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Nahian A, McFadden LM. Changes in Substance Use Diagnoses in the Great Plains during the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:1630. [PMID: 39201189 PMCID: PMC11353988 DOI: 10.3390/healthcare12161630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
As drug overdose mortality rises in the United States, healthcare visits present critical opportunities to mitigate this trend. This study examines changes in healthcare visits for substance use disorders (SUDs) and remission prior to and during the COVID-19 pandemic in the Great Plains, with a focus on identifying the characteristics of those served. Data were analyzed from 109,671 patient visits (mode = one visit per patient), encompassing diverse demographics, including sex, age, race, ethnicity, and geographic location. Visits analyzed included those for Alcohol Use Disorder (AUD), Opioid Use Disorder (OUD), or Stimulant Use Disorder (StUD) and those in remission of these disorders between March 2019 and March 2021. Patient demographic information and geographic factors, like rurality and Medicaid expansion status, were considered, and logistic regression was utilized. Visits were primarily by White (70.83%) and Native American (21.39%) patients, non-Hispanic (91.70%) patients, and males (54.16%). Various demographic, geographic, and temporal trends were observed. Findings indicated that males were more likely to receive an AUD diagnosis, while females were more likely to receive an OUD or StUD diagnosis. Metropolitan-residing patients were more likely to receive an AUD diagnosis, while non-metropolitan patients were more likely to receive an OUD diagnosis. Remission odds increased for StUD during the pandemic but decreased for AUD and OUD. These findings illuminate the demographic and geographic patterns of SUD-related healthcare visits, suggesting critical touchpoints for intervention. The results emphasize the urgent need for targeted healthcare strategies, especially in rural and underserved areas, to address persistent health disparities.
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Affiliation(s)
- Ahmed Nahian
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine at Seton Hill, Lynch Hall, 20 Seton Hill Dr, Greensburg, PA 15601, USA
| | - Lisa M. McFadden
- Division of Basic Biomedical Sciences, University of South Dakota, 414 E. Clarke St., Vermillion, SD 57069, USA
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Lazic A, Tilford JM, Davis VP, Brown CC. Association of copayments with healthcare utilization and expenditures among Medicaid enrollees with a substance use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209314. [PMID: 38369244 PMCID: PMC11090739 DOI: 10.1016/j.josat.2024.209314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The purpose of this study was to examine the association between copayments and healthcare utilization and expenditures among Medicaid enrollees with substance use disorders. METHODS This study used claims data (2020-2021) from a private insurer participating in Arkansas's Medicaid expansion. We compared service utilization and expenditures for enrollees in different Medicaid program structures with varying copayments. Enrollees with incomes above 100 % FPL (N = 10,240) had copayments for substance use treatment services while enrollees below 100 % FPL (N = 2478) did not. Demographic, diagnostic, utilization, and cost information came from claims and enrollment information. The study identified substance use and clinical comorbidities using claims from July through December 2020 and evaluated utilization and costs in 2021. Generalized linear models (GLM) estimated outcomes using single equation and two-part modeling. A gamma distribution and log link were used to model expenditures, and negative binomial models were used to model utilization. A falsification test comparing behavioral health telemedicine utilization, which had no cost sharing in either group, assessed whether differences in the groups may be responsible for observed findings. RESULTS Substance use enrollees with copayments were less likely to have a substance use or behavioral health outpatient (-0.04 PP adjusted; p = 0.001) or inpatient visit (-0.04 PP; p = 0.001) relative to their counterparts without copayments, equal to a 17 % reduction in substance use or behavioral health outpatient services and a nearly 50 % reduction in inpatient visits. The reduced utilization among enrollees with a copayment was associated with a significant reduction in total expenses ($954; p = 0.001) and expenses related to substance use or behavioral health services ($532; p = 0.001). For enrollees with at least one behavioral health visit, there were no differences in outpatient or inpatient utilization or expenditures between enrollees with and without copayments. Copayments had no association with non-behavioral health or telemedicine services where neither group had cost sharing. CONCLUSION Copayments serve as an initial barrier to substance use treatment, but are not associated with the amount of healthcare utilization conditional on using services. Policy makers and insurers should consider the role of copayments for treatment services among enrollees with substance use disorders in Medicaid programs.
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Affiliation(s)
- Antonije Lazic
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - Victor P Davis
- Actuarial Services & Enterprise Underwriting, Arkansas Blue Cross Blue Shield, Little Rock, AR 72201, USA
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA.
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Amoako EO, Zerden LD, Hughes TD, Gertner AK, Williams J, Belden CM, Ware OD. Examining facilitative services for entry into substance use disorder treatment: A cluster analysis of treatment facilities. PLoS One 2024; 19:e0304094. [PMID: 38781169 PMCID: PMC11115295 DOI: 10.1371/journal.pone.0304094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES We examined services to facilitate access to entering substance use disorder (SUD) treatment among a national sample of SUD treatment facilities. METHODS We analyzed data from the National Survey of Substance Abuse Treatment Services (N-SSATS) 2020. Facilities were included in the sample based on criteria such as SUD treatment provision and being in the U.S. Cluster analysis was conducted using variables including ownership, levels of care, and whether facilities provide services or accept payment options aimed at reducing treatment barriers. National and state-level data on the percentage of facilities in each cluster were presented. RESULTS Among N = 15,788 SUD treatment facilities four distinct clusters were identified: Cluster 1 consisted of for-profit and government outpatient facilities with high proportions of services to reduce barriers (22.2%). Cluster 2, comprised of non-profit outpatient facilities, offered the most comprehensive array of services to minimize barriers to treatment among all four clusters (25.2%). Cluster 3 included facilities with diverse ownership and care levels and provided a moderate to high degree of services aimed at reducing entry barriers to treatment (26.0%). Cluster 4 was primarily for-profit outpatient facilities with a low proportion of these services (26.6%). CONCLUSIONS This study revealed facility-level groupings with different services to reduce barriers to SUD treatment across various clusters of SUD treatment facilities. While some facilities offered extensive services, others provided fewer. Differences in cluster distributions point to possible facilitators to treatment access for some persons seeking admission to specific treatment facilities. Efforts should be made to ensure that individuals seeking SUD treatment can access these services, and facilities should be adequately equipped to meet their diverse needs.
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Affiliation(s)
- Emmanuel O. Amoako
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lisa D. Zerden
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Tamera D. Hughes
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Alex K. Gertner
- University of North Carolina Hospitals, Chapel Hill, NC, United States of America
| | - Joseph Williams
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - C. Micha Belden
- Mountain Area Health Education Center, Asheville, NC, United States of America
| | - Orrin D. Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Holt AG, Hussong A, Castro MG, Bossenbroek Fedoriw K, Schmidt AM, Prentice A, Ware OD. Smoking Policies of Outpatient and Residential Substance Use Disorder Treatment Facilities in the United States. Tob Use Insights 2024; 17:1179173X241254803. [PMID: 38752184 PMCID: PMC11095085 DOI: 10.1177/1179173x241254803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024] Open
Abstract
Tobacco use is associated with morbidity and mortality. Many individuals who present to treatment facilities with substance use disorders (SUDs) other than tobacco use disorder also smoke cigarettes or have a concomitant tobacco use disorder. Despite high rates of smoking among those with an SUD, and numerous demonstrated benefits of comprehensive SUD treatment for tobacco use in addition to co-occurring SUDs, not all facilities address the treatment of comorbid tobacco use disorder. In addition, facilities vary widely in terms of tobacco use policies on campus. This study examined SUD facility smoking policies in a national sample of N = 16,623 SUD treatment providers in the United States in 2021. Most facilities with outpatient treatment (52.1%) and facilities with residential treatment (67.8%) had a smoking policy that permitted smoking in designated outdoor area(s). A multinomial logistic regression model found that among facilities with outpatient treatment (n = 13,778), those located in a state with laws requiring tobacco free grounds at SUD facilities, those with tobacco screening/education/counseling services, and those with nicotine pharmacotherapy were less likely to have an unrestrictive tobacco smoking policy. Among facilities with residential treatment (n = 3449), those with tobacco screening/education/counseling services were less likely to have an unrestrictive tobacco smoking policy. There is variability in smoking policies and tobacco use treatment options in SUD treatment facilities across the United States. Since tobacco use is associated with negative biomedical outcomes, more should be done to ensure that SUD treatment also focuses on reducing the harms of tobacco use.
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Affiliation(s)
- Alison G. Holt
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hussong
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Gabriela Castro
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Amy Prentice
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Orrin D. Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Harp NR, Wager TD, Kober H. Neuromarkers in addiction: definitions, development strategies, and recent advances. J Neural Transm (Vienna) 2024; 131:509-523. [PMID: 38630190 DOI: 10.1007/s00702-024-02766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/12/2024] [Indexed: 04/28/2024]
Abstract
Substance use disorders (SUDs) are the most costly and prevalent psychiatric conditions. Recent calls emphasize a need for biomarkers-measurable, stable indicators of normal and abnormal processes and response to treatment or environmental agents-and, in particular, brain-based neuromarkers that will advance understanding of the neurobiological basis of SUDs and clinical practice. To develop neuromarkers, researchers must be grounded in evidence that a putative marker (i) is sensitive and specific to the psychological phenomenon of interest, (ii) constitutes a predictive model, and (iii) generalizes to novel observations (e.g., through internal cross-validation and external application to novel data). These neuromarkers may be used to index risk of developing SUDs (susceptibility), classify individuals with SUDs (diagnostic), assess risk for progression to more severe pathology (prognostic) or index current severity of pathology (monitoring), detect response to treatment (response), and predict individualized treatment outcomes (predictive). Here, we outline guidelines for developing and assessing neuromarkers, we then review recent advances toward neuromarkers in addiction neuroscience centering our discussion around neuromarkers of craving-a core feature of SUDs. In doing so, we specifically focus on the Neurobiological Craving Signature (NCS), which show great promise for meeting the demand of neuromarkers.
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Affiliation(s)
- Nicholas R Harp
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tor D Wager
- Department of Psychological & Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Hedy Kober
- Department of Psychiatry, Yale University, New Haven, CT, USA.
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Facente SN, Humphrey JL, Akiba C, Patel SV, Wenger LD, Tookes H, Bluthenthal RN, LaKosky P, Prohaska S, Morris T, Kral AH, Lambdin BH. Funding and Delivery of Syringe Services Programs in the United States, 2022. Am J Public Health 2024; 114:435-443. [PMID: 38478864 PMCID: PMC10937606 DOI: 10.2105/ajph.2024.307583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 03/17/2024]
Abstract
Objectives. To describe the current financial health of syringe services programs (SSPs) in the United States and to assess the predictors of SSP budget levels and associations with delivery of public health interventions. Methods. We surveyed all known SSPs operating in the United States from February to June 2022 (n = 456), of which 68% responded (n = 311). We used general estimating equations to assess factors influencing SSP budget size and estimated the effects of budget size on multiple measures of SSP services. Results. The median SSP annual budget was $100 000 (interquartile range = $20 159‒$290 000). SSPs operating in urban counties and counties with higher levels of opioid overdose mortality had significantly higher budget levels, while SSPs located in counties with higher levels of Republican voting in 2020 had significantly lower budget levels. SSP budget levels were significantly and positively associated with syringe and naloxone distribution coverage. Conclusions. Current SSP funding levels do not meet minimum benchmarks. Increased funding would help SSPs meet community health needs. Public Health Implications. Federal, state, and local initiatives should prioritize sustained SSP funding to optimize their potential in addressing multiple public health crises. (Am J Public Health. 2024;114(4):435-443. https://doi.org/10.2105/AJPH.2024.307583).
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Affiliation(s)
- Shelley N Facente
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Jamie L Humphrey
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Christopher Akiba
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Sheila V Patel
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Lynn D Wenger
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Hansel Tookes
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Ricky N Bluthenthal
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Paul LaKosky
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Stephanie Prohaska
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Terry Morris
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Alex H Kral
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
| | - Barrot H Lambdin
- Shelley N. Facente is with the School of Public Health, University of California Berkeley. Jamie L. Humphrey, Christopher Akiba, Sheila V. Patel, Lynn D. Wenger, Terry Morris, Alex H. Kral, and Barrot H. Lambdin are with RTI International, Berkeley. Hansel Tookes is with the University of Miami, Miami, FL. Ricky N. Bluthenthal is with University of Southern California, Los Angeles. Paul LaKosky and Stephanie Prohaska are with the North American Syringe Exchange Network, Tacoma, WA
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Zhu Y, Baldwin LM, Mooney LJ, Saxon AJ, Kan E, Hser YI. Co-occurring substance use disorders among patients with opioid use disorder in rural primary care clinics. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209269. [PMID: 38097045 DOI: 10.1016/j.josat.2023.209269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/10/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Co-occurring substance use disorders (SUDs) among individuals with opioid use disorder (OUD) are associated with additional impairment, overdose, and death. This study examined characteristics of patients who have OUD with and without co-occurring SUDs in rural primary care clinics. METHODS Secondary analysis used electronic health record (EHR) data from six rural primary care clinics, including demographics, diagnoses, encounters, and prescriptions of medication for OUD (MOUD), as well as EHR data from an external telemedicine vendor that provided MOUD to some clinic patients. The study population included all adult patients who had a visit to the participating clinics from October 2019 to January 2021. RESULTS We identified 1164 patients with OUD; 72.6 % had OUD only, 11.5 % had OUD and stimulant use disorder (OUD + StUD), and 15.9 % had OUD and other non-stimulant substance use disorder (OUD + Other). The OUD + StUD group had the highest rates of hepatitis C virus (25.4 % for OUD + StUD, 17.8 % for OUD + Other, and 7.5 % for OUD Only; p < 0.001) and the highest rates of mental health disorders (78.4 %, 69.7 %, and 59.9 %, respectively; p < 0.001). Compared to the OUD Only group, patients in the OUD + StUD and OUD + Other groups were more likely to receive telehealth services provided by clinic staff, in-clinic behavioral health services, and in-clinic MOUD. The OUD + StUD group had the highest proportion of referrals to the external telemedicine vendor. CONCLUSIONS More than 27 % of patients with OUD in rural primary care clinics had other co-occurring SUDs, and these patients received more healthcare services than those with OUD only. Future studies should examine variations in outcomes associated with these other services among patients with OUD and co-occurring SUDs.
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Affiliation(s)
- Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA 98195, United States of America
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States of America
| | - Andrew J Saxon
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, United States of America
| | - Emily Kan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America.
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Burstin H, Clark KJ, Duff N, Dopp AL, Bentley E, Wattenberg S, Sandbrink F, Beale RR, Ling SM, Eaton E, Freiling E, Salman A. Integrating Telehealth and Traditional Care in Chronic Pain Management and Substance Use Disorder Treatment: An Action Agenda for Building the Future State of Hybrid Care. NAM Perspect 2023; 2023:202310b. [PMID: 38784634 PMCID: PMC11114598 DOI: 10.31478/202310b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
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Mintz CM, Knox J, Hartz SM, Hasin DS, Martins SS, Kranzler HR, Greene E, Geng EH, Grucza RA, Bierut LJ. Demographic differences in the cascade of care for unhealthy alcohol use: A cross-sectional analysis of data from the 2015-2019 National Survey on Drug Use and Health. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1890-1903. [PMID: 37864538 PMCID: PMC10590988 DOI: 10.1111/acer.15176] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The screening, brief intervention, and referral to treatment (SBIRT) model is recommended by the U.S. Preventive Services Task Force to improve recognition of and intervention for unhealthy alcohol use. How SBIRT implementation differs by demographic characteristics is poorly understood. METHODS We analyzed data from the 2015-2019 National Survey on Drug Use and Health from respondents ≥18 years old who used an outpatient clinic and had at least one alcoholic drink within the past year. Respondents were grouped into one of three mutually exclusive groups: "no binge drinking or alcohol use disorder (AUD)," "binge drinking without AUD," or "AUD." Outcome variables were likelihood of screening, brief intervention (BI), referral to treatment (RT), and AUD treatment. The demographic predictors on which outcomes were regressed included gender, age, race and ethnicity, sexual orientation, insurance status, and history of military involvement. Consistent with SBIRT guidelines, the entire sample was included in the screening model; screened persons with either binge drinking without AUD or with AUD were included in the BI model; screened persons with AUD were included in the RT model, and persons referred to treatment with AUD were included in the AUD treatment model. RESULTS Analyses included 120,804 respondents. Women were more likely than men to be screened, but less likely to receive BI or RT. When referred to treatment, women were more likely than men to receive it. Persons aged ≥50 were least likely to be screened about alcohol, but most likely to receive BI, while persons aged 18-25 were least likely to receive BI or AUD treatment. Racial and ethnic minorities were less likely than White persons to be screened; Asians were less likely to receive RT, and Black persons were less likely to receive treatment than White persons. Persons identifying as gay, lesbian, or bisexual were equally as likely or more likely to receive SBIRT or AUD treatment as those identifying as heterosexual. Persons without insurance were less likely to be screened than those with insurance. Persons with a history of military involvement were more likely to be screened and receive BI and RT than persons who had not served in the military. CONCLUSIONS Demographic disparities in SBIRT implementation exist. Addressing the sources of these disparities and minimizing attrition from care could improve outcomes for persons with unhealthy alcohol use.
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Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah M. Hartz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Emily Greene
- Physician Assistant Program, The City College of New York School of Medicine, New York, New York, USA
| | - Elvin H. Geng
- Department of Medicine, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Richard A. Grucza
- Department of Family Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
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Dickson-Gomez J, Spector A, Krechel S, Li J, Montaque HDG, Ohlrich J, Galletly C, Weeks M. Barriers to drug treatment in police diversion programs and drug courts: A qualitative analysis. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2022; 92:692-701. [PMID: 36227322 PMCID: PMC9993933 DOI: 10.1037/ort0000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Drug treatment courts and police diversion programs are designed to divert people away from incarceration and into drug treatment. This article explores barriers in linking people who use drugs (PWUD) into drug treatment facilities in urban, suburban, and rural areas of Connecticut, Kentucky, and Wisconsin. Between December 2018 and March 2020, study teams in the three states conducted in-depth, semistructured interviews with key informants involved in programs to divert PWUD from criminal justice involvement including police, lawyers, judges, and others who work in drug treatment courts, and substance use disorder treatment providers who received referrals from and worked with police diversion programs or drug courts. Police diversion programs and drug treatment courts showed intraprogram variation in the structure of their programs in the three states and in different counties within the states. Structural barriers to successfully linking PWUD to treatment included a lack of resources, for example, a limited number of treatment facilities available, difficulties in funding mandated treatment, particularly in Wisconsin where Medicaid expansion has not occurred, and PWUDs' need for additional services such as housing. Many police officers, judges, and others within drug treatment court, including drug treatment specialists, hold stigmatizing attitudes toward medications to treat opioid use disorder (MOUD) and are unlikely to recommend or actively refer to MOUD treatment. Drug courts and police diversion programs offer a welcome shift from prior emphases on criminalization of drug use. However, for such programs to be effective, more resources must be dedicated to their success. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Antoinette Spector
- Department of Rehabilitation Services and Technology, University of Wisconsin, Milwaukee
| | - Sarah Krechel
- Institute for Health and Equity, Medical College of Wisconsin
| | | | | | - Jessica Ohlrich
- Institute for Health and Equity, Medical College of Wisconsin
| | - Carol Galletly
- Institute for Health and Equity, Medical College of Wisconsin
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