Co-occurring Substance Use Disorders Research Articles

74.2 EXPLORING BIOLOGIC INTERSECTIONS OF TRAUMA AND SUBSTANCE USE DISORDERS

The objectives of this presentation are to: 1) review overlapping functional domains and symptoms in PTSD and substance use disorders (SUDs); 2) learn about shared neurobiologic factors; and 3) explore how co-occurring disorders and findings may result in symptom exacerbation. A review of the literature was conducted in PubMed. Supplemented with case vignettes, we will present common functional domains in PTSD and SUD. Neurobiologic factors, including neuroimmune, neuroanatomy, and connectivity, will be discussed. Case vignettes will be used to facilitate group discussion of overlapping symptoms between trauma and states of substance intoxication or withdrawal and to explore how co-occurring disorders may result in symptom exacerbation. Neurodevelopment continues through adolescence, which is a vulnerable period for exposure to trauma and substance use. Youth with a history of childhood maltreatment are at increased risk of developing co-occurring PTSD and SUD. In addition, adolescence is a time of increasing autonomy and risk-taking behaviors. Increasing prevalence of substance use and risk taking may subsequently result in more traumatic exposures. Substance use may also exacerbate trauma symptoms, and trauma symptoms may reinforce substance use habits. Likewise, there is overlap in symptoms between specific states of intoxication or withdrawal and PTSD, including mood, autonomic hyperactivity, alterations in arousal and reactivity, hypervigilance, and sleep disturbance. Through clinical vignettes, we will synthesize overlapping symptoms, theories of co-occurring disorders, and suspected neurobiologic changes. Neurobiologic changes that will be reviewed include catecholamine expression, the hypothalamic-pituitary-adrenal (HPA) axis, neuroimmunology, and neuroanatomy and connectivity. Research has also identified impulsivity and resilience as common domains of interest, as well as the possibility of sensitization/cross-sensitization. PTSD and SUD commonly co-occur. It is important to develop an understanding of overlapping symptoms, mechanisms of reinforcement, and neurobiologic changes that may complicate treatment and lead to poorer outcomes.

Treatment of substance use disorder and psychological trauma: outcomes of the women of worth program

ABSTRACT Given the co-occurrence of substance use disorder (SUD) and posttraumatic stress disorder, existing SUD treatment programs are integrating the treatment of psychological trauma into their programming. The present study evaluated 120 women enrolled in the Women of Worth program, a gender-responsive treatment model, on several treatment outcomes. Substance use, depression, psychological trauma severity, and substance-related problems decreased significantly across time, only anxiety did not. Several study results also appear clinically meaningful. Overall, the results of the Women of Worth program may support the integration of psychological trauma treatment into existing SUD programs for women.

The Epidemiology of Substance Use Disorders among the Adult Jewish Population in Israel

Introduction: Substance use disorders (SUDs) are a leading cause of morbidity and mortality worldwide, having a profound and global impact on health, well-being, safety, and productivity. Although traditionally the prevalence of SUDs in Israel has been estimated to be lower than those in high-income countries, estimates and characteristics of individuals with SUDs in the past decade are lacking. In this work, we explored the prevalence of SUDs among the adult Jewish population in Israel, per different classes of substances across sex, age group, and other sociodemographic factors. Methods: Data from an online representative sample of 4,025 respondents were collected, including the alcohol, smoking, and substance involvement screening test (ASSIST) metric and sociodemographic data. Results: We found that the most common SUDs were alcohol (10.5% [9.5–11.4]), cannabis (9.0% [8.2–9.9]), and sedative (3.6% [3.0–4.2]) use disorders. Alcohol-cannabis (3.2% [2.7–3.7]) and alcohol-sedative (1.04% [0.7–1.35]) were the most prevalent co-occurring SUDs. Among those with cannabis use disorder, the prevalence of alcohol use disorder was found to be 35.3% [30.4–40.2]. The estimated risk for alcohol use disorder was found to be inversely proportional to age, cannabis use disorder increased, peaked, and decreased with age, and that of sedative use disorder increased with age, particularly among women. While older individuals (in the 51–60 years of age group) were at lower risk (OR = 0.5 [0.3, 0.8]) compared to those <20 years of age for alcohol use disorder, they were at increased risk for sedative use disorder (OR = 3.1 [1.2, 9.7]). Conclusions: These findings represent substantially higher rates of SUDs in Israel than those previously reported and should affect resources allocated to addiction prevention and treatment. Further research on the role of gender, age, culture, and ethnicity in the propensity to develop SUDs is necessary for the development of more focused preventive and intervention measures. Focusing on non-Jewish populations in Israel and broadening the scope to include behavioral addictions should be addressed in future studies.

Morbidity and mortality in schizophrenia with comorbid substance use disorders.

ObjectiveSchizophrenia is highly comorbid with substance use disorders (SUD) but large epidemiological cohorts exploring the prevalence and prognostic significance of SUD are lacking. Here, we investigated the prevalence of SUD in patients with schizophrenia in Finland and Sweden, and the effect of these co‐occurring disorders on risks of psychiatric hospitalization and mortality.Methods45,476 individuals with schizophrenia from two independent national cohort studies, aged <46 years at cohort entry, were followed during 22 (1996–2017, Finland) and 11 years (2006–2016, Sweden). We first assessed SUD prevalence (excluding smoking). Then, we performed Cox regression on risk of psychiatric hospitalization and all‐cause and cause‐specific mortality in SUD compared with those without SUD.ResultsThe prevalence of SUD ranged from 26% (Finland) to 31% (Sweden). Multiple drug use (n = 4164, 48%, Finland; n = 3268, 67%, Sweden) and alcohol use disorders (n = 3846, 45%, Finland; n = 1002, 21%, Sweden) were the most prevalent SUD, followed by cannabis. Any SUD comorbidity, and particularly multiple drug use and alcohol use, were associated with 50% to 100% increase in hospitalization (aHR any SUD: 1.53, 95% CI = 1.46–1.61, Finland; 1.83, 1.72–1.96, Sweden) and mortality (aHR all‐cause mortality: 1.65, 95% CI = 1.50–1.81, Finland; 2.17, 1.74–2.70, Sweden) compared to individuals without SUD. Elevated mortality risks were observed especially for suicides and other external causes. All results were similar across countries.ConclusionCo‐occurring SUD, and particularly alcohol and multiple drug use, are associated with high rates of hospitalization and mortality in schizophrenia. Preventive interventions should prioritize detection and tailored treatments for these comorbidities, which often remain underdiagnosed and untreated.

Substance use and symptoms of mental health disorders: a prospective cohort of patients with severe substance use disorders in Norway

BackgroundThere is high co-occurrence of substance use disorders (SUD) and mental health disorders. We aimed to assess impact of substance use patterns and sociodemographic factors on mental health distress using the ten-item Hopkins Symptom Checklist (SCL-10) over time.MethodsNested prospective cohort study of 707 participants with severe SUD across nine opioid-agonist-therapy outpatient clinics and low-threshold municipality clinics in Norway, during 2017–2020. Descriptive statistics were derived at baseline and reported by means and standard deviation (SD). A linear mixed model analysis was used to assess the impact of substance use patterns and sociodemographic factors on SCL-10 sum score with beta coefficients with 95% confidence intervals (CI).ResultsMean (SD) SCL-10 score was 2.2 (0.8) at baseline with large variations across patients. We observed more symptoms of mental health disorders among people with frequent use of benzodiazepines (beta 3.6, CI:2.4;4.8), cannabis (1.3, CI:0.2;2.5), opioids (2.7, CI:1.1;4.2), and less symptoms among people using frequent stimulant use (− 2.7, CI:-4.1;-1.4) compared to no or less frequent use. Females (1.8, CI:0.7;3.0) and participants with debt worries (2.2, CI:1.1;3.3) and unstable living conditions (1.7, CI:0.0;3.3) had also higher burden of mental health symptoms. There were large individual variations in SCL-10 score from baseline to follow-up, but no consistent time trends indicating change over time for the whole group. 65% of the cohort had a mean score > 1.85, the standard reference score.ConclusionsPeople with SUD have a considerable burden of mental health symptoms. We found no association between substance use patterns and change in mental health symptoms over time. This could suggest that the differences observed were indicating flattening of effects or self-medication to a larger degree than medication-related decline in mental health. This call for better individualized mental health assessment and patient care.

Parental Monitoring Predicts Depressive Symptom and Suicidal Ideation Outcomes in Adolescents Being Treated for Co-Occurring Substance Use and Psychiatric Disorders

BackgroundComorbidity of substance use disorders (SUDs) with mood disorders and other psychiatric conditions is common. Parenting processes and family functioning are impaired in adolescents with SUDs and mood disorders, and parent/family factors predict intervention response. However, limited research has examined the relationship between parent/family factors and mood symptom treatment response in adolescents with comorbid SUDs and psychiatric conditions. MethodThis study examined the predictive effects of parenting processes and family functioning on depressive symptoms and suicidal ideation (SI) in a randomized controlled trial of integrated cognitive-behavioral therapy vs. treatment as usual for 111 adolescents with comorbid SUDs and psychiatric disorders. Measures of parenting processes, family functioning, depressive symptoms, and SI were completed at baseline and 3-, 6-, and 12-month follow-ups. Exploratory analyses involved mixed-effects regression models. ResultsAcross treatment conditions, depressive symptoms and SI improved over 12 months. Family functioning domains of family roles (d=0.47) and affective involvement (d=0.39) significantly improved across treatment conditions over 12 months. Higher baseline parental monitoring predicted improved trajectory of depressive symptoms (d=0.44) and SI (d=0.46). There were no significant predictive effects for baseline family functioning or other parenting processes (listening, limit setting). LimitationsLimitations include the modest sample, attrition over follow-up, and generalizability to samples with higher rates of mood disorders and/or uncomplicated mood disorders. ConclusionsParental monitoring may be an important prognostic indicator of depressive symptoms and SI in adolescents with co-occurring SUDs and psychiatric conditions, and therefore may be useful to assess and target in treatment, in addition to family functioning.

Personality Disorders among Patients with Mental and Behavioral Disorders due to Psychoactive Substance Use in a Tertiary Care Center of Nepal: A Descriptive Cross-sectional Study

Introduction: Personality disorders is comprised of deeply ingrained and enduring behavioral patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations." Personality Disorders are frequently occurring among patients with substance use disorders. Co-occurrence of substance use disorders and personality disorder is associated with a greater functional impairment affecting treatment adherence. This study's objective was to find out the prevalence of personality disorders among substance use disorders from the Department of Psychiatry and Mental Health, of a tertiary care center of Nepal.&#x0D; Methods: A descriptive cross-sectional study was done at the Department of Psychiatry and Mental Health of Shree Birendra Hospital, Chhauni, Kathmandu, Nepal. The ethical approval was approved by the Institutional Review Committee prior to the study. The International Personality Disorder Examination ICD-10 module interview schedule was used to determine personality disorders. There were 100 patients, 86 males and 14 females of age ranging between 18-59 years, from different education levels, socioeconomic statuses, and ethnicities.&#x0D; Results: Of the total 100 patients, 63% of the patients with substance use disorders were found to have either single 24 (24%) or multiple 39 (39%) personality disorders. The most frequently identified disorders were Emotionally Unstable Borderline Type 34 (34%), Anxious Personality Disorder 27 (27%), Emotionally Unstable Impulsive Type 27 (27%).&#x0D; Conclusions: Present study indicates that personality disorders were highly comorbid with patients of substance use disorders with either single or multiple personality disorders. Personality disorders mostly found in substance use disorders are Emotional Unstable Borderline Type, Anxious Personality Disorder, and Emotional Unstable impulsive Type.

Adverse events among adult Medicaid enrollees with opioid use disorder and co-occurring substance use disorders

BackgroundIt is common for adults with opioid use disorder (OUD) to misuse additional substances, and these individuals may be particularly at risk for adverse events, including mortality. Less is known about how continued receipt of prescription opioids or risk of adverse events (e.g., suicidality, overdose, poisoning) differs for people with co-occurring OUD and additional substance use disorders (SUDs). MethodsWe conducted a retrospective study using IBM® MarketScan® Multi-State Medicaid Database enrollment/claims data. We used logistic regression to measure the association between sample characteristics and our dependent variables. The sample consisted of non-Medicare-eligible adults aged 18–64 years who were continuously enrolled in Medicaid in 2016–2017 with an OUD diagnosis on at least one claim in 2016. ResultsAdults with OUD and a co-occurring SUD were more likely than adults with OUD only to have an opioid-related poisoning event (odds ratio [OR] = 1.488, p = .0052), all-cause poisoning (OR = 1.756, p < .0001), or suicidal ideation (OR = 1.796, p < .0001) but not to receive ongoing opioid prescriptions (OR = 0.973, p = .1626). Adverse events varied by OUD-SUD combination. For example, adults with OUD and cocaine use disorder had the highest odds of all-cause (OR = 2.393, p < .0001) or opioid-related (OR = 1.890, p = .0027) poisoning among those with a drug-specific diagnosis and were most likely to be diagnosed with suicidal ideation (OR = 2.465, p < .0001). ConclusionsThis study provides evidence that adults with OUD and a co-occurring additional SUD have increased risk for several adverse events. Multisubstance use should be screened for and identified to determine the most appropriate course of treatment.

Sexual orientation and gender identity disparities in co-occurring depressive symptoms and probable substance use disorders in a national cohort of young adults

This study examined sexual orientation and gender identity differences in co-occurring depressive symptoms and substance use disorders (SUDs) among young adults in the Growing Up Today Study national cohort (n = 12,347; ages 20–35; 93% non-Hispanic white). Self-administered questionnaires assessed recent co-occurring depressive symptoms and probable nicotine dependence, alcohol use disorder, and drug use disorder. Multinomial logistic regressions with generalized estimating equations quantified differences in prevalences of depressive symptoms only, SUDs only, and co-occurrence, among sexual minorities (mostly heterosexual; lesbian, gay, and bisexual [LGB]) compared to completely heterosexual participants, and gender minorities compared to cisgender participants. Analyses stratified by sex assigned at birth revealed sexual minorities evidenced greater odds of co-occurrence than their completely heterosexual counterparts (assigned female AORs: 3.11–9.80, ps < 0.0001; assigned male AORs: 2.90–4.87, ps < 0.001). Sexual orientation differences in co-occurrence were pronounced among LGB participants assigned female at birth who evidenced nearly 10 times the odds of co-occurring depressive symptoms with nicotine dependence and drug use disorders than did heterosexual participants assigned female at birth. Relationships between gender identity and co-occurrence were generally weaker, possibly due to low power. Gender minorities assigned male at birth, however, evidenced greater odds of co-occurring depressive symptoms and alcohol use disorders (AOR 2.75, p = 0.013) than their cisgender counterparts. This study adds to the limited research quantifying sexual orientation or gender identity differences in recent co-occurring depressive symptoms and SUDs among young adults and suggests sexual and gender minority young adults should be prioritized in prevention and treatment of co-occurring depression and SUDs.

Health Professionals' Experiences with Treatment Engagement Among Immigrants with Co-occurring Substance Use- and Mental Health Disorders in Norway.

Immigrants face barriers in seeking and accessing mental health and addiction services. Health professionals are crucial in providing and promoting healthcare and it is important to understand their experiences in order to enhance the access of mental healthcare. The aim of this paper is to explore and describe health professionals’ experiences with treatment engagement among immigrants with co-occurring substance use disorders (SUD) and mental health disorders (MHD) in Norwegian mental health and addiction services. Within a collaborative approach, 3 focus group interviews were conducted with health professionals, who had provided various mental health and addiction care services to immigrants with co-occurring SUD and MHD. The focus group interviews were transcribed verbatim and analyzed using systematic text condensation. The analysis resulted in 5 main categories: (1) difficulties due to language barriers, (2) difficulties due to lack of culturally competent services, (3) difficulties due to social factors, (4) being curious and flexible improves the user-provider relationship, and (5) increasing access to mental health and addiction services. This study provides an enhanced understanding of how health professionals’ experienced treatment engagement among immigrants with co-occurring SUD and MHD in the Norwegian context. Implications of the findings for clinical practice and future research are discussed.

Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system

ObjectiveResearch has reported shortened lifespans (by 15–30 years) for those with severe mental illness (SMI) or substance use disorder (SUD), particularly among public mental health treatment consumers. We assessed SMI- and SUD-associated mortality in the understudied setting of a large, nonprofit integrated health care system. MethodThis retrospective cohort study examined 2010–2017 health system and death records for 564,592 adult patients. Half had SMI/SUD diagnosis; half were a demographically matched comparison group without SMI, other mental health, or SUD diagnoses. We estimated mortality risks, adjusting for demographic and physical health factors. ResultsHaving SMI or SUD was associated with higher odds of death (adjusted odds ratio = 1.87) and an average 6.3 years of earlier death relative to comparison individuals. Co-occurring SMI and SUD conferred higher mortality risk from major natural and unnatural causes than did SMI with no SUD. ConclusionsSome indicators of premature mortality were lower than those reported for U.S. public mental health consumers, but risk level varied widely by diagnosis. While patients' having insurance and broad access to care may lower risk, access to care may be insufficient to overcome the many patient-, provider-, and system-level factors contributing to poor physical health in SMI and SUD.

Medical Multimorbidity, Mental Illness, and Substance Use Disorder among Middle-Aged and Older Justice-Involved Adults in the USA, 2015-2018.

Adults age ≥ 50 are among the fastest growing populations in correctional supervision and are medically underserved while experiencing unique health disparities. Community-living older adults, referred to as "justice-involved," are people who have been recently arrested, or are on probation or parole. Although medical complexity is common among incarcerated older adults, the occurrence of medical morbidity, substance use disorder (SUD), and mental illness among justice-involved older adults living in US communities is poorly understood. To estimate the prevalence of medical multimorbidity (≥ 2 chronic medical diseases), SUDs, and mental illness among justice-involved adults age ≥ 50, and the co-occurrence of these conditions. Cross-sectional analysis. A total of 34,898 adults age ≥ 50 from the 2015 to 2018 administrations of the US National Survey on Drug Use and Health. Demographic characteristics of justice-involved adults age ≥ 50 were compared with those not justice-involved. We estimated prevalence of mental illness, chronic medical diseases, and SUD among adults age ≥ 50 reporting past-year criminal justice system involvement. Logistic regression was used to estimate the odds of these conditions and co-occurrence of conditions, comparing justice-involved to non-justice-involved adults. An estimated 1.2% (95% confidence interval [CI] = 1.1-1.3) of adults age > 50 experienced criminal justice involvement in the past year. Compared with non-justice-involved adults, justice-involved adults were at increased odds for mental illness (adjusted odds ratio [aOR] = 3.04, 95% CI = 2.09-4.41) and SUD (aOR = 8.10, 95% CI = 6.12-10.73), but not medical multimorbidity (aOR = 1.15, 95% CI = 0.85-1.56). Justice-involved adults were also at increased odds for all combinations of the three outcomes, including having all three simultaneously (aOR = 8.56, 95% CI = 4.10-17.86). Community-based middle-aged and older adults involved in the criminal justice system are at high risk for experiencing co-occurring medical multimorbidity, mental illness, and SUD. Interventions that address all three social and medical risk factors are needed for this population.

Utilization of treatment by Medicaid enrollees with opioid use disorder and co-occurring substance use disorders

BackgroundMultiple substance use is common among adults who misuse opioids. Adverse consequences of drugs are more severe among multisubstance users than among single drug users. This study sought to determine whether adults with opioid use disorder (OUD) and at least one other substance use disorder (SUD) are less likely than adults with OUD only to receive certain services. MethodsWe conducted a retrospective longitudinal study using the IBM® MarketScan® Multi-State Medicaid Database. We used logistic regression to measure associations between clinical characteristics and service utilization. The sample included non-Medicare-eligible adults aged 18–64 years with at least one claim in 2016 with a primary diagnosis of OUD who were continuously enrolled in Medicaid in 2016 and 2017. ResultsOf the 58,745 Medicaid enrollees with an initial OUD diagnosis in 2016, 29,267 had one or more additional SUD diagnoses. In the year following diagnosis, these adults were less likely than adults with OUD only to receive OUD medication treatment (OR = 0.88, p < .0001). This was true for all specifically diagnosed co-occurring SUDS. Adults with OUD and a co-occurring SUD, however, were more likely than those with OUD only to use any type of high-intensity services. ConclusionsAdults with OUD and at least one co-occurring SUD received more intensive services, which may reflect severity and lack of OUD medication treatment before misuse escalation. Programs should account for barriers to connecting these individuals to appropriate OUD treatment.

Disentangling the Social Context of Nonmedical Use of Prescription Stimulants in College Students

The aim of this study was to investigate the social context of nonmedical use of prescription stimulants (NMUPS) among college students who endorsed NMUPS with co-occurring substance use disorders (SUD) compared with those without co-occurring SUDs. Presented here are new analyses based on data previously collected from college students aged 18 to 28 years derived from the Boston metropolitan area who endorsed NMUPS (N = 100) at least once in their lifetime. Differences between those with lifetime history of SUD (N = 46) and without a history of SUD (N = 54) on the Massachusetts General Hospital ADHD Medication Misuse and Diversion Assessment were analyzed using the Student t test, the Pearson χ2 test, and the Wilcoxon rank-sum test. College students who endorsed NMUPS with co-occurring SUD were more likely than those without SUD to have bought or traded stimulants, bought or traded in their car, used at parties with drugs/alcohol, or used intranasally (all P < .05). Intranasal administration was common (38% of all students endorsing NMUPS) and was associated with misuse at a party and simultaneous use with cocaine (P = .04), marijuana (P < .001), and alcohol (P < .001), compared with only oral use. Notable characteristics were identified among individuals who engaged in NMUPS in the type, amount, cost, and ascertainment of stimulants. The concurrence of SUD and/or intranasal administration appear to represent a more severe phenotype of NMUPS that should be considered in the implementation of future prevention and intervention protocols on college campuses. (Am J Addict 2020;29:476-484).

Trauma-informed Drug Screens for Veterans with Co-occurring Disorders: A Case Series

Objective: This case series describes and illustrates the effective use of a trauma-informed approach, GLAPE, to provide drug screens for individuals in substance use treatment programs. The GLAPE approach recognizes that individuals who have experienced traumatic events and are recovering from substance use difficulties may also face unique challenges when engaging in mental health treatment. The nature of drug screening procedures in practice may feel invasive and triggering for clients with trauma histories. Finding ways to decrease barriers to treatment and increase engagement and retention are important components of effective substance use treatment. Methods: This case series involved three veteran cisgender men with posttraumatic stress disorder (PTSD) and co-occurring substance use conditions in an outpatient addiction recovery program in a Veterans’ hospital. The cases illustrate how recovery can be aided by trauma-informed approaches for urine drug screens. The treatment team evaluated various monitoring modalities and collaborated with each client to form a treatment plan that implemented the GLAPE approach to bolster their recovery. The GLAPE approach includes five components: Giving detailed instructions prior to the urine screen procedure, listening to and eliciting questions and concerns of the client, articulating options and exhibiting flexibility in the procedure to accommodate the needs of the individual client, giving permission to the client to voice concerns at any point during the procedure, and evaluating the process in collaboration with the client, including what could be improved for next time. Results: Use of the GLAPE approach effectively helped to engage and retain military veterans with co-occurring PTSD and substance use disorder within a trauma informed outpatient program. Preliminary evidence from three cases provides that this approach may be useful for use in substance use treatment with clients who have trauma histories. Conclusions: Given widespread use of observed urine drug screens in substance use treatment programs, and prominent co-occurrence of substance use disorder and PTSD, it is essential that staff approach this procedure in a trauma-informed way. This case series illustrates an approach that can improve client experience, aid clients in treatment engagement, and assist staff in the provision of effective care.

Dual Diagnosis and Application Problems in the Use of the Construct: A Review of Literature.

Dual diagnosis (DD) commonly identifies a condition of co-occurrence of substance use disorders and psychological or psychiatric disorders. Many scholars have tried to explain this phenomenon, yet no agreement has been found: methodologies of intervention and treatment are numerous, but there is no uniformity of methodology. Our work aims to search critical aspects linked to this fragmented framework, to facilitate those who use the construct of DD. We have elaborated a literary review focused on specific critical contributions to the theoretical and methodological complexity of the construct. Scopus, PubMed, and Scholar were used as search engines. Our research reveals significant problems around several thematic areas: Defining, Operative and Treatment; Economic and Policy; Pharmacological Approach; and Patients' Perspectives Issues. Consistent issues are discussed with regard to DD: innovation should start from its limits. Future research should look for alternative theoretical formulations and consequent intervention experiences to provide new perspectives.

Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders.

Immigrants are considered at risk of psychological distress and therefore involvement in substance abuse, due to a variety of pre- and post-migration factors. Further, there is lower treatment engagement, a higher dropout rate, and less frequent hospitalizations among this group compared to the general population. There are few studies on the subjective understanding of co-occurring substance use disorder (SUD) and mental health disorder (MHD) among immigrants in Norway. This qualitative study aims to explore the treatment experiences of immigrant men living with co-occurring SUD and MHD. Within a collaborative approach, individual interviews were conducted with 10 men of immigrant background, living with co-occurring SUD and MHD, who had treatment experiences from the Norwegian mental health and addiction services. Data were analyzed using a systematic text condensation. The analysis yielded 6 categories where participants described their treatment experiences in mental health and addiction services in Norway as: lack of connection, lack of individually tailored treatment, stigma and discrimination preventing access to treatment, health professionals with multi-cultural competence, care during and after treatment, and raising awareness and reducing stigma. A significant finding was the mention by participants of the value of being seen and treated as a “person” rather than their diagnosis, which may increase treatment engagement. They further mentioned aftercare as an important factor to prevent relapse. This study provides an enhanced understanding of how immigrant men living with co-occurring SUD and MHD experienced being treated in Norwegian healthcare settings. These experiences may add to the knowledge required to improve treatment engagement.

1224: Co-occurrence of psychiatric conditions and substance use disorders and effect on maternal and neonatal outcomes

Psychiatric comorbidities have been shown to affect substance use, treatment completion, and health outcomes in non-pregnant patients with substance use disorders (SUD). The aim of this study is to compare adjusted odds of maternal and neonatal outcomes for women with co-occurrence of psychiatric conditions and SUD compared to women with only SUD. A retrospective analysis of a prospective, population-based cohort (2011-2019) from two large delivery hospitals was performed. Every consenting subject is asked, in their native language and using bias-free terms, about their frequency of substance use. Presence of psychiatric conditions was determined via chart review. Maternal baseline characteristics, co-morbidities and maternal and neonatal outcomes were collected. Women who have psychiatric conditions and SUD (Group 1, n=111) were compared to women with SUD who do not have psychiatric conditions (Group 2, n=372). Univariate analyses were performed using Chi-square, t-tests, Mann-Whitney U tests as appropriate. Logistic regression modeling was then used to control for potential confounders identified in the univariate analyses. 23% of pregnant women with SUD also have psychiatric conditions in this cohort. Outcomes which were significantly different after univariate analyses are shown in Figure 1. After adjusting for potential confounders, women with co-occurrence of SUD and psychiatric conditions were more like to have chronic hypertension (aOR 3.25, 95% CI 1.15-9.32), and more likely to require antepartum admission (aOR 3.014, 95% CI 1.34-6.81) than women without psychiatric conditions. There was also a statistically significant, but not clinically significant difference in 5 minute Apgar score (Group 1: 8.76, Group 2: 8.55, p=0.03). Co-occurrence of psychiatric disorder with SUD is common among pregnant women, and can impact outcomes for both mother and neonate. This data further supports the need for specialized care for this population, with integration of obstetrics, psychiatry, addiction medicine, and comprehensive social services.

Factors associated with benzodiazepine prescribing in community mental health settings

ObjectiveOne class of drugs increasingly involved in overdose fatalities is benzodiazepines. Prescribing benzodiazepines to people with co-occurring substance use disorders (SUDs) poses risk for overdose and dependence and is not recommended. The current study reports prevalence rates of prescribing benzodiazepines to people with and without co-occurring SUDs in community mental health settings. Clinical and socio-demographic factors associated with receipt of a benzodiazepine were examined, including whether factors potentially indicative of prescribing biases (older age and race) moderated the relationship between having a co-occurring SUD and receiving a benzodiazepine prescription. MethodsRetrospective chart review data from service users treated between August 2014 and August 2017 were collected as part of an NIMH-funded RCT of Person-Centered Care Planning. Data were assessed from 774 charts collected across 14 sites nested within ten community mental health centers (CMHCs). Mixed effects logistic regression models examined direct and interaction effects related to receipt of a benzodiazepine. ResultsOf the 774 service users, 19.9% (N = 154) were prescribed at least one benzodiazepine. Of those prescribed a benzodiazepine, 35.1% (N = 54) had a co-occurring SUD and 31.8% (N = 49) had an anxiety disorder. Our main effects model did not find a significant difference in the odds of receiving a benzodiazepine among service users with and without a co-occurring SUD (OR = 0.77, CI: 0.50–1.17). However, moderation analyses found that the odds of being prescribed a benzodiazepine among people with co-occurring SUDs was greater among service users of older age (OR: 2.01, CI: 1.01–4.02) and non-Hispanic white race (OR = 3.34, CI: 1.55–7.22). DiscussionOur findings demonstrate that a considerable number of people with a documented co-occurring SUD are prescribed benzodiazepines in CMHCs, a practice that poses risks for dependence and overdose. Prescribing decisions may be influenced by service user age and race.

The impact of substance use disorders on treatment engagement among justice-involved veterans with posttraumatic stress disorder.

Veterans involved with the criminal justice system represent a particularly vulnerable population who experience high rates of both posttraumatic stress disorder (PTSD) and substance use disorders (SUD). This study sought to investigate whether having co-occurring SUD is a barrier to PTSD treatment. This is a retrospective observational study of a national sample of justice-involved veterans served by the Veterans Health Administration Veterans Justice Outreach program who had a diagnosis of PTSD (N = 27,857). Mixed effects logistic regression models with a random effect for facility (N = 141 medical centers) were utilized to estimate the odds of receiving each type of PTSD treatment as a function of having a SUD diagnosis. Results indicate that a majority of veterans with PTSD served by the Veterans Justice Outreach program have an SUD diagnosis (73%), and having a co-occurring SUD was associated with higher odds of receiving PTSD treatment, after adjusting for demographic differences. Although not without limitations, these results suggest that among justice-involved veterans enrolled in the Veterans Health Administration with PTSD, having an SUD comorbidity is not a barrier to PTSD treatment and may in fact facilitate access to PTSD treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).