen and PICS raw score was determined by stepwise linear regression analysis. The PICS T score has been shown to correctly classify substance abuse treatment need as no treatment (T<35), brief office intervention (T = 35-40), outpatient or short-term treatment (T = 41-54), and inpatient or long-term treatment (T> or =55). Sensitivity and specificity rates for predicting a PICS T score of 55 or higher were calculated from 2 x 2 tables. Ninety-nine adolescents were tested (70.7% female, 36.4% black, 32.3% white, 19.2% Hispanic, mean age, 16.3 years). The 9 items had good internal consistency (Cronbach alpha = .79). Stepwise linear regression analysis identified 6 items whose total combined score was highly correlated with PICS (Pearson r = 0.84, P<.01). This model correctly classified 86% of subjects according to the PICS criteria. Two or more yes answers had a sensitivity of 92.3% and specificity of 82.1% for intensive AOD treatment need. The 6 items were arranged into a mnemonic (CRAFFT). Further research must confirm the test's psychometric properties in a general clinic population. However, CRAFFT seems promising as a brief AOD screening test.

Marijuana initiates and their impact on future drug abuse treatment need

This paper presents estimates of the number of people who will need treatment for illicit drug abuse problems for the years 2000 through 2020. The methodology employs logistic regression models, with treatment need as a dependent variable, using data from lifetime marijuana users included in the National Household Survey on Drug Abuse. Age at first use of marijuana was found to be the most important predictor in these models. Other variables included in the models were age, gender, and race/ethnicity. By generating estimates under alternative assumptions about future rates of initiation, it was projected that if current rates of initiation continue, treatment need will increase by 57% by 2020, and that the need for treatment will remain high even if initiation rates decrease dramatically, because of the aging baby boom cohort.

Comorbid Affective Disorders and Personality Traits in Alcohol Abuse Inpatients at an Air Force Medical Center

A retrospective chart review of 2 years of admissions (1995-1996) for alcohol abuse and alcohol dependence patients on an inpatient substance abuse unit showed the prevalence of comorbid affective disorders, personality disorders/subsyndromal personality traits, and the combination of all three diagnoses to be 8.2, 17.5, and 9.6%, respectively. The available literature on these additional diagnoses in substance abusers is reviewed and compared with the findings of the current study. Patients identified for inpatient substance abuse treatment need full psychiatric evaluation for other Axis I and Axis II comorbidity that may greatly affect their treatment plans and clinical prognoses.

Drug abuse history and treatment needs of jail inmates.

The current study evaluates the extent of prior drug use and psychosocial dysfunction related to drug use among 499 jail inmates referred to the Hillsborough County Sheriff's Office Substance Abuse Treatment Program. Results indicate that inmates were involved with drugs for an average of more than 7 years, and with cocaine for almost 5 years. The majority of inmates reported extremely heavy use of drugs in the month prior to the last arrest, including 83% that had used cocaine. Many drug-dependent inmates reported a shift over time from intranasal to freebase cocaine use. Half of all referrals indicated a pattern of regular use within a year of involvement with drugs. The need for lengthy, heavily structured, and intensive treatment approaches for drug-dependent jail inmates is underscored by a history of chronic cocaine and polydrug abuse, a compulsive pattern of drug use, few successful periods of voluntary abstinence, and severe disruption in vocational, social, and psychological functioning. Their history of infrequent and unsuccessful involvement in rehabilitation programs reflects a significant need for compulsory treatment following release from jail, community supervision to ensure compliance with treatment, and development of linkages between jail drug treatment programs, courts, and community treatment providers.