Alcohol and Drug Use, Pain and Psychiatric Symptoms among Adults Seeking Outpatient Psychiatric Treatment: Latent Class Patterns and Relationship to Health Status

Abstract

Background Substance use, psychiatric problems and pain frequently co-occur; yet clinical profiles of treatment-seeking patients are poorly understood. To inform service and treatment planning, substance use and symptom patterns were examined in an outpatient psychiatry clinic, along with the relationship of these patterns to demographic characteristics and physical health. Methods Patients (N=405; age M=38; 69% White; 60% female) presenting for intake in a psychiatry outpatient clinic completed a computerized assessment of psychiatric problems, drinking, and drug use. Substance use and psychiatric symptom patterns among the sample were identified using latent class analysis. Results A 4-class model fit the data best: Class 1) Moderate symptoms/Wide range users (22.0%) had moderate depression and panic, tobacco, cocaine, hallucinogen, and ecstasy use; and high cannabis use. Class 2) Moderate depression/panic (37.8%) had moderate depression and panic. Class 3) Depression/Anxiety, tobacco and cannabis users (28.0%) had high depression, obsessions, and panic; and moderate pain severity, social phobia, compulsions, trauma, tobacco, and cannabis use. Class 4) Severe/wide range symptoms/users (12.0%) had high panic, depression, social phobia, obsessions, drug use; and moderate pain. Gender, ethnicity, and health status varied by class. Conclusions Findings highlight the preponderance of substance use (particularly cannabis) and its relationship to psychiatric symptom severity, pain and health status among those presenting for mental health treatment.

A systematic review of substance use screening in outpatient behavioral health settings

“…Four studies were single-site [ 37 , 40 – 42 ], three studies included multiple sites ranging from 2 to 48 [ 36 , 39 , 43 ], and one study did not report the number of sites [ 38 ]. The majority of the studies (62.5%) were conducted in adult clinics [ 37 , 39 , 40 , 42 , 44 ], with one study focused on college students [ 42 ]. Two studies included pediatric patients [ 36 , 43 ], and one study did not report age [ 41 ].…”

“…All of the studies screened for alcohol, the majority screened for drugs (N = 6) [ 36 , 37 , 39 , 40 , 42 , 43 ], and half of the studies screened for tobacco (N = 4) [ 36 , 39 , 40 , 42 ]. Of those that screened for drugs, two studies administered screeners which did not differentiate type of substance [ 36 , 37 ].…”

“…Of those that screened for drugs, two studies administered screeners which did not differentiate type of substance [ 36 , 37 ]. Of the remaining four, all specifically queried about marijuana/cannabis [ 39 , 40 , 42 , 43 ], and three screened for other drugs, including opioids [ 39 , 40 , 42 ]. A range of 1 to 5 screeners was used to assess for substance use.…”

“…Additionally, one study administered both a pre-screening instrument and a screening instrument [ 42 ]. The most commonly used screeners were the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) [ 38 , 42 , 45 ], the CRAFFT [ 36 , 43 , 46 ], the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) [ 39 , 42 , 47 ], and the Short Michigan Alcohol Screening Test (SMAST) [ 40 , 41 , 48 ] (all N = 2).…”

“…The three studies that reported on the race of screened patients included predominantly white patients, with these participants ranging from 52.8 to 72% of the sample [ 39 , 40 , 43 ]. The next most represented race was Asian, ranging from 9 to 10.5% of the sample.…”