1
|
Kneeland IJ, Biesen JN, Fink BC, Keeling LA, Lindsey L. The Association Between COVID-fear with Psychological Distress and Substance Use: the Moderating Effect of Treatment Engagement. J Behav Health Serv Res 2024:10.1007/s11414-024-09905-3. [PMID: 39187735 DOI: 10.1007/s11414-024-09905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
The purpose of this brief report was to examine the association between COVID-fear with psychiatric symptoms severity and substance use risk in an outpatient population with co-occurring substance use and mental health disorders and whether these associations were moderated by treatment engagement, especially after providers had shifted from an in-person care model to a telehealth format. A total of 136 patients receiving outpatient treatment for comorbid substance use and mental health disorders completed self-report questionnaires on their psychiatric symptoms, substance use, and treatment engagement (i.e., frequency, length, and helpfulness of phone and video sessions with a mental health counselor, psychiatrist, or primary care provider) in the past month between November 2020 and March 2021. Results showed that COVID-fear was significantly associated with psychiatric symptom severity, but not substance use risk. Additionally, perceived helpfulness of phone counseling sessions moderated the associations between COVID-fear and global psychiatric symptom severity, such that COVID-fear and global psychiatric symptom severity were positively associated when perceived helpfulness was low, and not associated if perceived helpfulness was high. The present results highlight the importance of directly addressing fears specific to a national emergency, as well as for providers to build strong rapport with their clients.
Collapse
Affiliation(s)
| | - Judith N Biesen
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, 33604, USA.
| | - Brandi C Fink
- Department of Psychiatry and Behavioral Science, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Larissa Lindsey
- Addictions and Substance Abuse Program, University of New Mexico Hospitals, Albuquerque, NM, USA
| |
Collapse
|
2
|
Schachman KA, Macomber CA, Mitchell ML, Brown JM, Scott JL, Darr RL, Fabbro MA, Morrone WR, Peckham KA, Charbonneau-Ivey TK. Gaining Recovery in Addiction for Community Elders (GRACE) Project: The Impact of Age-Specific Care on Clinical Outcomes and Health Care Resource Utilization in Older Adults With Substance Use Disorder in an Interprofessional Addiction Clinic. J Am Psychiatr Nurses Assoc 2024:10783903241261694. [PMID: 39049443 DOI: 10.1177/10783903241261694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND The prevalence of substance use disorders (SUDs) in older adults has been increasing, necessitating tailored and effective addiction care for this aging demographic. AIMS The purpose of this study was to assess the impact of age-specific, interprofessional addiction care on clinical outcomes and health care resource utilization in older adults with SUD. METHODS This quasi-experimental study directly compares patients enrolled in the Gaining Recovery in Addiction for Community Elders (GRACE) Project, an interprofessional age-specific addictions treatment program, with age-matched older adults who received conventional "treatment as usual" (TAU). Through retrospective comparative analysis, substance use outcomes, mental and physical health improvements, and inappropriate use of emergency services were examined among 78 older adults with SUD. RESULTS Clinical outcomes and health care resource utilization were superior for older adults who received age-specific addictions care through the GRACE Project, as compared to mixed-age conventional "TAU." GRACE patients had improved treatment adherence, fewer relapses, and longer treatment engagement. While both groups exhibited significant reductions in depression and anxiety scores, GRACE patients showed greater improvements. This group demonstrated superior control of both hypertension and diabetes. Importantly, they had fewer inappropriate emergency department visits and avoidable hospitalizations than conventional "TAU." CONCLUSIONS Addiction treatment delivered by an interprofessional team to meet the unique strengths and needs of older adults has the potential to improve treatment adherence and more favorable long-term outcomes in substance use, mental health, and chronic medical conditions. Nurses are poised to lead interprofessional teams to meet the growing demand for specialized addiction treatment and integrated care for older adults.
Collapse
Affiliation(s)
- Kathleen A Schachman
- Kathleen A. Schachman, PhD, FNP-BC, PMHNP-BC, FIAAN, FAANP, Saginaw Valley State University, University Center, MI, USA
| | - Catherine A Macomber
- Catherine A. Macomber, PhD, LMSW, Saginaw Valley State University, University Center, MI, USA
| | - Matthew L Mitchell
- Matthew L. Mitchell, DHA, LMSW, MBA, CAADC, CCS, Saginaw Valley State University, University Center, MI, USA
| | - Jill M Brown
- Jill M. Brown, PhD, MOST, OTRL, Saginaw Valley State University, University Center, MI, USA
| | - Jennifer L Scott
- Jennifer L. Scott, DNP, FNP-BC, PMHNP-BC, Saginaw Valley State University, University Center, MI, USA
| | - Rachel L Darr
- Rachel L. Darr, PhD, RD, CSSD, Saginaw Valley State University, University Center, MI, USA
| | - Mindy A Fabbro
- Mindy A. Fabbro, DNP, FNP-BC, PMHNP-BC, Saginaw Valley State University, University Center, MI, USA
| | - William R Morrone
- William R. Morrone, DO, MPH, MS, FACOFP, Recovery Pathways, LLC, Bay City, MI, USA
| | - Kari A Peckham
- Kari A. Peckham, EMT-B, CADC, Saginaw Valley State University, University Center, MI, USA
| | | |
Collapse
|
3
|
Lin J, Arnovitz M, Kotbi N, Francois D. Substance Use Disorders in the Geriatric Population: a Review and Synthesis of the Literature of a Growing Problem in a Growing Population. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2023:1-20. [PMID: 37360959 PMCID: PMC10241125 DOI: 10.1007/s40501-023-00291-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review Substance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults. Recent findings PubMed, Ovid MEDLINE, and PsychINFO databases were searched from their inception through June 2022 using the following keywords: "substance use disorder," "substance abuse," "abuse," "illicit substances," "illicit drugs," "addiction," "geriatric," "elderly," "older adults," "alcohol," "marijuana," "cannabis," "cocaine," "heroin," "opioid," and "benzodiazepine." Our findings suggest an increasing trend in substance use in older adults despite medical and psychiatric consequences when using such substances. The majority of older patients admitted to substance abuse treatment programs were not referred by healthcare providers, suggesting room for improvement in the screening and discussion of substance use disorders. Our review also suggests that there should be careful consideration of COVID-19 and racial disparities when screening, diagnosing, and treating substance use disorders in the older population. Summary This review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine.
Collapse
Affiliation(s)
- Jenny Lin
- Weill Cornell Medicine, New York, NY USA
| | - Mitchell Arnovitz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Nabil Kotbi
- Weill Cornell Medicine, New York Presbyterian/Westchester, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Dimitry Francois
- Weill Cornell Medicine, New York Presbyterian/Westchester, 21 Bloomingdale Road, White Plains, NY 10605 USA
| |
Collapse
|
4
|
Bantounou MA. A narrative review of the use of alcohol during the Covid-19 pandemic; effects and implications. J Addict Dis 2023; 41:30-40. [PMID: 35373718 DOI: 10.1080/10550887.2022.2058852] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The Covid-19 pandemic created an environment wherein stress and isolation could increase alcohol consumption. The effects of alcohol consumption on Covid-19 susceptibility and the impact of the Covid-19 pandemic on alcohol use, related harms and services were explored.Search terms were inputted to Medline and Embase databases, with relevant published papers written in English chosen.Alcohol ingestion both increased and decreased throughout the population globally, however, the overall trend was an increase. Risk factors for this included female sex, young age, family conflicts, unemployment, mental health disorders, substance misuse and lack of support. Alcohol misuse was found to be an aggravator of domestic violence and worsening mental health. It exacerbated the risk of contracting SARS-CoV-2 and worsened the Covid-19 infection severity, with >10 drinks/week increasing the acute respiratory distress syndrome (ARDS) risk similarly to established risk factors. This was attributed to the immunosuppressive and disinhibition effects of alcohol. Therefore, healthcare professionals should provide support to vulnerable groups, encouraging stress reduction, healthy habits, limiting alcohol consumption (<5 drinks/week) and promoting coping techniques. Self-help tools that monitor individual alcohol intake and psychosocial interventions in a primary care setting can also be employed. Finally, governing bodies should inform the public of the risks of alcohol ingestion during the Covid-19 pandemic.Thus, the Covid-19 pandemic could create a cycle whereby alcohol misuse could become a risk factor for Covid-19 infection and the Covid-19 pandemic could become a risk factor for alcohol misuse. Healthcare professionals should counsel people on alcohol misuse risk and protective factors.
Collapse
Affiliation(s)
- Maria A Bantounou
- School of Medicine, University of Aberdeen, Aberdeen, UK.,Department of Pharmacy, Aberdeen Royal Infirmary, Aberdeen, UK
| |
Collapse
|
5
|
Khare A, Sidana A, Mohemmed A, Allicock DM, Waterstone A, Zimmer MA, Il'yasova D. Acceleration of opioid-related EMS runs in the spring of 2020: The National Emergency Medical Services Information System data for 2018-2020. Drug Alcohol Depend 2022; 232:109271. [PMID: 35051696 DOI: 10.1016/j.drugalcdep.2022.109271] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND State- and county-level reports suggest that the COVID-19 pandemic exacerbated the opioid crisis. We examined US national trends of nonfatal opioid overdose in 2020 in comparison to pre-COVID years 2018-2019. METHODS We used National Emergency Medical Services Information System (NEMSIS) data to conduct a temporal analysis from 2018 to 2020. Opioid-related EMS run was defined using five scenarios of naloxone administration. To determine annual patterns and slope inflection points, we used the Prophet model of the time series analysis. Linear slopes and their 95% confidence intervals (CIs) were calculated for pre-stay-at-home (pre-SaH) and SaH periods in 2020 and compared to the slopes during the same time in 2018-2019. Three cut-points for SaH start were considered: March 19, 24, and 29. RESULTS We identified 91,065, 144,802, and 242,904 opioid-related EMS runs in 2018-2020, respectively. In 2020, opioid-related runs increased in January-June, with a pronounced acceleration in March, which coincides with the stay-at-home (SaH) orders. In both 2018 and 2019, opioid-related runs increased in January-August without the spring acceleration. In 2020, weekly increases (95% CI) during SaH for all examined cut-points were significantly greater than in pre-SaH: 18.09 (16.03-20.16) vs. 6.44 (3.42-9.47) for March 19, 17.77 (15.57-19.98) vs. 4.85 (2.07-7.64) for March 24, 18.03 (15.68-20.39) vs. 4.97(2.4-7.54) for March 29. No significant difference was found between these periods in 2018-2019. CONCLUSIONS The acceleration of opioid-related EMS runs during the SaH period of 2020 suggests that EMS data may serve as an early warning system for local health jurisdictions to deploy harm reduction/prevention resources.
Collapse
Affiliation(s)
- Akshat Khare
- Maverick Quantum, Inc., Level 9, Unit-2A Octave, Knowledge City, Hitech City, Hyderabad, Telangana 500081, India
| | - Arsh Sidana
- Maverick Quantum, Inc., Level 9, Unit-2A Octave, Knowledge City, Hitech City, Hyderabad, Telangana 500081, India
| | - Ammar Mohemmed
- MTX Group Inc., 17 Eaglewood Gdns S, Beaumont Hills, NSW 2155, Australia
| | | | - Anna Waterstone
- Department of Emergency Medicine, Stanford University, 900 Welch Road - Suite 350, Palo Alto, CA 94304, USA
| | - Matthew Aaron Zimmer
- MTX Group Inc., 1450 Western Ave. STE 304, Albany, NY 12203, USA; Maverick Quantum, Inc., 6303 Cowboys Way STE 400, Frisco, TX 75034, USA
| | - Dora Il'yasova
- MTX Group Inc., 1450 Western Ave. STE 304, Albany, NY 12203, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, DUMC Box 2914, Durham, NC 27710, USA.
| |
Collapse
|
6
|
Abstract
Coronavirus disease 2019 (COVID-19)-related stressors and restrictions, in the absence of social and institutional support, have led many individuals to either increase their substance consumption or relapse. Consequently, treatment programs for substance use disorders (SUDs) made a transition from in-person to remote care delivery. This review discusses the following evidence regarding changes prompted by the COVID pandemic to the clinical care of individuals with SUDs: (1) reduction in availability of care, (2) increase in demand for care, (3) transition to telemedicine use, (4) telemedicine for treatment of opioid use disorders, and (5) considerations for use of telemedicine in treating SUDs.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment. RECENT FINDINGS Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions. SUMMARY Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.
Collapse
Affiliation(s)
- Christina Marel
- University of Sydney, Matilda Centre for Research in Mental Health and Substance Use, Sydney, New South Wales, Australia
| | | | | |
Collapse
|