A Single-Question Screening Test for Drug Use in Primary Care

BACKGROUND: Individuals with substance use disorders (SUD) have high rates of chronic illness and readmission, yet few are engaged in addiction treatment. Hospitalization may be a reachable moment for initiating and coordinating addiction care, but little is known about motivation for change in the inpatient setting. OBJECTIVE: To explore the experiences of hospitalized adults with SUD and to better understand patient and system level factors impacting readiness for change. DESIGN: We performed a qualitative study using individual interviews. The study was nested within a larger mixed-methods needs assessment. PARTICIPANTS AND SETTING: Hospitalized adults admitted to medical or surgical units at an urban academic medical center who reported high-risk alcohol or drug use on AUDIT-C or single-item drug use screener. APPROACH: We conducted a thematic analysis, using an inductive approach at a semantic level. KEY RESULTS: Thirty-two patients participated. The mean age was 43 years; 75% were men, and 68% identified as white. Participants reported moderate to high-risk alcohol (39%), amphetamine (46%), and opioid (65%) use. Emergent themes highlight the influence of hospitalization at the patient, provider, and health system levels. Many patients experienced hospitalization as a wake-up call, where mortality was motivation for change and hospitalization disrupted substance use. However, many participants voiced complex narratives of social chaos, trauma, homelessness, and chronic pain. Participants valued providers who understood SUD and the importance of treatment choice. Patient experience suggests the importance of peers in the hospital setting, access to medication-assisted treatment, and coordinated care post-discharge. CONCLUSIONS: This study supports that hospitalization offers an opportunity to initiate and coordinate addiction care, and provides insights into patient, provider, and health system factors which can leverage the reachability of this moment.

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“…9,10 All protocols and materials were approved by the institutional review board of Oregon Health & Science University.…”

Section: Methodsmentioning

confidence: 99%

“It’s been an Experience, a Life Learning Experience”: A Qualitative Study of Hospitalized Patients with Substance Use Disorders

et al. 2016

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“…However, definitive proof favoring screening and brief intervention for drug use awaits randomized controlled trials to assess whether the interventions reduce drug use and improve health outcomes at reasonable cost. 38 In the meantime, screening tools are available, 39,40 and clinicians may wish to use these results to help them target their screening where it is likely to be positive.…”

Section: Discussionmentioning

confidence: 99%

Trajectories of Drug Use and Mortality Outcomes Among Adults Followed Over 18 Years

et al. 2012

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BACKGROUND: For adults in general population community settings, data regarding long-term course and outcomes of illicit drug use are sparse, limiting the formulation of evidence-based recommendations for drug use screening of adults in primary care. OBJECTIVE: To describe trajectories of three illicit drugs (cocaine, opioids, amphetamines) among adults in community settings, and to assess their relation to all-cause mortality. 1987/88, 1990/91, 1992/93, 1995/96, 2000/01, 2005/ 06. Survey-based assessment of demographics and psychosocial characteristics. Mortality over 18 years. RESULTS: Trajectory analysis identified four groups: Nonusers (n=3691, 85.8%), Early Occasional Users (n= 340, 7.9%), Persistent Occasional Users (n=160, 3.7%), and Early Frequent/Later Occasional Users (n=110, 2.6%). Trajectories conformed to expected patterns regarding demographics, other substance use, family background and education. Adjusting for demographics, baseline health status, health behaviors (alcohol, tobacco), and psychosocial characteristics, Early Frequent/Later Occasional Users had greater all-cause mortality (Hazard Ratio, HR = 4.94, 95% CI = 1. 58-15.51, p=0.006). LIMITATIONS: Study is restricted to three common drugs, and trajectory analyses represent statistical approximations rather than identifiable "types". Causal inferences are tentative. CONCLUSIONS:Four trajectories describe illicit drug use from young adulthood to middle age. Two trajectories, representing over one third of adult users, continued use into middle age. These persons were more likely to continue harmful risk behaviors such as smoking, and more likely to die.

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“…Both the MoCA and MMSE are used clinically in the assessment of depression, as cases of depression often have mild impairments on these two instruments. [42] was conducted by the study psychiatrist to gather details about each participant's history of alcohol and substance abuse.…”

Section: Methodsmentioning

confidence: 99%

Telemedicine for Depression in Older People Living with HIV

Bourgeois¹

2017

Acta Psychopathol

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A Single-Question Screening Test for Drug Use in Primary Care

Cited by 402 publications

References 20 publications

“It’s been an Experience, a Life Learning Experience”: A Qualitative Study of Hospitalized Patients with Substance Use Disorders

“It’s been an Experience, a Life Learning Experience”: A Qualitative Study of Hospitalized Patients with Substance Use Disorders

Trajectories of Drug Use and Mortality Outcomes Among Adults Followed Over 18 Years

Telemedicine for Depression in Older People Living with HIV

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