Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs

Abstract

BackgroundSubstance use disorders are regarded as one of the most prevalent, deadly and costly of health problems. Research has consistently found that the prevalence of other psychiatric disorders among those with substance related disorders is substantial. Combined, these disorders lead to considerable disability and health years lost worldwide as well as extraordinary societal costs. Relatively little of the literature on substance dependence and its impact on healthcare utilization and associated costs has focused specifically on chronic drug users, adolescents or women. In addition, the research that has been conducted relies largely on self-reported data and does not provide long-term estimates of hospital care utilization. The purpose of this study is to describe the long-term (24–32 year) healthcare utilization and it’s associated costs for a nationally representative cohort of chronic substance abusing women (adults and adolescents) remanded to compulsory care between 1997–2000 (index episode). As such, this is the first study investigating healthcare costs for women in compulsory treatment in Sweden.MethodsWomen (n = 227) remanded to compulsory care for substance abuse were assessed at intake and their hospital care utilization was retrieved 5-years post compulsory care from national records. Unit costs for ICD-10 diagnoses were applied to all hospital care used from 1975–2006. Attempts are made to estimate productivity losses associated with hospitalization and premature death.ResultsUpon clinical assessment it was found that a majority of these women had a comorbid psychiatric disorder (primarily personality disorder). The women followed in this study were admitted to hospital five to six times that of the general population and had stays six to eight times that of the general population. Total direct healthcare costs per person over the study period averaged approximately $173,000 and was primarily the result of psychiatric department visits (71 %) and inpatient treatment (98.5 %; detoxification and short-term rehabilitation).ConclusionsWomen placed in compulsory care use more hospital resources than that of the general Swedish population and when compared to international research of hospital care use and substance abuse. Direct hospital costs vary greatly over the life course. Effective services can have significant economic benefit.

Improved drug-use patterns at 6 months post-discharge from inpatient substance use disorder treatment: results from compulsorily and voluntarily admitted patients

“…Thus, the results suggest optimism for individuals and psychosocial intervention outcomes for SUD treatment in both VA and CA patients. In addition, having an aftercare plan and evaluating treatment outcomes in terms of appropriate patient-centred measures, such as quality of life, might become increasingly important when combinations of interventions are to be evaluated for chronic conditions within a long-term perspective [ 27 , 28 ].…”

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

“…In screening for psychiatric disorders, the concept of mental distress is widely used. For example, it is estimated that among patients with SUDs between 30 and 50% suffer from a psychiatric disorder [13]. Other studies have shown that 30–40% of people with alcohol related disorders and 40-50% of people with other SUDs also have a psychiatric disorder [14–17].…”

Opioid Use among Women on a Stable Methadone Dose

“…Women were likely to ignore the side effects of co-current use of opioids and methadone. Studies indicate that opioids are used to self-treat mental health problems by women (23,24). However, providing mental health services can be helpful (21).…”