Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls.
TL;DR: Pain-related diagnoses among patients dependent on narcotic analgesics highlight the need for linkages between primary care and substance abuse treatment and point to the importance of examining comorbid medical conditions and substance Abuse in both primary and specialty care.
Abstract: Background Substance abuse and health problems seem to be inextricably related. Yet, prior research on the health conditions related to substance abuse is largely focused on alcohol and is from patients treated in publicly funded programs, inpatients, and the general population. Methods This study compares the prevalence of medical and psychiatric conditions among 747 substance abuse patients and 3690 demographically matched controls from the same health maintenance organization, and examines whether any heightened prevalence for substance abuse patients (relative to controls) varies according to demographic subgroups and type of substance. Results Approximately one third of the conditions examined were more common among substance abuse patients than among matched controls, and many of these conditions were among the most costly. We also found that pain-related diagnoses, including arthritis, headache, and lower back pain, were more prevalent among such patients, particularly those dependent on narcotic analgesics. Conclusions Our findings point to the importance of examining comorbid medical conditions and substance abuse in both primary and specialty care. Our findings regarding pain-related diagnoses among patients dependent on narcotic analgesics highlight the need for linkages between primary care and substance abuse treatment. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of an underlying substance abuse disorder.
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TL;DR: Comorbidity of alcohol dependence with other substance disorders appears due in part to unique factors underlying etiology for each pair of disorders studied while comorbidities of alcohol addiction with mood, anxiety, and personality disorders appears more attributable to factors shared among these other disorders.
Abstract: Background Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available. Objectives To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and Participants Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N = 43 093). Main Outcome Measures Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders. Results Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P Conclusions Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.
2,855 citations
TL;DR: This essay describes how a basic scientist was thrust into the epicenter, the political cauldron of the authors' national drug control policy, and how the experience altered her professional trajectory and perspective.
Abstract: This essay describes how a basic scientist was thrust into the epicenter, the political cauldron of our national drug control policy, and how the experience altered her professional trajectory and perspective.
918 citations
TL;DR: SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a rangeof patients.
630 citations
TL;DR: The exploratory results suggest that multiple episodes of care over several years are the norm and that rather than thinking of multiple episodes in terms of "cumulative dosage," it might be better thought of as further evidence of chronicity and that the authors need to develop and evaluate models of longer term recovery management.
315 citations
Additional excerpts
..., Watkins, Pincus, Tanielian, & Lloyd, 2003; Weisner, Mertens, Parthasarathy, Moore, & Lu, 2001), mental-health system (SAMHSA, 2002; Mertens et al., 2003) and criminaljustice system (Scott et al....
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TL;DR: There is strong evidence to support inequalities in medical care disadvantaging those who have a psychiatric illness or a substance use disorder.
Abstract: Background
There has been long-standing concern about the quality of medical care offered to people with mental illness.
Aims
To investigate whether the quality of medical care received by people with mental health conditions, including substance misuse, differs from the care received by people who have no comparable mental disorder.
Method
A systematic review of studies that examined the quality of medical care in those with and without mental illness was conducted using robust critical appraisal techniques.
Results
Of 31 valid studies, 27 examined receipt of medical care in those with and without mental illness and 10 examined medical care in those with and without substance use disorder (or dual diagnosis). Nineteen of 27 and 10 of 10, respectively, suggested inferior quality of care in at least one domain. Twelve studies found no appreciable differences in care or failed to detect a difference in at least one key area. Several studies showed an increase in healthcare utilisation but without any increase in quality. Three studies found superior care for individuals with mental illness in specific subdomains. There was inadequate information concerning patient satisfaction and structural differences in healthcare delivery. There was also inadequate separation of delivery of care from uptake in care on which to base causal explanations.
Conclusions
Despite similar or more frequent medical contacts, there are often disparities in the physical healthcare delivered to those with psychiatric illness although the magnitude of this effect varies considerably.
299 citations
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TL;DR: A policy of not making adjustments for multiple comparisons is preferable because it will lead to fewer errors of interpretation when the data under evaluation are not random numbers but actual observations on nature.
Abstract: Adjustments for making multiple comparisons in large bodies of data are recommended to avoid rejecting the null hypothesis too readily. Unfortunately, reducing the type I error for null associations increases the type II error for those associations that are not null. The theoretical basis for advocating a routine adjustment for multiple comparisons is the "universal null hypothesis" that "chance" serves as the first-order explanation for observed phenomena. This hypothesis undermines the basic premises of empirical research, which holds that nature follows regular laws that may be studied through observations. A policy of not making adjustments for multiple comparisons is preferable because it will lead to fewer errors of interpretation when the data under evaluation are not random numbers but actual observations on nature. Furthermore, scientists should not be so reluctant to explore leads that may turn out to be wrong that they penalize themselves by missing possibly important findings.
4,854 citations
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...No adjustments were made for multiple comparisons.(26)...
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TL;DR: Findings support the effectiveness and specificity of different substance abuse treatments, suggest methodologic reasons for the lack of similar findings in previous studies, and demonstrate the importance of psychiatric factors in substance abuse treatment.
Abstract: Male alcoholics (n = 460) and drug addicts (n = 282) were evaluated at six-month follow-up after treatment in six rehabilitation programs. Initial analyses of the unstratified samples showed significant patient improvement, but no evidence of differential effectiveness from different treatments or from "matching" patients to treatments. The two samples were then divided into groups based on the number, duration, and intensity of their psychiatric symptoms at admission, ie, their overall "psychiatric severity." Patients with low psychiatric severity improved in every treatment program. Patients with high psychiatric severity showed virtually no improvement in any treatment. Patients with midrange psychiatric severity (60% of the samples) showed outcome differences from different treatments and especially from specific patient-program matches. These findings support the effectiveness and specificity of different substance abuse treatments, suggest methodologic reasons for the lack of similar findings in previous studies, and demonstrate the importance of psychiatric factors in substance abuse treatment.
823 citations
"Medical and psychiatric conditions ..." refers background in this paper
...The need for treatment of psychiatric comorbidities is important; female patients with higher levels of psychiatric severity are at increased risk of early dropout,(34) and patients with psychiatric problems have generally poorer treatment outcomes.(35,36) Conditions whose prevalences were not found to be different between cases and controls included cancer of the breast, lung, prostate, or colon, as well as diabetes, renal failure, cerebrovascular diseases, and benign conditions of the prostate....
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TL;DR: Cannabinoids derived from herbal cannabis interact with endogenous cannabinoid systems in the body and cause dose-related impairments of psychomotor performance with implications for car and train driving, aeroplane piloting and academic performance.
Abstract: Increasing prevalence of recreational cannabis use among the young population has stimulated debate on the possible effects of acute and long-term use. This paper aims to highlight recent knowledge of mechanisms of action, effects on psychomotor and cognitive performance, and health risks associated with cannabis consumption.
The paper reviews recent literature on the prevalence of cannabis use, the potency of modern cannabis preparations and the pharmacological actions of cannabis. The paper outlines that cannabinoids derived form herbal cannabis interact with endogenous cannabinoid systems in the body. Actions on specific brain receptors cause dose-related impairments of psychomotor performance with implications for car and train driving, aeroplane piloting and academic performance. Other constituents of cannabis smoke carry respiratory and cardiovascular health risks similar to those of tobacco smoke. The paper concludes that cannabis is not, as widely perceived, a harmless drug but poses risks to the individual and to society.
773 citations
"Medical and psychiatric conditions ..." refers background in this paper
...Long-term marijuana use has been found to be associated with cognitive impairments such as memory and attention deficits,(14,15) bronchitis,(14,15) and adverse cardiovascular effects.(14) There is evidence among cocaine users of cardiovascular complications,(6,16,17) and neurologic and psychiatric disorders....
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TL;DR: There is conflicting evidence about many of the effects of cannabis use, so the evidence on the most probable adverse health and psychological consequences of acute and chronic use is summarized.
773 citations
TL;DR: Cocaine is the most commonly used illicit drug among subjects seeking care in hospital emergency departments or drug-treatment centers, and it is also the most frequent drug-related visits to emergency departments.
Abstract: Cardiovascular complications are among the most common and dangerous complications of cocaine abuse, ranging from episodic arrhythmias to myocardial infarction, strokes, cardiomyopathy, and sudden death. The central nervous system-mediated action of cocaine triggers an increase in circulating catecholamines, resulting in arterial vasoconstriction, increase in myocardial oxygen demand, myocardial ischemia, tachycardia, and other arrhythmias. The peripheral cardiovascular action of cocaine involves the inhibition of reuptake of catecholamines at adrenergic nerve terminals, with local release of epinephrine, direct stimulation and vasospasm of the coronary arteries, coronary intimai hyperplasia, inhibition of baroreceptors, interference with the electrical conduction through the myocardium, and direct myocardial toxicity. The cardiovascular complications of cocaine include cardiac dysrhythmias and hypertension, acute myocardial infarction, myocarditis, infectious endocarditis, ventricular dysfunction, dilated cardiomyopathy, hypotensive shock, and cerebral strokes. Cocaine-related vascular changes in the pregnant woman and fetus have been related to an increased incidence of abortion, abruptio placentae, and congenital anomalies of the fetus.
723 citations