Impact Of Substance Use Disorders Research Articles

Perinatal substance use disorder: Examining the impact on adverse pregnancy outcomes

ObjectiveSubstance use disorder is a growing concern in the USA, especially among pregnant women. This study was undertaken to assess the impact of substance use disorder on adverse pregnancy outcomes using a nationwide sample of inpatient pregnancy hospitalizations in the USA, and to elucidate the influence on each type of adverse pregnancy outcome. Study designA cross-sectional analysis of inpatient pregnancy hospitalizations in the USA from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020 was conducted. International Classification of Diseases – 10th revision and diagnosis-related group codes were used to identify inpatient pregnancy-related delivery hospitalizations with a substance use disorder and/or adverse pregnancy outcomes. Propensity score matching and multiple logistic regression analyses were undertaken to predict the likelihood of adverse pregnancy outcomes among pregnancy hospitalizations with and without substance use disorder. Subgroup analyses were performed to estimate the impact of substance use disorder on each adverse pregnancy outcome. ResultsFrom 3,238,558 hospitalizations, the prevalence of adverse pregnancy outcomes was substantially higher among pregnancy hospitalizations with substance use disorder (35.6 %) compared with pregnancy hospitalizations without substance use disorder (25.1 %, p < 0.001). After matching and model adjustment for sociodemographic covariates, substance use disorder was identified as an independent predictor of adverse pregnancy outcomes [adjusted odds ratio (aOR) 1.47, 95 % confidence interval (CI) 1.45–1.49]. In subgroup analyses based on type of adverse pregnancy outcome, the greatest exposure risks were fetal growth restriction (aOR 1.96, 95 % CI 1.91–2.01), antepartum hemorrhage (aOR 1.79, 95 % CI 1.73–1.85) and preterm birth (aOR 1.65, 95 % CI 1.62–1.68). ConclusionPatients with substance use disorder are at higher risk of adverse pregnancy outcomes, particularly fetal growth restriction, antepartum hemorrhage and preterm birth.

Exploring perceptions of self-stigma of substance use and current alcohol and marijuana use patterns among college students.

While research has examined the effect of stigma from others towards individuals with substance use disorders, few studies have examined the relationship between perceived self-stigma and engagement in substance use more broadly, especially among non-clinical samples. The present study examined the relationships between perceptions of self-stigma if one were to develop a substance use disorder, consisting of negative self-esteem and negative self-efficacy, and alcohol or marijuana use behaviors and outcomes. Participants (n = 2,243; 71.5% female) were college students within the U.S. recruited to participate in an online survey on substance use with a special focus on alcohol and marijuana. Results indicated no significant differences in stigma scores across individuals with different lifetime alcohol and marijuana use. Stigma ratings did differ between individuals with different profiles of last 30-day alcohol and marijuana use where, generally, individuals with lifetime use but no use in the last 30-day reported higher levels of self-stigma. Correlation analyses indicated that perceived impact of substance use disorder on sense of self-efficacy and self-esteem related negatively to nearly all observed factors of alcohol and marijuana use. Though self-stigma, and stigma more broadly, has been shown to have negative implications for people with substance use disorders, the present study suggests that for non-clinical populations there may be some protective association between perceived self-stigma and alcohol or marijuana use engagement. This is not to say that self-stigma is a positive clinical intervention. Rather, we interpret these findings to indicate that negative perceptions of substance use disorder on the sense of self may be associated with distinct alcohol and marijuana use behaviors among young adults.

A Cross-Sectional Study On Psychiatric Disorders among Poor Academic Performance Primary School (6-12 Years) Children with Substance Use Disorders in Their Parents

Abstract Background: Psychiatric disorders are more prevalent among children with poor academic performance. There is limited literature on the impact of substance use disorders (SUD) in parents on psychiatric symptoms of these children. Objectives: (1) To assess the psychiatric disorders in primary school (6–12 years) children with poor academic performance. (2) To assess the prevalence and type of SUD in parents of these children. Materials and Methods: A cross-sectional study was conducted on children with poor academic performance. Simple randomization was adopted and 115 children and their parents were included in the study. Mini International Neuropsychiatry Interview-Kid (M.I.N.I. Kid) was used to screen psychiatric symptoms and various scales were used to assess the severity of symptoms. Parents of these children were interviewed for the presence of SUD. The diagnosis was made as per the International Classification of Diseases tenth revision (ICD-10). The association between psychiatric disorders and parental SUD was assessed using Chi-square test. Results: The prevalence of psychiatric disorders was 54.78% and most prevalent disorder was emotional disorders with onset specific to childhood with prevalence of 21.74%. Prevalence of SUD among parents of these children was found to be 18.26% and alcohol dependence syndrome (ADS) was more common type (12.17%). There was no significant association between psychiatric disorders in these children and SUD in their parents (χ2-2.93, df-10, P = 2013-.98). Conclusion: Emotional disorders with onset specific to childhood are more commonly prevalent psychiatric disorders among children with poor academic performance. A study found no significant association between SUD among parents of these children and psychiatric symptoms.

Global perspectives on substance use treatment: A review of cross-cultural approaches and conceptual solutions for public health

Substance use disorders represent a significant public health challenge worldwide, necessitating a nuanced understanding of cultural variations in treatment approaches. This review examines global perspectives on substance use treatment, focusing on cross-cultural approaches and conceptual solutions aimed at enhancing public health outcomes. Cross-cultural perspectives underscore the importance of recognizing diverse cultural beliefs, values, and practices in addressing substance use disorders. Cultural factors such as stigma, religious beliefs, and societal norms profoundly influence individuals' perceptions of substance use and treatment-seeking behaviors. Understanding these cultural nuances is crucial for developing effective interventions tailored to specific populations. Moreover, this review explores various treatment modalities that have been implemented across different cultural contexts. From traditional healing practices rooted in indigenous knowledge to evidence-based interventions adapted for cultural relevance, a spectrum of approaches exists to address substance use disorders globally. Integrating traditional healing methods with modern evidence-based treatments showcases promising outcomes in promoting recovery and reducing substance-related harm. Furthermore, conceptual solutions for enhancing public health outcomes emphasize the importance of a comprehensive and holistic approach. This includes addressing social determinants of health, promoting community engagement, and fostering collaboration between diverse stakeholders, including governments, healthcare providers, and community organizations. This review highlights the necessity of adopting culturally sensitive approaches to substance use treatment to effectively address the complex interplay between culture, health beliefs, and treatment outcomes. By recognizing and respecting cultural diversity, we can develop more inclusive and effective strategies to mitigate the impact of substance use disorders on individuals and communities worldwide.

348. Impact of Substance Use Disorders on Outcomes of Medically Insured Persons Receiving Multiweek Outpatient Parenteral Antimicrobial Therapy

Abstract Background Catheter complications, misuse, nonadherence, safety, and legal concerns often prohibit persons with a history of substance use disorder (SUD) from receiving outpatient parenteral antimicrobial therapy (OPAT). However, single center studies in the U.S. found similar rates of readmission and adverse events among patients receiving OPAT regardless of SUD history. As such, we compared outcomes and complications between patients with and without a history of SUD who were treated with multiweek OPAT using claims data from multiple years across the U.S. Methods We used data from the IBM MarketScan Databases to identify patients who were ≥ 18 years and treated with intravenous vancomycin, daptomycin, nafcillin, oxacillin, or cefazolin for ≥ 7 days after hospital discharge between July 1, 2016 and July 31, 2020. Those with a history of end stage renal disease or Clostridioides difficile infection were excluded. Patients were separated into two cohorts based on a history of SUD using ICD-10-CM diagnosis codes prior to hospital discharge. The rates of adverse events including drug overdose and catheter complications during OPAT, all-cause readmissions within 90 days after completion of OPAT, and infection-related readmissions within 90 days after completing OPAT were compared between groups. Results Of 5903 patients included, 18% (n = 1058) had a history of SUD. Those with a history of SUD were younger than individuals without a history of SUD (47 ± 12 vs 53 ± 15 years, P &amp;lt; 0.0001) and there were fewer male patients in the SUD group (52% vs 56%, P = 0.02). Type 2 diabetes mellitus (43% vs 52%, P &amp;lt; 0.0001), arrhythmias (33% vs 31%, P = 0.152), and depression (49% vs 30%, P &amp;lt; 0.0001) were most common among both groups. More patients in the SUD group experienced at least one adverse event during OPAT (8% vs 5%, P = 0.004). All-cause readmissions and infection-related readmissions within 90 days after completion of OPAT were more common among patients with a history of SUD (40% vs 32%, P &amp;lt; 0.0001 and 27% vs 22%, P = 0.02, respectively). Conclusion Patients with a history of SUD experienced higher rates of adverse events during OPAT and were more likely to require readmission for any reason, including readmissions due to infection, within 90 days after completion of OPAT. Disclosures All Authors: No reported disclosures

A Majority of U.S. Adults Have Experienced the Impact of Substance Use Disorders.

Alcohol addiction is the most prevalent.

7.2 The Multigenerational Impact of Substance Use Disorder–Related Stigma and How to Address It With Families

7.2 The Multigenerational Impact of Substance Use Disorder–Related Stigma and How to Address It With Families

The prevalence and treatment utilization of substance use disorders among Muslims in the United States: A national epidemiological survey.

Research on substance use disorder (SUD) among Muslims in the United States (US) is limited. There are several unique factors, including denial and stigma, that make this population at risk of SUD. This study explored the prevalence, treatment utilization, and impact of SUD among Muslims in the US compared with a matched control group from general respondents. Data from 372 self-identified Muslims were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions III. A matched non-Muslim control group (N = 744) were selected based on demographics and other SUD-relatedclinical variables. The impact of SUD was assessed using the 12-Item Short Form Health Survey (SF-12). Among the 372 Muslims, 53 (10.85%) had lifetime alcohol/drug use disorder, while 75 (18.42%) had lifetime tobacco use disorder (TUD). With statistical significance, alcohol use disorder (AUD) was lower while TUD was higher in the Muslim group than in the control group. The rates of all other substances were not statistically different between the Muslim and control groups. The Muslim group have higher help-seeking and a lower mean score on the SF-12 emotional scale than the control group. Muslim Americans have higher prevalence of TUD, lower prevalence of AUD, and similar prevalence of other SUD compared to the public. Affected individuals have poor emotional functioning which may be exacerbated by the impact of stigma.This is the first study to estimate prevalence of variety of SUD in American Muslims from a national representative sample.

The impact of substance use disorders on families and carers: A scoping review

Substance Use Disorder (SUD) is a persistent and global public health and social problem. This scoping review explores and describes the impact that Substance Use Disorders (SUDs) have on families and carers. It draws on 36 research articles published between January 2007 and August 2021. The review findings are presented according to three themes, namely (1) the impact of SUDs on families/ carers, (2) the burden on carers, and (3) coping responses to living with a person with SUD. The evidence indicates that SUDs in a family affects almost all domains of family members' and carers' lives, suggesting the need to develop targeted harm reduction interventions that could reduce vulnerability and help restore the bio-psychosocial well-being of family members and carers.

EPH68 Impact of Treatment with Central Nervous System Stimulant and Risk of Substance Use Disorder in Adults with Attention-Deficit/Hyperactivity Disorder in West Virginia

Our objectives were to examine the relative risk of substance use disorder (SUD) and impact of SUD on healthcare resource utilization (HRU) among adults with Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) who were prescribed with stimulant compared who were not.

Impact of substance use disorders on employment for veterans.

Approximately 1.1 million veterans meet criteria for substance use disorders (SUDs) with 1 in 4 struggling with illicit drugs, 4 in 5 struggling with alcohol use, and 1 in 13 struggling with both. The purpose of this study was to examine the impact of SUDs on closure status (exiting with employment, did not exit with employment) for veterans served in a Department of Veterans Affairs' Veterans Health Administration (VHA) vocational rehabilitation (VR) program. Data (N = 2,620) from a VHA VR program in the Veterans Integrated Service Network 12 network were obtained for the purpose of the present study and consisted of veterans enrolled from 2012 to 2018. Findings showed that veterans without SUDs were more likely to exit with employment, and veterans enrolled in transitional work and community-based employment were more likely to exit with employment compared to those within supported employment (SE). Given that SE helps to serve veterans with the most severe psychological or medical conditions (e.g., active psychosis, schizophrenia, bipolar disorder, spinal cord injury, traumatic brain injury), findings suggest veterans are more successful with less serious mental health conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of Cannabis Use, Substance Use Disorders, and Psychiatric Diagnoses on COVID-19 Outcomes: A Retrospective Cohort Study.

Objective: While psychiatric disorders have been recognized as a risk factor for COVID-19 outcomes, the impact of substance use disorders (SUD) on COVID-19 outcomes has not, to date, been examined in a systematic manner. We examined the association between SUD (cannabis, cocaine, alcohol, opioid, and benzodiazepine) as well as psychiatric diagnoses (schizophrenia, mood disorders, anxiety disorders) and COVID-19 outcomes in a large, retrospective cohort study. Methods: COVID-19–positive patients admitted to a large health care system in the US between January and December 2020 were included in this study. SUD and psychiatric diagnoses were identified from urine toxicology reports and ICD-10 diagnosis codes in the electronic medical record, respectively. Multivariable logistic regression was performed controlling for potential confounders such as age, race, sex, smoking status, and medical comorbidities. COVID-19–relevant outcomes included mortality, need for intensive care unit (ICU) admission, need for ventilatory support, length of hospitalization, and number of hospitalizations. Results: Among COVID-19 patients (N = 6,291), those with SUD were more likely to require ICU admission (adjusted odds ratio = 1.46, P = .003) and ventilatory support (AOR = 1.49, P = .01). The association between SUD and ICU admission was driven by alcohol use disorder (AUD), whereas that between SUD and ventilatory support was driven by both AUD and opioid use disorder (OUD). Patients with SUD were more likely to have a longer mean maximum length of hospitalization (11.32 vs 8.62 days, P < .0001) and a greater mean number of hospital admissions in 2020 (2.96 vs 2.33, P < .0001). These associations were significant for cannabis use disorder, AUD, OUD, and benzodiazepine use disorder. The association with greater number of admissions was also significant for cocaine use disorder. Patients with psychiatric diagnoses were also more likely to have a greater maximum length of hospitalization (11.93 vs 8.39 days, P < .0001) and hospital admissions (2.72 vs 2.31, P < .0001). These associations were significant for schizophrenia, mood disorders, and anxiety disorders. Conclusions: COVID-19 patients with SUD had greater likelihood of requiring critical interventions, such as ICU admission and ventilatory support. SUD and psychiatric diagnoses were also associated with a longer duration of hospitalization and greater number of hospital admissions. These findings identify COVID-19 patients with SUD and psychiatric comorbidities as a high-risk group.

Evaluating the Impact of Substance Use Disorder Resources on Outcomes of Persons Who Inject Drugs with Infections.

The aim of the study is to evaluate the impact of inpatient substance use disorder (SUD) resources on outcomes of persons who inject stimulants and/or opioids (PWIDs) with infections. This retrospective cohort evaluated PWIDs hospitalized from July 1, 2020, to May 31, 2021, and prescribed an antimicrobial course. The patients were compared based on inpatient implementation of SUD resources, including consultation of addiction medicine/behavioral health, implementation of an opioid withdrawal treatment protocol, or continuation/initiation of medications for opioid use disorder. The primary outcome was a composite of antibiotic completion, no unplanned discharge, and no 30-day readmission. Notable secondary outcomes included length of stay and presence of stigmatizing language in the electronic medical record. A total of 119 patients were analyzed-74 (62.2%) received SUD resources. The primary outcome was met by 43 patients with SUD resources implemented (58.1%) and 19 patients without resources (42.2%, P = 0.093). After adjustment for infection type, implementation of SUD resources (adjusted odds ratio, 2.593; 95% confidence interval, 1.162-5.789) was independently associated with primary outcome success. The patients who received SUD resources had a median length of stay of 7 days (4-13.3) compared with 4 days (2-6.5) in those without resources ( P < 0.001). Stigmatizing language was present in 98% of patient electronic medical records. Patient care provided to PWIDs with infections is optimized when SUD resources are implemented. This study further supports the necessity of improving SUD management when PWIDs are admitted to healthcare facilities.

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

Effects of Substance Use Disorder on In-Hospital Outcomes of Young Patients Presenting With a Cardiovascular Event: A Nationwide Analysis.

BackgroundSubstance use is widely prevalent among young adults and is associated with increased cardiovascular morbidity and mortality such as sudden cardiac arrest, acute coronary syndrome, arrhythmias, and cardiomyopathy. However, they are limited studies analyzing the impact of substance use disorder on in-hospital outcomes among young patients with cardiovascular events.MethodsAll patients aged 18-39 years admitted primarily for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, cardiac arrest, acute ischemic stroke, and venous thromboembolic events in 2019 were identified in the National Inpatient Sample database. They were then categorized into those with and without concomitant substance use disorder (SUD). The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest.ResultsOf 57,985 hospitalizations with cardiac events, 12,115 (20%) of young adults had concomitant SUD. SUD was significantly associated with cardiac arrest (OR 3.3; CI 2.4-4.4), atrial fibrillation (OR 1.5; CI 1.3-1.7), AMI (OR 1.3; CI 1.2-1.6), heart failure (OR 2.6; CI 2.4-3.0) (all p<0.05) despite a lower prevalence of traditional cardiovascular risk factors than non-users. Logistic regression showed acute kidney injury (aOR 1.5; CI 1.3-1.8; p<0.001) and inpatient mortality (aOR 1.6; CI 1.2-2.2; p<0.001) were also significantly higher in young patients presenting with cardiac events and concomitant SUD. There was no difference in the length of stay or incidence of gastrointestinal bleed between the two groups.ConclusionIn young patients presenting with a cardiovascular event, concurrent substance use disorder was associated with increased in-hospital mortality despite significantly lower comorbidities.

Detecting drug diversion in health-system data using machine learning and advanced analytics.

PurposeThe theft of drugs from healthcare facilities, also known as drug diversion, occurs frequently but is often undetected. This paper describes a research study to develop and test novel drug diversion detection methods. Improved diversion detection and reduction in diversion improves patient safety, limits harm to the person diverting, reduces the public health impact of substance use disorder, and mitigates significant liability risk to pharmacists and their organizations.MethodsTen acute care inpatient hospitals across 4 independent health systems extracted 2 datasets from various health information technology systems. Both datasets were consolidated, normalized, classified, and sampled to provide a harmonious dataset for analysis. Supervised machine learning methods were iteratively used on the initial sample dataset to train algorithms to classify medication movement transactions as involving a low or high risk of diversion. Thereafter, the resulting machine learning model classified the risk of diversion in a historical dataset capturing 8 to 24 months of history that included 27.9 million medication movement transactions by 19,037 nursing, 1,047 pharmacy, and 712 anesthesia clinicians and that included 22 known, blinded diversion cases to measure when the model would have detected the diversion compared to when the diversion was actually detected by existing methods.ResultsThe machine learning model had 96.3% accuracy, 95.9% specificity, and 96.6% sensitivity in detecting transactions involving a high risk of diversion using the initial sample dataset. In subsequent testing using the much larger historical dataset, the analytics detected known diversion cases (n = 22) in blinded data faster than existing detection methods (a mean of 160 days and a median of 74 days faster; range, 7-579 days faster).ConclusionThe study showed that (1) consolidated datasets and (2) supervised machine learning can detect known diversion cases faster than existing detection methods. Users of the technology also noted improved investigation efficiency.

Impact of Substance Use Disorder on Between-Network Brain Connectivity in Early Psychosis.

The Triple Network Model of psychopathology identifies the salience network (SN), central executive network (CEN), and default mode network (DMN) as key networks underlying the pathophysiology of psychiatric disorders. In particular, abnormal SN-initiated network switching impacts the engagement and disengagement of the CEN and DMN, and is proposed to lead to the generation of psychosis symptoms. Between-network connectivity has been shown to be abnormal in both substance use disorders (SUD) and psychosis. However, none have studied how SUD affects connectivity between sub-networks of the DMN, SN, and CEN in early stage psychosis (ESP) patients. In this study, we collected data from 113 ESP patients and 50 healthy controls to investigate the effect of SUD on between-network connectivity. In addition, we performed sub-group analysis by exploring whether past SUD vs current SUD co-morbidity, or diagnosis (affective vs non-affective psychosis) had a modulatory effect. Connectivity between four network-pairs, consisting of sub-networks of the SN, CEN, and DMN, was significantly different between ESP patients and controls. Two patterns of connectivity were observed when patients were divided into sub-groups with current vs past SUD. In particular, connectivity between right CEN and the cingulo-opercular salience sub-network (rCEN-CON) showed a gradient effect where the severity of abnormalities increased from no history of SUD to past+ to current+. We also observed diagnosis-specific effects, suggesting non-affective psychosis patients were particularly vulnerable to effects of substance use on rCEN-CON connectivity. Our findings reveal insights into how comorbid SUD affects between-network connectivity and symptom severity in ESP.

Aerobic exercise as a promising nonpharmacological therapy for the treatment of substance use disorders.

Despite the prevalence and public health impact of substance use disorders (SUDs), effective long-term treatments remain elusive. Aerobic exercise is a promising, nonpharmacological treatment currently under investigation as a strategy for preventing drug relapse. Aerobic exercise could be incorporated into the comprehensive treatment regimens for people with substance abuse disorders. Preclinical studies of SUD with animal models have shown that aerobic exercise diminishes drug-seeking behavior, which leads to relapse, in both male and female rats. Nevertheless, little is known regarding the effects of substance abuse-induced cellular and physiological adaptations believed to be responsible for drug-seeking behavior. Accordingly, the overall goal of this review is to provide a summary and an assessment of findings to date, highlighting evidence of the molecular and neurological effects of exercise on adaptations associated with SUD.

Relation of substance use disorders to mortality, accident and emergency department attendances, and hospital admissions: A 13-year population-based cohort study in Hong Kong

BackgroundThe impact of substance use disorders (SUD) in an Asian population has not been fully explored. We aimed to assess the risk of mortality, accident and emergency (A&E) department attendances, and hospital admissions associated with SUD in a population-based cohort study. MethodPatients diagnosed with SUD in public A&E departments from 2004 to 2016 (N = 8,423) were identified in the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority and 1:1 matched to patients without SUD by propensity score (N = 6,074 in each group). Relative risks of mortality, A&E attendances and hospital admissions were assessed using Cox regression and Hurdle negative binomial regression. ResultsPatients with SUD had higher mortality (hazard ratio=1.43; 95% confidence interval [CI]=1.26–1.62) and more often died from poisoning or toxicity and injuries. The odds ratio (OR) for A&E attendances and all-cause hospital admissions associated with SUD were 2.80 (95% CI=2.58–3.04) and 3.54 (95% CI=3.26–3.83), respectively. The impact of SUD on the above outcomes was greatest among school-aged individuals (≤ 21 years) and decreased with age. The relative risk of mental disorder-related hospital admissions was much higher than that for infections, respiratory diseases, and cardiovascular diseases. In patients with SUD, ketamine and amphetamine use were associated with increased A&E attendances than opioid use. ConclusionsSUD was associated with increased mortality, A&E attendances and hospital admissions, especially in school-aged individuals. Our findings suggest prioritising early treatment and preventive interventions for school-aged individuals and focusing on the management of comorbid mental disorders and the use of ketamine and amphetamine.

Cocaine-Positive Patients Undergoing Elective Surgery: From Avoiding Case Cancellations to Treating Substance Use Disorders.

Cocaine-Positive Patients Undergoing Elective Surgery: From Avoiding Case Cancellations to Treating Substance Use Disorders.