1
|
Touali R, Chappuy M, Berger-Vergiat A, Deletoille M, Ragonnet D, Rochet T, Poulet E, Tazarourte K, Haesebaert J, Michel P, Rolland B. Screening problematic use of substances among young subjects attending an emergency department, and subsequent treatment seeking. L'ENCEPHALE 2024; 50:170-177. [PMID: 37331923 DOI: 10.1016/j.encep.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Young individuals constitute a key population for the screening of problematic use of substances (PUS), but they are not likely to seek support and are hard to reach. Targeted screening programs should thus be developed in the places of care they may attend for other reasons, including emergency departments (EDs). We aimed to explore the factors associated with PUS in young people attending an ED; we measured the subsequent access to addiction care after ED screening. METHODS This was a prospective interventional single-arm study which included any individual aged between 16 and 25 years who attended the main ED of Lyon, France. Baseline data were sociodemographic characteristics, PUS status using self-report questionnaires and biological measures, level of psychological health, and history of physical/sexual abuse. Quick medical feedback was provided to the individuals presenting a PUS; they were advised to consult an addiction unit, and contacted by phone at three months to ask whether they had sought treatment. Baseline data were used to compare PUS and non-PUS groups using multivariable logistic regressions, to provide adjusted odds ratios (aORs) and 95% confidence intervals (95% CI), with age, sex, employment status, and family environment as the adjustment variables. The characteristics of PUS subjects who subsequently sought treatment were also assessed using bivariable analyses. RESULTS In total, 460 participants were included; 320 of whom (69.6%) were presenting current substance use, and 221 (48.0%) with PUS. Compared to non-PUS individuals, PUS ones were more likely to be males (aOR=2.06; 95% CI [1.39-3.07], P<0.001), to be older (per one-year increase: aOR=1.09; 95% CI [1.01-1.17], P<0.05), to have an impaired mental health status (aOR=0.87; 95% CI [0.81-0.94], P<0.001), and to have a history of sexual abuse (aOR=3.33; 95% CI [2.03-5.47], P<0.0001). Only 132 (59.7%) subjects with PUS could be reached by phone at 3 months, among whom only 15 (11.4%) reported having sought treatment. Factors associated with treatment seeking were social isolation (46.7% vs. 19.7%; P=0.019), previous consultation for psychological disorders (93.3% vs. 68.4%; P=0.044), lower mental health score (2.8±1.6 vs. 5.1±2.6; P<0.001), and post-ED hospitalization in a psychiatric unit (73.3% vs. 19.7%; P<0.0001). DISCUSSION/CONCLUSION EDs are relevant places to screen PUS in youth, but the level of seeking further treatment needs to be substantially improved. Offering systematic screening during an emergency room visit could allow for more appropriate identification and management of youth with PUS.
Collapse
Affiliation(s)
- Rdah Touali
- Service universitaire d'addictologie de Lyon (SUAL), CH Le Vinatier, pôle MOPHA, 95, boulevard Pinel, 69500 Bron, France; Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France.
| | - Mathieu Chappuy
- Service universitaire d'addictologie de Lyon (SUAL), CH Le Vinatier, pôle MOPHA, 95, boulevard Pinel, 69500 Bron, France; Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France; CSAPA, groupement hospitalier Nord, hospices civils de Lyon, Lyon, France; Service pharmaceutique, hospices civils de Lyon, Lyon, France
| | - Aurélie Berger-Vergiat
- Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Marion Deletoille
- Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Delphine Ragonnet
- Service universitaire d'addictologie de Lyon (SUAL), groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Thierry Rochet
- Service de Pédopsychiatrie, CH Le Vinatier, Bron, France
| | - Emmanuel Poulet
- Service de psychiatrie d'urgences, groupement hospitalier centre, hospices civils de Lyon, Lyon, France; Inserm U1028, CNRS UMR 5292, CRNL, université de Lyon, UCBL1, Bron, France
| | - Karim Tazarourte
- Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France; Service d'accueil des urgences, groupement hospitalier centre, hospices civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France; Service recherche et épidémiologie cliniques, hospices civils de Lyon, pôle santé publique, 69003 Lyon, France
| | - Philippe Michel
- Research on Healthcare Performance RESHAPE, Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France; Service recherche et épidémiologie cliniques, hospices civils de Lyon, pôle santé publique, 69003 Lyon, France
| | - Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), CH Le Vinatier, pôle MOPHA, 95, boulevard Pinel, 69500 Bron, France; Inserm U1028, CNRS UMR 5292, CRNL, université de Lyon, UCBL1, Bron, France
| |
Collapse
|
2
|
Lyons VH, Myers MG, Cunningham RM, Zimmerman MA, Carter PM, Walton MA, Goldstick J. Experiencing violence and other predictors of within-person same-day use of multiple substances in youth: a longitudinal study in emergency settings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:218-228. [PMID: 38563511 DOI: 10.1080/00952990.2024.2307546] [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: 11/10/2022] [Accepted: 01/06/2024] [Indexed: 04/04/2024]
Abstract
Background: Although experiencing violence is a risk factor for substance use among youth, its association with same-day use of multiple substances (a form of polysubstance use) and mitigating factors is less well understood.Objectives: To identify whether prosocial factors modified the effect of experiencing violence on the frequency of same-day use, and examine gender-specific risk/protective factors for same-day use.Methods: We analyzed longitudinal data from a cohort of youth who use drugs aged 14-24 (n = 599; 58% male) presenting to an urban emergency department between 2009-2011 and assessed biannually for two years. Using Poisson-generalized linear models with person-level fixed effects, we estimated within-person associations between self-reported experiencing violence and same-day use and analyzed gender and peer/parent support as effect modifiers. We adjusted for negative peer influence, parental drug and alcohol use, family conflict, anxiety and depression, and age.Results: Overall, positive parental support corresponded to lower rates of same-day use (rate ratio [RR]:0.93, 95% CI:0.87-0.99) and experiencing violence was associated with higher rates of same-day use (RR:1.25, 95% CI:1.10-1.41). Violence exposure was a risk factor among males (RR:1.42, 95% CI:1.21-1.66), while negative peer influences and parental substance use were risk factors among females (RR:1.63, 95% CI:1.36-1.97 and RR:1.58, 95% CI:1.35-1.83, respectively). Positive peer support reduced the association between violence exposure and same-day use among males (RR:0.69, 95% CI:0.57-0.84, p < .05).Conclusions: Tailored interventions may address gender differences in coping with experiencing violence - including interventions that promote parental support among males and reduce influence from parental substance use among females.
Collapse
Affiliation(s)
- Vivian H Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Social Development Research Group, University of Washington, Seattle, WA, USA
| | - Matthew G Myers
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Prevention Research Center of Michigan, University of Michigan, Ann Arbor, MI, USA
| | - Patrick M Carter
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jason Goldstick
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Seewald L, Bonar E, Bohnert ASB, Carter PM, King CA, Losman ED, Bacon L, Wheeler T, Walton M. Lifetime non-fatal overdose experiences among at-risk adolescents and young adults in the emergency department with past-year opioid use in the USA. Inj Prev 2024:ip-2023-045072. [PMID: 38331586 DOI: 10.1136/ip-2023-045072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Adolescents and young adults with risk factors for opioid misuse and opioid use disorder are at elevated risk for overdose. We examined prior non-fatal overdose experiences among at-risk adolescents/young adults to inform prevention efforts. METHODS Adolescents/young adults (ages 16-30) in two US emergency departments self-reporting past year opioid misuse or opioid use plus a misuse risk factor completed a baseline survey as part of an ongoing randomised controlled trial. We describe baseline factors associated with (a) overall non-fatal overdose experiences and (b) groups based on substance(s) used during the worst overdose experience. RESULTS Among 771 participants (27.9% male), 40.7% reported a non-fatal overdose experience. Compared with those without a prior overdose experience, those with prior overdose experience(s) were less likely to be heterosexual, and more likely to report a prior suicide attempt and greater peer substance misuse. Regarding the worst overdose experience, substance(s) included: 36.6% alcohol only, 28.0% alcohol and cannabis, 22.6% alcohol with other substance(s) and 12.7% other substance(s) only (eg, opioids). Compared with the alcohol only group, the alcohol and cannabis group were younger and less likely to be heterosexual; the alcohol with other substance(s) group were older and had greater peer substance misuse; and the other substance(s) only group were more likely to be male, receive public assistance, screen positive for anxiety and less likely to be heterosexual. CONCLUSIONS Among at-risk adolescents/young adults, findings support the need for tailored overdose prevention efforts based on substance(s) used, with consideration of sexuality, mental health and peer substance use. TRIAL REGISTRATION NUMBER NCT04550715.
Collapse
Affiliation(s)
- Laura Seewald
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Department of Emergency Medicine, Ann Arbor, Michigan, USA
| | - Erin Bonar
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy S B Bohnert
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA
- University of Michigan Department of Anesthesiology, Ann Arbor, Michigan, USA
| | - Patrick M Carter
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Department of Emergency Medicine, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheryl A King
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Eve D Losman
- University of Michigan Department of Emergency Medicine, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Linnea Bacon
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Tiffany Wheeler
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
| | - Maureen Walton
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan Department of Psychiatry, Ann Arbor, Michigan, USA
- University of Michigan Addiction Center, Ann Arbor, Michigan, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Goldstick JE, Bonar EE, Myers M, Bohnert ASB, Walton MA, Cunningham RM. Within-Person Predictors of Same-Day Alcohol and Nonmedical Prescription Drug Use Among Youth Presenting to an Urban Emergency Department. J Stud Alcohol Drugs 2022; 83:85-90. [PMID: 35040763 PMCID: PMC8819893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Simultaneous alcohol and nonmedical prescription drug use (NMPDU) increases acute risks (e.g., overdose) associated with each; understanding social, substance use, and mental health predictors of same-day use may suggest intervention targets. METHOD At an urban emergency department, research assistants recruited youth ages 14-24 reporting past-6-month substance use (n = 599; 58.8% male). Participants self-administered validated measures of alcohol consumption, cannabis use severity (quantity and consequences), mental health symptoms, and social influences at baseline and at four biannual follow-ups. In addition, participants completed Timeline Followback calendars that assessed same-day use of alcohol and prescription drugs. We used negative binomial regression with person-level fixed effects to isolate within-person predictor effects on same-day use frequency. RESULTS Between 6.0% (baseline) and 8.6% (6-month follow-up) of youth reported same-day alcohol use and NMPDU across follow-ups. Within-person increases in alcohol consumption, cannabis use severity, and depression and anxiety symptoms all corresponded to greater same-day alcohol and NMPDU frequency, with consistent findings across genders. Increased positive peer behaviors corresponded to decreased same-day use frequency among males but not females. Decreased parental support and increased delinquent peer exposures corresponded to greater same-day use frequency among females but not males. CONCLUSIONS Substance use and mental health symptom escalation are robust predictors of greater same-day use frequency, whereas the roles of social factors appear gender-specific. Interrupting worsening trajectories of substance use and mental health symptoms, and enhancing social support and reducing delinquent peer exposures, may reduce same-day use frequency.
Collapse
Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Correspondence may be sent to Jason E. Goldstick at the Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, or via email at:
| | - Erin E. Bonar
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Matthew Myers
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan,Injury Prevention Center, University of Michigan, Ann Arbor, Michigan,Hurley Medical Center, Flint, Michigan
| |
Collapse
|