Rates Of Substance Abuse Disorders Research Articles

1135: Increasing rate of no prenatal care in pregnancies complicated by Hepatitis C in the US

Despite efforts to expand access to prenatal care under the umbrella of Healthy People 2020, certain populations of women continue to be at risk for not accessing prenatal care. We aim to describe the relationship between no prenatal care (PNC) with pregnancies complicated by Hepatitis C in the US. Population-based retrospective cohort study of all US live births from 2012-2016 using vital statistic records. Quantity of PNC is recorded on the US certificate of live birth as “total number of prenatal visits” for the pregnancy. No PNC was defined as zero prenatal visits, and inadequate PNC defined as < 50% of recommended number of visits adjusted for gestational age at birth using the Kessner Index. Presence of Hepatitis C (Hep C) is also recorded on the US birth certificate. Frequency of no PNC was calculated per year among all live births (20-42 wks) and compared to births to mothers with Hep C. The rate of no PNC overall during the study period was 1.47%, increasing from 1.36% in 2012 to 1.58% in 2016, p< 0.001. Of the 19,547,691 births analyzed, 0.29% mothers had Hep C. Among births to mothers with Hep C, the rate of no PNC rose from 1.21% to 6.31%, greater than 5-fold increase, p< 0.001. The largest annual increase of no PNC with Hep C was in 2014 with a 3.5-fold increase over 1 year, an increase not similarly observed in the overall population (figure). Rates of inadequate prenatal care similarly increased in women with Hep C during the study period. The overall rate of no PNC in the US rose slightly from 2012-2016. However, the rate increased more dramatically among women with Hep C. This may be related to higher rates of maternal substance use disorders among women with Hep C, particularly intravenous drug use. Mothers’ perceptions of negative legal ramifications of having illicit drug use identified during pregnancy may lead to avoidance of prenatal care. Public health initiatives should focus on improving access to care for women with high-risk pregnancy conditions, especially as rates of substance abuse disorders and Hepatitis C are on the risk in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Ten-year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study.

Prevalence rates of mental disorders in patients with chronic pain vary and may be overestimated when assessed by screening instruments only. Objectives were to estimate the 10-year prevalence of different mental disorders diagnosed by psychiatrists in patients with chronic pain compared with the Danish general population. Patients (n=7197) consulted in the interdisciplinary Pain Clinic South at Odense University Hospital, Denmark, from 2005 to 2015 were included. Data from the Pain Clinic were linked to the Danish National Patient Register-Psychiatry and the Danish Civil Registration System. Age and gender standardized prevalence ratios (SPR) were calculated. In all, 17.8% of patients with chronic pain had been diagnosed with a mental disorder. The most frequent diagnoses were adjustment disorders (subcategory of anxiety disorders) (8.9%), depression (6.1%), personality disorders (3.8%), and substance abuse disorders (3.5%). Women and men with chronic pain had higher rates of anxiety disorders (SPR 3.1; 95% CI 2.9-3.4) and depression (SPR 2.5; 95% CI 2.3-2.8), whereas men had higher rates of substance abuse disorders (SPR 1.6; 95% CI 1.3-1.9) than found for the general population. Although depression and anxiety were noted more frequently among patients with chronic pain than the general population, prevalence rates were lower than previously reported. The most frequent diagnoses were adjustment disorders. Prevalence rates of anxiety and depression diagnosed by psychiatrists in patients with chronic pain were found to be lower than previous findings using screening instruments. Adjustment disorders were the most frequent disorders diagnosed, as this study is the first to investigate.

Treatment of Substance Abuse in Military Hampered by “Old-fashioned” Approach

TO COMBAT EMERGING SUBSTANCE use problems among military personnel and veterans, the Department of Defense (DOD) must abandon outdated treatment practices, strengthen its clinician workforce, and promote early treatment through screening and confidential care, according to a report from the Institute of Medicine (IOM) (http://tinyurl.com/cqngzkz). Substanceusedisordershavelongbeen a major concern for the military, as personnel grapple with the stresses of deployments and the physical and psychological traumasofwar.Butrecentanecdotalreportsanddatasuggestthatrisky alcohol consumption and prescription drug abuse have increased substantially inthemilitaryoverthepastdecade.Nearly half of the service men and women surveyed in 2008 reported binge drinking (definedasdrinking5ormoredrinkson the same occasion) in the past month, compared with 35% in 1998, according to data from the DOD Surveys of Health RelatedBehaviorsamongMilitaryPersonnel.Additionally, reportedmisuseofopioidpainmedicationshas increased from 2% in 2002 to 11% in 2008. Congress mandated an outside review of substance abuse care for members of the military as part of the NationalDefenseAuthorization Act, and the DOD commissioned the IOM to conduct the review. Senator Claire McCaskill (D, Mo) proposed the review and other measures to overhaul care for substance abuse in the military following a whistle-blower report of inadequate staffing and other problems hindering substance abuse treatment at Fort Leonard Wood in Missouri. The IOM found that the care being offered for substance abuse disorders in the military is decades behind the times. Committee member Dennis McCarty, PhD, professor of public health and preventive medicine at Oregon Health & Science University in Portland, explained that clinicians in the TRICARE program, which serves most active-duty service members, are bound by regulations enacted in the 1980s that were based on the treatment paradigms of the 1970s and 1980s. The result, he said, has been an overemphasis on inpatient care that not only limits access to care but also fails to account for the chronic and often relapsing nature of substance abuse disorders. Current evidence-based care reserves inpatient treatment for the most medically complex cases and emphasizes multidisciplinary outpatient care, according to the report. McCarty noted that TRICARE clinicians are also prohibited from treating substance abuse disorders with agonist medications such as buprenorphine, which have become a key tool for managing cravings in patients with these disorders. “Modern treatment of substance abuse disorders does involve medications,” said Charles P. O’Brien, MD, PhD, chair of the IOM committee that developed the report and director of the Center for Studies of Addiction at the University of Pennsylvania in Philadelphia. “The approach to treatment of substance use disorders in the military tends to be old-fashioned.” The IOM called for better adherence to the 2009 Clinical Practice Guideline for the Management of Substance Abuse Disorders created by the Department of Veterans Affairs (VA) and the DOD (http://tinyurl.com /cc4eqt4), noting that this has helped improve care at VA facilities. However, adherence in TRICARE has been low because there has been no requirement to provide evidence-based care, according to the report. Inadequate staffing levels, particularly of clinicians with appropriate training, have also impaired the military’s response to increasing rates of substance abuse disorders. The report calls for the adoption of a model in which multidisciplinary teams, each led by a primary care physician, provide sub-

Does Resilience Protect Minorities From Mental Illness?

Does Resilience Protect Minorities From Mental Illness?

Distant Trauma: A Prospective Study of the Effects of September 11th on Young Adults in North Carolina

In 2001, 730 young adults (aged 19-21) were given a detailed assessment as part of an ongoing longitudinal, epidemiological study of the development of psychiatric disorders across childhood and adolescence. Each participant had been interviewed up to 6 times previously, beginning in 1993. Parents were also interviewed until participants reached 16 years old. By chance in 2001, two-thirds (475) of the participants were interviewed before September 11, 2001; and one-third (255) were interviewed afterward. This provided an opportunity (a) to compare current psychopathology in those interviewed before and after September 11th, (b) to test whether September 11th acted as an additional stressor, and (c) to examine the factors from participants' earlier lives that increased the impact of September 11th. Substance use, and substance abuse disorder (SUD), were significantly more prevalent after September 11th in women. Men interviewed after September 11th were slightly more likely to have 1 or more symptoms of posttraumatic stress disorder, but rates of SUD were significantly lower. No other psychiatric disorders showed an increase after September 11th. All psychiatric disorders were more likely to occur in 2001 in those with a previous history of the same diagnosis but only substance abuse in women showed an interaction with September 11th. Overall prevalence of SUD in men was lower after September 11th in both those with and those without a previous history. Examination of a range of risk factors that might predict psychopathology following a trauma showed effects in those with relatively low levels of previous risk, but not in those at the highest levels of risk. This study of young adults living some 500 miles from the events of September 11, 2001, on whom data were available both before and after that date, suggests that the main effect was on drug abuse and dependence. Drug use and abuse increased in women and decreased in men. This finding is in line with earlier work showing that some forms of psychiatric disorder can decrease during times of civic crisis. September 11th served as an additional stressor for those under low to moderate levels of stress but did not affect those already under high stress.

COMMENTARY ON WHY NATIONAL EPIDEMIOLOGICAL ESTIMATES OF SUBSTANCE ABUSE BY RACE SHOULD NOT BE USED TO ESTIMATE PREVALENCE AND NEED FOR SUBSTANCE ABUSE SERVICES AT COMMUNITY AND LOCAL LEVELS

Large-scale epidemiological studies suggest substantially lower prevalence rates of substance abuse disorders in Black Americans than in White Americans. This is counterintuitive since indicators of socioeconomic status, which on an average are lower in Blacks than Whites, are inversely associated with the prevalence of psychiatric disorders. Herein, we recommend against the use of race-specific national epidemiological data to estimate prevalence of substance abuse disorders and need for services at community/local levels. This is important so that catchment areas with high proportions of minorities receive equitable levels of substance abuse prevention and treatment resources. We illustrate our recommendation through observations and potential biases (e.g., reporting bias) identified from large-scale epidemiological studies of the prevalence of substance use disorders between Black and White Americans.

Socioeconomic Status and Psychiatric Disorder among Blacks and Whites

This article examines the relationship between socioeconomic status (SES) and current (six-month) and lifetime rates of psychiatric disorders among blacks and whites. Overall, SES is inversely related to psychiatric disorder for both racial groups. This association is weaker for black males than for white males. There is some variation among specific disorders, with the strongest relationship with SES occurring for alcohol abuse. The six- month rate of depression is unrelated to SES among blacks but inversely related for whites. In contrast to our expectations, we found that lower-SES white males have higher rates of psychiatric illness than their black peers. Lawer-SES black females have higher rates of substance abuse disorders than their white counterparts. These findings underscore the need for research efforts to identify the mechanisms and processes that link social stratification to disease.

Socioeconomic Status and Psychiatric Disorder among Blacks and Whites

This article examines the relationship between socioeconomic status (SES) and current (six-month) and lifetime rates of psychiatric disorders among blacks and whites. Overall, SES is inversely related to psychiatric disorderfor both racial groups. This association is weakerfor black males than for white males. There is some variation among specific disorders, with the strongest relationship with SES occurringfor alcohol abuse. The sixmonth rate of depression is unrelated to SES among blacks but inversely related for whites. In contrast to our expectations, we found that lower-SES white males have higher rates of psychiatric illness than their black peers. Lower-SES black females have higher rates of substance abuse disorders than their white counterparts. These findings underscore the need for research efforts to identify the mechanisms and processes that link social stratification to disease.

Drug and alcohol abuse by bulimic women and their families.

The author studied patterns of drug and alcohol abuse in 35 bulimic women, 35 healthy control subjects, and their first- and second-degree relatives. The bulimic women and their families had significantly higher rates of substance abuse disorders.