Patterns of Substance Abuse Treatment Seeking Following Cocaine-Related Emergency Department Visits

Abstract

Chest pain is the most common medical complaint among cocaine-using emergency department (ED) patients. Correlates of substance abuse treatment seeking were examined using 3-month post-discharge surveys from 170 ED patients admitted with cocaine-related chest pain. Four treatment categories were specified as the dependent variable in an ordered logistic regression: no treatment (74.7%), informal treatment only (7.1%) formal treatment only (5.9%) both formal an informal treatment (12.4%). The following variables were found to be positively associated with a higher treatment category: frequency of cocaine use (OR=1.07; CI95=1.01-1.15, p=0.03), global severity index (OR=2.26, CI95=1.04-4.90; p=0.04) number of endorsed stigma barriers (OR=4.40; CI95=1.41-13.78; p=0.01), interpersonal consequences (OR=1.41; CI95=1.01- 1.88; p=0.02), and pre-baseline informal treatment (OR=6.69; CI95=1.58-28.36, p=0.01). Physical consequences were found to be negatively associated with a higher treatment category (OR=0.63, CI95=0.47-0.85; p<0.01). ED visits for cocaine-related chest pain represent missed opportunities to link patients to substance abuse treatment and interventions are needed to motivate patients to seek care.

Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders

“…Twelve studies that did not ask participants to rate directly the influence of stigma on their treatment-seeking decisions did use statistical methods to determine whether or not stigma predicted treatment motivation and/or utilization. 13 , 15 , 42 , 54 , 59 – 66 Of these, five found stigma to be a positive predictor or copredictor, 54 , 60 , 63 – 65 three found it to be a negative predictor or copredictor, 15 , 61 , 62 and three found it not to be a predictor at all. 13 , 42 , 59 …”

“…The first study that found stigma to be a positive predictor found that stigma barriers significantly predicted treatment utilization at 3-month follow-up for cocaine users seen in the emergency room, while other types of treatment barriers did not. 60 The second study found that pregnant women in a detoxification program who reported an acceptability barrier (a category that included stigma) had increased treatment-motivation scores, while gestational age of the fetus was a negative predictor. 54 The third and fourth studies were different analyses of the same data.…”

“…Of the positive (co)predictor studies, two looked at stigma within a larger category of barriers, 54 , 65 two probed the stigma of being a user (as opposed to the stigma of getting into treatment), 63 , 64 and one looked at individuals who had experienced a significant health event related to their use. 60 It stands to reason that measuring stigma within a larger category loses some specificity in terms of the direct impact of stigma on treatment-seeking decisions. Additionally, probing stigma of use is quite different from probing the stigma of getting treatment.…”

“…In a number of studies, the most frequently cited reasons not to seek treatment were not being ready to stop using, 10 , 12 , 52 not accepting that there was a problem with use, 13 , 39 , 42 , 50 , 51 or other attitudes about treatment. 8 , 11 , 14 , 44 , 45 , 47 , 48 Stages of readiness to change must be considered when looking at the impact of stigma, 60 , 62 , 83 as it stands to reason that someone who does not recognize they have a problem with drug or alcohol use at all will not be particularly influenced by perceived stigma against substance-use treatment, as the idea of getting treatment does not enter their consciousness. In other words, if one wishes to measure the influence of stigma on treatment seeking, first one must know where the sample falls in terms of problem recognition.…”

Utilization of emergency and hospital services among individuals in substance abuse treatment

“…These individuals frequent the emergency room due to chest pain, drug-induced psychosis, depression, overdose, vehicle accidents, or drug-seeking behavior [7,8]. ER users are more socioeconomically disadvantaged and use drugs more often than non-ER users [9].…”