Comparison of Substance Use Disorder Diagnosis Rates From Electronic Health Record Data With Substance Use Disorder Prevalence Rates Reported in Surveys Across Sociodemographic Groups in the Veterans Health Administration

Abstract

IMPORTANCE Substance use disorders (SUDs) are major contributors to morbidity and mortality globally, but they are often underrecognized and underdiagnosed, particularly in some sociodemographic subgroups. Understanding the extent to which clinical diagnoses underestimate these conditions within subgroups is imperative to achieving equitable treatment, regardless of race, ethnicity, gender, or age, and to informing and improving performance monitoring. OBJECTIVE To compare clinically documented diagnosis rates of alcohol use disorder (AUD), drug use disorder (DUD), and total SUD (AUD and/or DUD) with the prevalence of these disorders as reported in surveys-based on structured, validated diagnostic assessments-across demographic subgroups. DESIGN, SETTING, AND PARTICIPANTSA telephone-based survey was conducted from January 8, 2018, to April 30, 2019, among 5995 Veterans Health Administration (VHA) outpatients who were randomly sampled from 30 VHA facilities and were 18 years of age or older, could complete the survey in English, and had a valid address and telephone number. Survey data were linked to electronic health record (EHR) data for all participants. Statistical analysis was performed between

Associations Between Distinct Co-occurring Substance Use Disorders and Receipt of Medications for Opioid Use Disorder in the Veterans Health Administration

“…29 Race and ethnicity were measured as a proxy for having lived experiences impacted by systemic racism, 30 and adjusted for because systemic racism drives disparities in clinically-documented SUDs and MOUD access. [31][32][33] Homelessness/housing instability was defined as having ≥1 clinic visit code, ICD code, or screening documentation from an electronic clinical reminder indicating homelessness or other housing instability in the 2 years before the index date. 34 Any mental health condition (depression, posttraumatic stress disorder, anxiety, other mood disorders, bipolar disorder, psychoses, and/or schizophrenia) and diagnoses included in the Charlson comorbidity index (adjusted for separately as binary variables rather than a continuous weighted score 35 ) were defined as having ≥1 relevant ICD code in the year before the index date.…”

Psychometric Performance of a Substance Use Symptom Checklist to Help Clinicians Assess Substance Use Disorder in Primary Care

“…Study findings support the symptom checklist’s construct validity as a scaled measure of SUD severity. The strong psychometric performance identified may help clinicians feel confident in measurement-based tools to support SUD identification and care in general medical settings where they are underrecognized and undertreated . A lack of clinically meaningful difference between expected total scores on the symptom checklist for patients of different ages, sexes, races, and ethnicities supports its use in diverse patient populations.…”

“…4 However, the proportion of patients who receive an SUD diagnosis is much lower (0.8%-4.6%). [5][6][7][8][9] Low rates of diagnosis decrease opportunities for patients to receive treatment 10,11 despite evidence-based options (eg, pharmacotherapy for opioid use disorder, behavioral treatments for cannabis and stimulant use disorders). [12][13][14] Brief, validated substance use screens, recommended in primary care by the US Preventive Services Task Force, 15 typically ask about frequency of cannabis and other drug use and are useful for screening for SUDs.…”

“…Overall, 7% of US adults meet diagnostic criteria for substance use disorder (SUD), defined as having 2 or more of 11 criteria by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) ( DSM-5 ) . However, the proportion of patients who receive an SUD diagnosis is much lower (0.8%-4.6%) . Low rates of diagnosis decrease opportunities for patients to receive treatment despite evidence-based options (eg, pharmacotherapy for opioid use disorder, behavioral treatments for cannabis and stimulant use disorders) …”

The impact of COVID‐19 on trends in alcohol use disorder treatment in Veterans Health Administration

“…Patients in each monthly cohort included VHA patients ages ≥ 18 years with at least one VHA outpatient encounter with an AUD diagnosis (either primary or secondary) in the 12 months prior to and including the month of interest. AUD was defined using International Classification of Diseases, 10th revision (ICD‐10) codes for alcohol abuse (F10.1) and alcohol dependence (F10.2), which have previously been used to study AUD in VHA [26–28]. The second cohort was comprised of patients who received any AUD treatment in the pre‐COVID‐19 and COVID‐19 periods to assess for changes in patient characteristics and number of AUD treatment visits between the pre‐COVID‐19 and COVID‐19 periods.…”