Psychiatric distress, risk behavior, and treatment enrollment among syringe exchange participants

Abstract

The present study evaluated psychiatric distress as a predictor of treatment enrollment in out-oftreatment injection opioid users newly registered at the Baltimore Needle Exchange Program (BNEP). Study participants (n = 281) completed the Addiction Severity Index (ASI), the Risk Assessment Battery (RAB), and the Symptom Checklist-90 (SCL-90-R), and were randomly assigned to one of three different conditions for 4-months that evaluated referral strategies designed to promote treatment interest and enrollment. The Global Severity Index (GSI) of the SCL-90 was used as a measure of psychiatric distress. A logistic regression showed that higher GSI scores predicted more treatment enrollment (Adjusted OR = 2.15, CI = 1.10 -4.23, p < .05), after controlling for study condition, demographic variables, syringe exchange site, and severity of drug use. The results suggest that the data from the assessment of psychiatric distress in syringe exchange settings can be used to support motivational strategies for encouraging syringe exchangers to seek substance abuse treatment.Keywords syringe exchange; psychiatric distress; substance abuse treatment I.0 IntroductionInjection drug users enrolled in community syringe exchange programs (SEPs) exhibit rates of other psychiatric disorders that are higher than reported in general population estimates (Brienza et al., 2000; Kessler et al., 2005;Kidorf et al., 2004). At least three practical concerns are associated with the high rates of psychiatric comorbidy in this subgroup of injection drug users. The first is that the psychiatric distress associated with the presence of other psychiatric disorders may further impair their already poor psychosocial functioning (e.g., Brooner et al., Phone: (410) Fax: (410) 550-2957, mkidorf@jhmi.edu. Contributors Drs. Kidorf and Brooner designed the study. Dr. Kidorf wrote the first draft of the manuscript. Ken Kolodner conducted the statistical analyses. Drs. Van King, Jessica Pierce, Christopher Burke, and Robert Brooner provided assistance with literature searches and editing subsequent drafts of the manuscript. All of the authors contributed to and have approved the final manuscript. Conflict of InterestAll authors declare that they have no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A relationship between psychiatric distress and treatment enrollment has been suggested across a number of epidemiological studies (Mojtabai et al., 2002; Ross, Linn, & Cunningham, 1999). Most recently, Cohen et al. (2007) showed that individuals with both an alcohol use disorder and a c...

Mental distress following inpatient substance use treatment, modified by substance use; comparing voluntary and compulsory admissions

“…Patients that used injected drugs exhibited higher rates of mental distress, consistent with previous findings [52]. This finding suggested that the severity of a SUD was related to the level of mental distress.…”

Prospective effects of traumatic event re‐exposure and post‐traumatic stress disorder in syringe exchange participants

“…The possibility that PTSD and traumatic event exposure could be associated with drug abuse treatment‐seeking follows from the considerable evidence supporting a connection between PTSD and higher rates of medical and psychiatric treatment‐seeking , and between generalized psychiatric distress and drug abuse treatment‐seeking . Injecting drug users who report that the extreme negative consequences of their drug use have prompted their desire for treatment are popularly said to have hit ‘rock bottom’ , which can be associated with sustained remission .…”

Psychiatric correlates of injection risk behavior among young people who inject drugs.

“…A number of studies with methadone maintenance or other drug treatment patients (Camacho, et al, 1996; Kleinman, et al, 1994; Malow, et al, 1992; Metzger, et al, 1991; Perdue, et al, 2003; Pilowsky, et al, 2011; Woody, et al, 1997), and drug users not in treatment (Johnson, et al, 2003; Johnson, et al, 2002; Simpson, et al, 1993; Strathdee, et al, 1997), including syringe exchange program participants (Kidorf, et al, 2010), have found that symptoms of psychological distress or dysfunction, particularly symptoms of depression, are associated with injection risk behavior, including sharing syringes and other equipment, number of sharing partners, sharing with strangers, and sharing with a person known to be HIV-positive.…”