Screening For Substance Use Disorders Research Articles

Heterogeneity in Jail Nursing Medical Intake Forms: A Content Analysis.

Despite high prevalence of infectious diseases and substance use disorders in jails, there are limited guidelines for the nursing intake process in this setting. We performed a content analysis of nursing intake forms used at each of the 14 Massachusetts county jails, focusing on infectious disease and substance use disorder. Only 85% of jails offered HIV testing during nursing intake and 50% of jails offered hepatitis C testing. Preventive interventions such as vaccines or pre-exposure prophylaxis therapy were infrequently offered during nursing intake. Screening for substance use disorder was present on the majority of intake forms, but only 23% of intake forms inquired about ongoing medication-assisted treatment for opioid use disorder. The results reflect heterogeneity in nursing intake forms, highlighting missed opportunities for public health interventions.

Elevated risk of substance use disorder and suicidal ideation among Black and Hispanic lesbian, gay, and bisexual adults

ObjectiveBlack and Hispanic persons who identify as lesbian, gay, or bisexual (LGB) experience health disparities relative to non-Hispanic White and heterosexual groups respectively, including higher rates of suicidal ideation (SI) and substance use disorder (SUD). To elucidate intersectional risk, we used a large national sample to examine rates of SI, SUD, and their co-occurrence (SI + SUD) at the intersection of sexual identity and race/ethnicity. MethodData were from five years (2015–2019) of the National Survey of Drug Use and Heath (unweighted N = 189,127). Multinomial logistic regressions with persons without SI and SUD as references were stratified by gender and controlled for survey year, age, education, marital status, and income. ResultsCompared to same-race and same-gender heterosexual adults, White, Black, and Hispanic LGB men and women showed higher odds of SI (AOR = 2.86–4.45), SUD (AOR = 1.23–3.01), and SI + SUD (AOR = 2.72–6.85). Compared to same-gender White heterosexual adults, Black and Latinx heterosexual men and women showed lower odds of SI (AORs = .54–.65), SUD (AORs = .52–.78) and SI + SUD (AORs = .41–.57). Compared to same-gender White LGB adults, Black and Hispanic women, but not men, showed lower SI odds (AORs = .58–.72). Compared to same-gender White heterosexual adults, Black and Hispanic LGB men and women showed higher odds of SI (AORs = 1.71–2.51) and SI + SUD (AORs = 1.91–2.97). ConclusionsConsistent with research showing effects of multiple minority stress on behavioral health, adults with intersecting racial/ethnic and sexual minority identities showed increased odds of SI, SUD, and SI + SUD relative to Non-Hispanic White heterosexual peers. Black, Hispanic, and White LGB adults may benefit from screening and intervention for SI and SUD.

Women substance use in india: An important but often overlooked aspect

IntroductionSubstance abuse has traditionally been considered as a disease of men. Women were believed to have some kind of immunity in terms of “social inoculation”. However, due to change in societal norms and beliefs, substance use is currently increasing among women also.ObjectivesTo focus on female substance use in IndiaMethodsIn India, traditional use of various substances by women during religious festivals is not unknown. Chewing tobacco is a common practice among many women across the country. Cultural use of alcohol has been known in some tribal populations but gradually the use is increasing. There is major difference in pattern of male and female substance use including initiation, progression, recovery and relapse. Women experience greater medical, physiological and psychological impairment and experience loss of control sooner than males. Teatment needs of female substance users is different and requires a gender specific comprehensive strategy which will require medical services, mental health services, services for family and child and employment opportunities.ResultsCurrently, there is no Indian policy for women substance use. However, Government of India has started a convergence program which includes National AIDS Control program (NACP), National rural health mission (NRHM) and reproductive or sexually transmitted infection (RTI/STI) to combat some aspects.Conclusions India is in great need of a policy or at least a standard operative protocol for management of female substance use disorder which may include screening for substance use disorder for all females accessing health sector, counselling, referral to addiction services, formation of a treating team and after –care.DisclosureNo significant relationships.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

The substance use intervention team: A hospital-based intervention and outpatient clinic to improve care for patients with substance use disorders.

In response to the opioid crisis, public health advocates urge hospitals to perform substance use disorder (SUD) screening, brief intervention, discharge planning with referral to treatment, and naloxone education. Universal screening makes specialized treatment available to all patients and decreases stigma around SUDs, allowing patients and providers to address SUDs during their hospitalization. Additionally, hospital and emergency department-initiated medications to treat SUD improve patient engagement with treatment and decrease opioid use, and use of medications for opioid use disorder after nonfatal overdoses decreases mortality. A substance use intervention team (SUIT) service was established to offer universal screening and consultation by an interdisciplinary team at our urban academic medical center. The SUIT program provides inpatient consultation services as well as medical and behavioral clinic visits to transition patients to long-term treatment and is comprised of physicians, nurse practitioners, a clinical pharmacist, social workers, and a nurse. Successes attributed to enhanced medication use as a function of having a designated pharmacist as an integral member of the team are highlighted. Our medical center initiated screening efforts in tandem with its interdisciplinary team and clinic. The team attempts to start appropriately selected patients with SUD on medications for SUD while hospitalized. From January through December 2018, 87.2% of patients admitted to the hospital received initial SUD screening. Of the patients who screened positive, 1,400 received a brief intervention by a unit social worker; the SUIT service was consulted on 880 patients, and multiple medications for SUD were started during inpatient care. A screening, brief intervention, and referral to treatment service was successfully implemented in our hospital, with the SUIT program in place to provide interdisciplinary addiction care and initiate medications for SUD in appropriate patients.

Validated scales for substance use disorders in the geriatric population: A scoping review

Substance use disorders in the elderly population can be assessed through scales and questionnaires. These scales are used for not only screening for substance use disorders but also for assessment for improvement with time and/or intervention. Validity parameters of these scales help us know how do they perform during application in the clinical or community setting. The objective of the review was to (1) review available validated screening tools for substance use disorders, (2) summarize elderly-focused studies, and (3) provide recommendations for use in clinical care. We aimed to review the validated scales of substance use disorders in the geriatric population. We looked at PubMed and Web of Science databases for identifying English language peer-reviewed publications that reported at least one validity parameter for scale in geriatric patients with substance use disorders. We identified 22 studies, with majority of them focusing on alcohol use disorder. Alcohol Use Disorder Identification Test and Cut Down, Annoyed, Guilty, and Eye-Opener Questionnaire (CAGE) were the most common scales used in the population. While most of the studies reported acceptable area under receiver operator curve, sensitivity, and specificity, some of the studies reported lower sensitivity/specificity at optimal cutoff. Validity parameters of various scales have been assessed in the geriatric population. Using suitable cutoffs, they can be useful in the screening of elderly individuals with substance-related problems, so that due evaluation and care can be provided. More instruments need to be assessed for validity to diagnose tobacco use disorders, benzodiazepine use disorders, and other substance use disorders.

Changes in knowledge, attitudes and beliefs in BSN students after SBIRT education and practice in home health.

Substance Use Disorders (SUD) have detrimental effects on US population's health, healthcare system, and economy. Nursing knowledge gaps in SUD justifies need for nursing education in screening for SUD. Purposes include examining differences in: METHOD: This single-group, pretest-posttest study of 488 BSN students who completed education for integrating SBIRT into home assessments. Instruments included a demographics' survey, SBIRT Knowledge instrument, and Substance Abuse and Attitude Survey (SAAS). Descriptive statistics using analysis of variance (ANOVA) models and paired-sample t-tests were employed to analyze data. Successful identification of knowledge and attitudes significantly improved after BSN education and revealed specific areas for future research. No significant differences in knowledge, and attitudes and beliefs based on gender, race, and ethnicity were found. Understanding educational interventions' influence on knowledge and attitudes and beliefs of BSN students toward clients may have a significant effect on quality of care. Positive findings support students SBIRT education. Integrating SBIRT education and practice provides knowledge and attitudinal enhancements for SUD care and supports population and public health initiatives.

Treatment of Opioid Use Disorder in the Elderly

With the increasing age of those born between 1946 and 1965, issues relating to the “baby boomer” generation are more relevant than ever. This review aims to both highlight the importance of screening for substance use disorders in the elderly (specifically in this case, opioid use disorder) and then summarize the available treatment options for this vulnerable population. A narrative review of the literature showed surprisingly little research on the treatment of substance use disorders, especially opioid use disorder, in the elderly. None of the three medications that are FDA approved for opioid use disorder in adults (methadone, buprenorphine, and naltrexone) is contraindicated in the elderly. All medications should be used cautiously, keeping in mind that the elderly often have more medical issues (which can include chronic pain) as well as are on multiple medications that can lead to medication interactions. Because there is very limited data on treatment of opioid use disorder in later life, current treatment generally follows recommendations for the general/mixed age population. More research into the topic is needed, especially with a larger percentage of the “baby boomer” generation entering the 65+ age range.

Non-disclosure of drug use in outpatient health care settings: Findings from a prospective cohort study in Vancouver, Canada

BackgroundIllicit drug use is associated with severe health-related harms, yet people who use drugs (PWUD) face substantial barriers to healthcare. We sought to identify factors associated with disclosure of drug use to a healthcare provider and describe differences in self-reported quality of care received based on disclosure status. MethodsA client-reported experience questionnaire on healthcare access and quality, adapted from the World Health Organization Survey on Health and Health System Responsiveness, was administered within two ongoing prospective cohort studies of PWUD in Vancouver, Canada. Respondents not currently receiving addiction treatment were asked about experience of care and drug use disclosure to their most commonly accessed outpatient healthcare provider in the past 6 months. We used an adjusted logistic regression model to identify client characteristics associated with disclosure. ResultsFrom a total of 261 respondents (34.1% female), less than half (n = 125, 47.8%) reported disclosing drug use to their healthcare provider. Indigenous participants were less likely to disclose compared to non-Indigenous participants (adjusted OR: 0.55, 95% confidence interval: 0.30, 0.97). Disclosure was associated with lower self-reported quality of care (overall rating: disclosed 8.2 vs. did not disclose 8.8, p = 0.04). ConclusionsIn a sample of PWUD accessing outpatient healthcare services, we observed low rates of drug use disclosure, particularly for Indigenous respondents, and reduced quality of care for those who disclosed. These findings highlight the need for culturally safe and non-stigmatizing care to address pervasive stereotyping in the healthcare system and improved screening for substance use disorder in outpatient healthcare services.

A Pilot Interprofessional Course on Substance Use Disorders to Improve Students’ Empathy and Counseling Skills

Objective. To implement and assess the effectiveness of an interprofessional course designed to provide pharmacy and nursing students with opportunities to improve their understanding of substance use disorders (SUDs), assess their attitudes toward patients with SUDs, receive instruction and feedback on behavior change counseling, and engage in interprofessional education. Methods. The course consisted of four interactive class sessions that focused on empathy and recognition of personal bias, behavioral change counseling, and SUD recognition, screening, and treatment. Classes were taught by an interprofessional faculty member. Students also attended a 12-step recovery meeting in the community, counseled an authentic patient using behavioral change counseling, and received feedback based on a faculty member's direct observation of their counseling. Students completed validated assessments of their attitudes toward patients with SUDs and interprofessional collaboration. A faculty member used the Behavioral Change Counseling Index (BECCI) to assess students' counseling of SUD patients. Counseled patients were asked their preference for follow-up care for their SUD. Results. Twenty-seven pharmacy and nursing students completed this course, along with 51 students from other professions. The pharmacy and nursing students demonstrated significant improvements in their attitudes toward patients with SUDs and toward interprofessional collaboration, as measured by the Substance Abuse Attitudinal Scale (SAAS) and Student Perception of Interprofessional Clinical Education (SPICE-R2). Approximately 93% of pharmacy and nursing students counseled a patient with a SUD, with 96% of counseled patients reporting their intent to receive follow-up care. Conclusion. An interprofessional SUD course enriched pharmacy and nursing students' understanding, attitudes, and behaviors toward patients with SUDs and interprofessional collaboration. Students demonstrated an ability to provide behavior change counseling to patients, and 96% of counseled patients stated a willingness for follow-up care for their SUD.

Psychopathology and Hypersexuality among Veterans with and without Histories of Alcohol-use Disorders.

Little research has examined the clinical characteristics of U.S. post-9/11 military veterans coping with alcohol problems. Specifically, we examined psychopathology and hypersexuality among male and female post-9/11 veterans with and without a lifetime history of alcohol-use disorders (AUDs). Using data from a baseline telephone interview and follow-up web-based survey, we examined frequencies of AUDs, mental health and addictive disorders, sexual behaviors, hypersexuality, and problematic use of pornography in a national convenience sample of 283 U.S. veterans. Many (39.1%) veterans met lifetime criteria for AUDs. Bivariate associations revealed that veterans with lifetime AUDs met clinically significant levels of posttraumatic stress disorder and criteria for drug-use disorders (lifetime). Veterans with lifetime AUDs also attended religious services less often, engaged in more solitary masturbation in the past month, and reported more issues with problematic use of pornography and hypersexuality compared with veterans without AUDs. Results from a logistic regression found that lifetime drug-use disorders (odds ratio [OR] = 4.22) and posttraumatic stress disorder symptoms (OR = 1.98) were significant predictors of veterans with lifetime AUD status. We found differences among veterans with lifetime AUDs compared with those without on select measures of psychopathology, sexual behavior, and hypersexuality. Further screening for substance-use disorders and hypersexuality in Veterans Affairs is strongly encouraged while veterans are transitioning back into civilian life. (Am J Addict 2019;28:398-404).

Behavior Change Counseling of Patients with Substance Use Disorders by Health Professions Students.

The purpose of this project was to create an interprofessional substance use disorders (SUDs) course that provided health professions students an opportunity to acquire and apply behavior change counseling skills for patients with SUDs with direct observation, assessment, and feedback. The interprofessional SUDs course was offered five times within one academic year as part of a one-month psychiatry clerkship. The course focused on developing empathy and examining personal bias, behavioral change counseling, and recognition, screening, and treatment of SUDs. Students practiced behavior change counseling during the course and with a SUD patient. A faculty member experienced in behavior change counseling assessed students' patient counseling using the validated Behavior Change Counseling Index (BECCI). Seventy-eight students from medicine, nursing, pharmacy, social work, and physician assistant programs completed the one-month course. Fifty-three students counseled a SUD patient. Students' BECCI-rated counseling skills indicated they performed recommended counseling practices and spoke "less than half the time" or "about half the time" when counseling. Ninety-three percent of SUD patients reported a willingness for follow-up care about their substance use after the student-led session with a student. Following participation in an innovative interprofessional SUD course that included behavior change counseling, students demonstrated their ability to apply their skills during training and with a SUD patient. The study demonstrated promising patient outcomes following student counseling.

Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care: An evaluation in three pilot sites

BackgroundThis pilot study evaluated whether use of evidence-based implementation strategies to integrate care for cannabis and other drug use into primary care (PC) as part of Behavioral Health Integration (BHI) increased diagnosis and treatment of substance use disorders (SUDs). MethodsPatients who visited the three pilot PC sites were eligible. Implementation strategies included practice coaching, electronic health record decision support, and performance feedback (3/2015-4/2016). BHI introduced annual screening for past-year cannabis and other drug use, a Symptom Checklist for DSM-5 SUDs, and shared decision-making about treatment options. Main analyses tested whether the proportions of PC patients diagnosed with, and treated for, new cannabis or other drug use disorders (CUDs and DUDs, respectively), differed significantly pre- and post-implementation. ResultsOf 39,599 eligible patients, 57% and 59% were screened for cannabis and other drug use, respectively. Among PC patients reporting daily cannabis use (2%) or any drug use (1%), 51% and 37%, respectively, completed an SUD Symptom Checklist. The proportion of PC patients with newly diagnosed CUD increased significantly post-implementation (5 v 17 per 10,000 patients, p < 0.0001), but not other DUDs (10 vs 13 per 10,000, p = 0.24). The proportion treated for newly diagnosed CUDs did not increase post-implementation (1 vs 1 per 10,000, p = 0.80), but did for those treated for newly diagnosed other DUDs (1 vs 3 per 10,000, p = 0.038). ConclusionsA pilot implementation of BHI to increase routine screening and assessment for SUDs was associated with increased new CUD diagnoses and a small increase in treatment of new other DUDs.

Obstetrician/Gynecologist Perception of Prescription Drug Monitoring Program Effectiveness [15I

INTRODUCTION: Prescription drug monitoring programs (PDMPs) are primary prevention tools designed to reduce rising rates of substance use disorders (SUD) and sequelae such as neonatal abstinence syndrome. Evidence regarding OB/GYN perceptions of PDMPs, which may impact PDMP utilization, is unavailable. This study examines perceived PDMP effectiveness among OB/GYNs compared to primary care physicians (PCPs). METHODS: In the absence of national-level data, independent surveys of PDMP users in Florida, Kentucky, and California were evaluated based on a Likert-type item to assess perception of PDMP effectiveness in reducing prescription drug abuse and diversion. Response distributions of OB/GYNs versus PCPs were compared using chi square tests for each state. RESULTS: In Florida, there were 41 OB/GYN and 511 PCP respondents; Kentucky, 46 OB/GYNs and 265 PCPs; and California, 41 OB/GYNs and 162 PCPs. In each state OB/GYNs viewed PDMPs as less effective, positive, or useful compared to PCPs (p≤0.01, all states). Florida: 64.1% OB/GYN vs. 83.7% PCP “agree positive impact”. Kentucky: 45.0% OB/GYN vs. 68.5% PCP “effective”. California: 73.2% OB/GYN vs. 86.4% PCP “useful”. CONCLUSION: These results suggest OB/GYNs view their state's PDMP as less effective than do PCPs. These perceptions may present barriers to PDMP utilization and decrease opportunities for SUD interventions. Outreach and guidelines to OB/GYNs regarding PDMP effectiveness as a SUD screening tool would be helpful. Further engagement of all prescribers, including OB/GYNs, is needed to inform future strategies, programs, policies and PDMP features to increase PDMP effectiveness.

Medical complications associated with substance use disorders in patients with type 2 diabetes and hypertension: electronic health record findings.

Screening for substance use disorder (SUD) in general medical settings may be particularly important in patients with comorbid health conditions exacerbated by SUD. This study evaluated whether SUD is associated with type 2 diabetes mellitus (T2DM) complications in patients with co-occurring T2DM and hypertension. Analysis of a limited data set obtained through IBM Watson Health Explorys, a platform integrating data from electronic health records. Matched controls were defined for each of five SUDs: tobacco use disorder (TUD), opioid use disorder (OUD), cocaine use disorder, cannabis use disorder (CUD) and alcohol use disorder (AUD) using Mahalanobis distance within propensity score calipers. All patients were seen in the MetroHealth System (Cleveland, OH, USA) and had diagnosis codes for T2DM and hypertension. SUD group participants had a diagnosis of abuse/dependence for the substance of interest. Controls for each SUD group had no diagnosis code related to the SUD of interest and were selected to match the SUD patients on demographics, residential zip code median income and body mass index. Total sample sizes for each SUD-control comparison ranged from 1160 for CUD to 22 128 for TUD. Outcome was diagnosis (yes/no) of four T2DM complications (cerebrovascular accident, diabetic neuropathy, diabetic renal disease, myocardial infarction) and all-cause mortality. Logistic regressions revealed that SUD was significantly associated with greater risk of cerebrovascular accident [TUD odds ratio (OR)=1.79, OUD-OR=1.94, cocaine use disorder OR=2.67], diabetic neuropathy [TUD-adjusted OR (aOR)=1.47, cocaine use disorder-aOR=1.35, AUD-aOR=1.27], diabetic renal disease (TUD-aOR=1.25, OUD-OR=1.34), myocardial infarction (TUD-OR=1.96, OUD-OR=2.01, cocaine use disorder-OR =2.68, CUD-OR=2.48, AUD-OR=1.42) and mortality (TUD-OR=1.15, cocaine use disorder-OR=1.61, CUD-OR=1.49, AUD-OR=1.35). Among patients in Ohio USA with both type 2 diabetes mellitus (T2DM) and hypertension, those with substance use disorders appear to have greater risk for T2DM complications and all-cause mortality.

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Barriers Faced by Physicians in Screening for Substance Use Disorders Among Adolescents.

This study identifies key barriers faced by primary care providers (PCP) in implementation of screening, brief intervention, and referral to treatment (SBIRT) services for substance use disorders among adolescents. The authors used mixed methods, including 12 key informant interviews and a survey with 75 PCPs, to identify key barriers to PCP implementation of SBIRT services. Time constraints, challenges related to parental involvement, a perceived lack of effectiveness of brief intervention services, and lack of training in providing brief intervention were barriers to screening and brief intervention. Referral to treatment was frequently perceived as a challenge. Increased reimbursement and dedicated resources were important interventions for improving screening rates. Increased reimbursement could support workflow enhancements to improve the consistency of SBIRT procedures and alleviate time constraints. Consistent SBIRT applications for all adolescents could also be supported by increasing PCP training in brief intervention.

The availability of alcohol, tobacco and other drug services for adults in New York State Community Health Centers

ABSTRACTNY State community health center sites were surveyed in 2012 to assess the availability of alcohol, tobacco, and other drug services for the underserved. Surveys were completed from 156 of 251 adult primary care clinical sites (62% response rate). Seventy-one percent of sites had guidelines requiring screening for mental health problems while less than half (46%) had guidelines for substance use disorders. In practice, 55% of clinics reported nearly all adults were screened for mental health disorders compared to 32% of adults for substance use disorders (SUD). Forty three percent of sites that screened patients for SUD did not use a standard screening instrument. More than three quarters of sites offered tobacco cessation services while 17% reported offering SUD treatment. Findings from multi-level analyses suggested that FQHC organizations influence sites’ SUD screening requirements but not the provision of on-site treatment. Analyses further suggested that neither geographic setting (urban/rural) nor the size of the FQHC organization influenced screening requirements or on-site treatment availability. Although more research is needed to explore differences between site and organizational level reporting, this study suggests that SUD screening rates remain low among FQHC primary care sites, but that FQHC organization could improve rates across sites by requiring SUD screening using a standard instrument.

718: Drug-related maternal deaths in Utah, 2013-2016

The Utah Perinatal Mortality Review is a multi-disciplinary committee that reviews all maternal and infant deaths in Utah. We described causes of maternal deaths in Utah from 2013-16, and evaluated the impact of committee classification of drug-related deaths as pregnancy-related (rather than pregnancy-associated) beginning in 2015. Retrospective review of all Utah maternal deaths from 2013-16. Pregnancy-associated (PA) death defined as death of a woman during pregnancy or within one year of the end of pregnancy, regardless of cause. Pregnancy-related (PR) death defined as death of a woman in the same time period, from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. Accidental drug-related deaths included deaths from prescribed and illicit drugs. Contributing factors, defined by Centers for Disease Control and Prevention, were identified for each death. Beginning in 2015, the Committee classified accidental drug-related deaths as PR given mounting evidence that substance use disorder (SUD) and mental health (MH) conditions may be aggravated during pregnancy and in the post-partum period. To assess the impact of reclassifying accidental drug-related death as PR, we compared the PR mortality ratio in Utah in 2013-2016 using test of trend. In 2015-2016, 40 PA deaths and 26 PR deaths occurred: accidental drug toxicity was the leading cause of both PA (n=10, 25%) and PR (n=10, 38%) death (Figure 1). In 2015-2016, all women with accidental drug-related deaths had MH conditions and 80% of these deaths occurred 43-365 days postpartum. For all PA deaths (n=40), contributing factors included SUD (n=18, 45%), mental health conditions (n=16, 40%) and clinical issues, namely inadequate screening and treatment for SUD and MH conditions (n=15, 38%). In 2013-2014, there were 44 PA deaths. Leading causes were motor vehicle accident (n=10, 20%) followed by accidental drug-related death (n=7, 17.5%) (Figure 1). From 2013-2016, there was no significant increase in PR deaths attributable to reclassification of drug-related deaths as PR (p=0.06) (Figure 2). Accidental drug-related death was the most common identifiable cause of PR death in Utah in 2015-6 following reclassification of drug-related deaths as PR. Effective interventions aimed at identifying and treating pregnant and postpartum women with SUD and MH conditions are imperative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Acute Phase Treatment Outcomes of Electroconvulsive Therapy in Adolescents and Young Adults.

Electroconvulsive therapy (ECT) is a highly efficacious, well-tolerated treatment in adults. Little is known, however, about its effectiveness in adolescents and young adults. Our objectives were to assess clinical outcomes after acute phase ECT in adolescents and young adults and determine whether screening positive or negative for a substance use disorder (SUD) is associated with differences in treatment outcomes. Study sample consisted of all patients 16 to 25 years old who received ECT from May 2011 to August 2016 and who completed self-reported SUD screens and the Behavior and Symptom Identification Scale-24 (BASIS-24) initially and completed the BASIS-24 again after the fifth ECT treatment. For 5 BASIS-24 domains, longitudinal changes in mean domain scores were assessed; mean changes by SUD screening status were also examined using linear mixed models. One hundred ninety adolescents and young adults, with mean age 21.0 ± 2.6 years, met inclusion criteria. Electroconvulsive therapy was associated with significant clinical improvement (score decreases) in all 5 BASIS-24 domains during the acute phase treatment (P < 0.001). Sixty-four percent (122/190) screened positive for SUD. Compared with adolescents and young adults screening negative for SUD, those screening positive for co-occurring SUD had greater improvement in depression/functioning (-0.37 ± 0.14, P = 0.009), interpersonal relationships (-0.27 ± 0.13, P = 0.045), and emotional lability (-0.27 ± 0.14, P = 0.044) domains after the fifth ECT treatment. Electroconvulsive therapy in adolescents and young adults was associated with significantly improved clinical outcomes during acute phase treatment. Adolescents and young adults screening positive for SUD had better acute phase ECT outcomes in self-reported depression/functioning, interpersonal relationships, and emotional lability than those screening negative. More research is needed to clarify adolescents and young adult patient characteristics that may be associated with differential ECT outcomes.