Identification Of Substance Use Disorders Research Articles

Assessing Substance Use Disorder Among Social Security Administration Disability Applicants.

Co-occurrence of substance use disorder and mental illness complicates treatment and is associated with increased disability. However, identification of substance use disorder in populations recently engaged in treatment can be challenging. This study aimed to examine traditional screening tools for substance use disorder and proxy characteristics (i.e., demographic characteristics, behaviors, and diagnoses) as predictors of clinician-observed substance use disorder. The Supported Employment Demonstration, funded by the Social Security Administration, studied 2,960 adults whose applications for disability benefits because of mental illness were recently denied. In a subsample (N=1,354) for whom substance use disorder was determined by community-based teams during follow-up, the authors used logistic regression to identify baseline predictors of observed substance use disorder and compared the sensitivity and specificity of detection by using standardized screening tools (Alcohol Use Disorder Identification Test [AUDIT], 10-item Drug Abuse Screening Test [DAST-10]) with detection via decision trees based on proxy characteristics. Using decision trees based on a combination of personal characteristics (sensitivity=0.47, specificity=0.83, area under the curve [AUC]=0.71) or personal characteristics including diagnostic data (sensitivity=0.54, specificity=0.81, AUC=0.72) provided more accurate identification of substance use disorder than using a combination of the AUDIT and DAST-10 (sensitivity=0.34, specificity=0.88, AUC=0.61). Adding the combined AUDIT and DAST-10 substance use disorder indicator to either tree negligibly improved accuracy. In populations recently engaged in treatment, for whom standardized substance use disorder screening tools are less accurate than expected, consideration of personal characteristics could improve the detection of substance use disorder essential for treatment planning.

Characteristics of Substance Use Screening at Intake in a Sample of U.S. Jails.

Despite high rates of substance use among justice-involved populations, the use of substance screening tools in justice settings varies. Data are from the National Jail Health Care Study, which surveyed jails across the U.S. about their health care practices (n=371). Jails were asked to voluntarily submit their medical intake forms. A content analysis of intake forms (n=63) specific to questions about substance use was completed. Seventy-three percent (73%) of intake forms used non-standardized questions to assess current substance use, and 27% did not ask any questions about substance use. Alcohol use was most assessed (52%), followed by tobacco (30%), and marijuana (22%). Less than 11% of jails asked about use of opioids and 40% of forms asked about withdrawal history. The lack of adequate substance use screening in jails hinders identification of substance use disorders, potential for withdrawal symptoms, and appropriate connection to treatment resources.

Criminal Justice Alcohol and Drug Screening in Practice: Using the Substance Abuse Subtle Screening Inventory to Identify Substance Use Disorder in Offenders

Objective The substance abuse subtle screening inventory (SASSI) has been used successfully in correctional treatment settings and correctional screening since 1988. These screenings include outpatient evaluations of offenders within community settings, as well as assessments of incarcerated individuals within federal, state, city, and county correctional facilities. One key element towards reducing recidivism and reoffending, is that individuals receive treatment for substance use disorders (SUD’s) while in the correctional system. While SUD is not the only contributing factor to criminality, it does significantly increase the likelihood of legal infraction and violations, placing these individuals at a higher risk of re-offending. Thus, identifying SUD as early as possible helps provide tailored treatment to those who need it, while simultaneously reducing the risk of future legal difficulties. Now in its fourth iteration (SASSI-4), this article discusses the SASSI screening tools’ utility with criminal offenders and serving clinical needs, and reviews a case study of a young male’s clinical evaluation while incarcerated. Results For this case study, we reviewed the SASSI-4 screening results of a 24-year-old male whom we will call "Bryon". Bryon was in his 4th week of detention at a local mid-western jail in the United States. He was arrested after turning himself in for a prior domestic violence offense committed while under the influence of alcohol and for which he had fled the state. Bryon had one prior arrest (for receiving stolen property, which he subsequently traded for drugs). The intake counselor conducting Bryon’s assessment had been meeting with him at the jail for several weeks. The court was particularly interested in determining the level of risk that Bryon would again flee the area. Conclusion This case presents us with a good example of the value of early identification of substance use disorder, and potential problems in criminal justice settings. Bryon's SASSI results clearly demonstrate a well-established pattern of substance misuse that will require relatively intensive intervention. Therefore, he may be a solid candidate for diversion into an alcohol and drug treatment program as a way of reducing the risk of future offenses.

Investigating a Nurse With Suspected Substance Use Disorder: Guidance for Nurse Leaders and Hospital Administration

Substance use while on duty and diversion of controlled substances represent significant societal and economic challenges facing healthcare facilities, the nursing profession, and occupational licensing boards. Nursing-specific policies and education for healthcare staff will aid in protecting patients through early identification of substance use disorder (SUD) and diversion. Such actions could be the first step in supporting nurses in need of assistance and facilitating entry into treatment for substance use disorders, when appropriate. Established healthcare facility policies will assist in conducting a thorough investigation and could facilitate swift action by state boards of nursing (BONs) to protect patients and nurses. Collaboration between a healthcare facility and a BON is an essential element of the regulatory mandate to protect the public. The North Carolina Board of Nursing has developed state-specific processes that could be beneficial to healthcare facilities and other BONs. This manuscript will detail the processes of conducting nurse SUD and drug diversion investigations with the goal of developing nursing regulatory guidance to enhance public protection.

Neonatal Outcomes of Infants Born to Pregnant Women With Substance Use Disorders: A Multilevel Analysis of Linked Data

Objective This study examines the associations of substance use disorders in pregnancy with a set of neonatal outcomes. Methods This is a quantitative retrospective study. Three linked datasets of a 10-year period (2007–2016) from New South Wales, Australia, were examined. Pregnant women were identified positive for substance use disorders when at least one hospital admission during pregnancy or delivery had opioid-, or cannabis-, or stimulant-, or alcohol- or two or more of the four substance groups- related ICD-10-AM diagnostic code. As there was a hierarchical structure in the dataset, the adjusted odds ratio (AOR) was estimated using multilevel logistic regression. Findings Of the 622,640 birth records, 1677 (0.27%) women had opioid-related, 1857 (0.30%) had cannabis-related, 552 (0.09%) had stimulant-related, 595 (0.10%) had alcohol-related and 591 (0.09%) had polysubstance-related ICD-10-AM diagnostic codes. There were significant relationships between opioid use in pregnancy and neonatal health outcomes including preterm birth (AOR 3.2; 95% CI 2.8, 3.7) and admission to the neonatal intensive care unit (NICU) (AOR 10.0; 95% CI 8.8, 11.3). Substance use disorders due to cannabis, stimulants, alcohol or polysubstance were significantly associated with preterm birth, low birthweight, low APGAR score and admission to NICU. Also, alcohol and polysubstance use disorders in pregnancy were found to be significantly associated with stillbirth. Conclusion Results demonstrate that substance use disorders in pregnancy are associated with an increased risk of adverse neonatal outcomes. Early identification of substance use disorders through screening and adherence to pharmacotherapy and other psychosocial interventions could improve neonatal outcomes.

One million screened: Scaling up SBIRT and buprenorphine treatment in hospital emergency departments across Maryland

PurposeIdentification of problematic alcohol use and substance use in the population has been a clinical challenge, especially during the heightened years of the opioid epidemic. Bringing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to scale in medical settings, such as hospital emergency departments (EDs) could facilitate broad identification of substance use disorders, timely delivery of brief interventions, and successful linkages to treatment. ProceduresThis large-scale data analysis pulled electronic health record (EHR) data from 23 hospitals in the state of Maryland for over 1 million patient visits between July 2014 and November 2018. FindingsOf the 1,097,142 ED patients screened, 17.2% screened positive for problematic alcohol or any drug use in the previous 12 months. During this same period, 79,899 brief interventions were delivered, 15,961 referrals to outpatient treatment were made and 38.3% of those were successfully linked to treatment. Of the 950 patients exhibiting withdrawal symptoms, over two-thirds patients (70.1%; n = 666) were administered buprenorphine, 94.6% (n = 630) accepted a referral to buprenorphine treatment in the community, and 64.6% (n = 430) attended their first outpatient buprenorphine treatment visit. A total of 2382 patients presented to the ED with a suspected opioid overdose, over half were referred to the intervention program (53.8%) and 63.2% were successfully engaged by the PRCs in the ED. ConclusionsThis analysis supports the scalability of SBIRT in hospital EDs and presents an implementation model that can be replicated in EDs nationwide.

Identification of substance use disorders among pregnant women: A comparison of screeners

BackgroundThe purpose of this study is to evaluate five self-report, non-proprietary questionnaires in the identification of substance use disorders [including alcohol, cannabis, opioids, and stimulants] among pregnant women. ProceduresA total of 1220 pregnant women completed the NIDA Quick Screen, CRAFFT, Substance Use Risk Profile-Pregnancy (SURP-P), Wayne Indirect Drug Use Questionnaire (WIDUS), and the 5 Ps, as well as the MINI diagnostic interview for substance use disorders, which served as the reference standard. Measures of merit calculated for each screener included sensitivity, specificity, accuracy, and area under the receiver operating curve (AUROC). Main findingsThe participants were socioeconomically diverse, with a mean age of 29 years. Over 15% met diagnostic criteria for a substance use disorder. AUROCS for identifying any substance use disorder (including alcohol) ranged from a high of 0.75 for the CRAFFT (95% CI = 0.72–79) and 0.74 for the SURP-P (95% CI = 0.71–.78) to a low of 0.62 for the NIDA Quick Screen (95% CI = 0.59–.65). Overall accuracy of most tested measures was higher for identification of alcohol use disorders than for other substance use disorders (e.g., AUROCs for the CRAFFT and SURP-P for identifying alcohol use disorders were 0.78 and 0.77, respectively). Principal conclusionsThe CRAFFT and SURP-P showed modest ability to identify substance use disorders among pregnant women. Future research is needed to develop an ideal questionnaire set in the complicated societal context which includes increasing rates of use and potential sanction.

Identification of substance use disorders in burn patients using simple diagnostic screening tools (AUDIT/DAST-10)

Introduction and objectivesSubstance use is disproportionately high in burn patients and associated with adverse outcomes. Screening methods for substance use disorders may help predict or avoid adverse outcomes.The University of Utah Burn Center records self-reported Alcohol Use Disorders Identification Tests (AUDIT) and Drug Abuse Screening Tests (DAST-10) for all adult burn admissions. This study assessed for association between AUDIT/DAST-10 scores and burn patient outcomes. MethodsA retrospective chart review of adult burn patients admitted to the University of Utah from 05/01/2014–06/30/2017. Patient demographics, injury data, and substance use data were collected and analyzed. Results322 patients underwent AUDIT/DAST-10 screening (n = 322). 56 (17.4%) had positive AUDIT screens (score ≥ 8). 15/50 with alcohol use at time of injury (TOI) had negative AUDIT screens. Median AUDIT score with TOI alcohol use was 12, without TOI alcohol use was 1. 30/55 patients offered alcohol counseling accepted.14 patients (4.3%) had positive DAST-10 screens (score ≥3). 9/25 with drug use at TOI had negative DAST-10 screens. No patients without TOI drug use had DAST-10 scores >2. 9/11 patients offered drug counseling accepted.Mean standardized length of stay (LOS) per TBSA burn injury was 1.7 days for positive AUDIT, 1.6 days for negative AUDIT. Median standardized LOS was 1.4 days for positive DAST-10, 1.7 days for negative DAST-10. ConclusionsAUDIT and DAST-10 screens can identify burn patients with problematic substance use, allowing early intervention. Positive screening scores do not independently predict longer hospital stays, increased wound severity, or treatment noncompliance.

The Adolescent Domain Screening Inventory (ADSI) as a screen for assessing opiate use

Background: The terms epidemic and crisis appear almost daily in the media in relation to opiates. Barriers to treatment include the lack of early identification of substance use disorders. A review of the literature revealed no instruments specifically tested to identify opiate users for early intervention. One instrument that may serve this purpose is the Adolescent Domain Screening Inventory, or ADSI. Methods: This exploratory study is a secondary analysis and was conducted in 2018 on data collected in 2000; the study employed the use of an independent t-test and logistic regression through IBM SPSS 24 software. Results: The independent t-test showed a statistically significant difference between the ADSI scores for non-opiate users and opiate users (p < .001). The ADSI showed a 20% increase over the beginning block, and predicted 72.8% of opiate users in this sample. Conclusion: This study suggests that the ADSI may be a useful tool in identifying opiate users who are early in their use, in an effort to provide substance use intervention and treatment in a timely manner.

When Addiction Co-Occurs With Traumatic Brain Injury

When Addiction Co-Occurs With Traumatic Brain Injury

Clinical Characteristics and Health Service Use of Veterans With Comorbid Bipolar Disorder and PTSD

Clinical Characteristics and Health Service Use of Veterans With Comorbid Bipolar Disorder and PTSD

Accuracy of self-report and toxicological assays to detect substance misuse disorders in parasuicide patients.

To assess the accuracy of self-reported substance use and toxicological assays in subjects admitted for Intentional Drug Overdose (IDO), using as a reference diagnosis of substance use disorder. Self-reported substance use was collected and toxicological assays were carried out in urine samples in 507 patients with IDO. A standardized psychiatric evaluation was performed in 100 randomly selected subjects. In routine practice, the emergency department staff did not investigate substance use in nearly one of two patients. Patients' statements and toxicological assays were more specific than sensitive, with lower scores for toxicological assays. Patients' statements made it possible to detect nearly 80% of subjects with substance use disorder. Identification of substance use disorder in subjects with IDO has strong clinical consequences regarding treatment and prevention of suicidal behaviour. Thus, emergency department staff should be made aware of the value of more systematically exploring self-reported substance use.

Substance use disorder comorbidity among inpatient youths with psychiatric disorder.

Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder. A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected. Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD. Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.

The impact of substance use screening on a public psychiatric inpatient population.

This study sought to determine the impact of a formal screening program for substance use disorders among psychiatric inpatients. Both identification of these disorders and referrals to aftercare were measured. A total of 193 patients admitted to a state psychiatric facility during a two-month period before screening was initiated were compared with 183 patients admitted during the same two months a year later when screening was in place. Patients were screened using the Chemical Use, Abuse, and Dependence Scale. Data were collected from hospital and statewide computerized files. Consistent with findings of previous studies, the formal screening procedure increased the identification of substance use disorders, even among those who were not screened during the screening period. However, despite heightened awareness of staff, referrals to outpatient treatment in the community after discharge did not increase. In fact, patients who did not have a comorbid substance use disorder were more frequently referred to aftercare than were dually diagnosed patients. Access to services for dually diagnosed patients may be limited by both staff and patient barriers. Underdiagnosis may be partly overcome by formal screening procedures, but staff bias may influence use of screening tools as well as aftercare referrals. In turn, individuals with a comorbid disorder who are not referred to aftercare may be more resistant to treatment and follow-up care. These issues must be clinically addressed by educating and sensitizing staff, as well as by administrative means.