Identifying substance abuse treatment gaps in substate areas

McAuliffe, William; Woodworth, Ryan; Zhang, Caroline Hui; Dunn, Ryan P.

doi:10.1016/s0740-5472(02)00263-5

Cited by 18 publications

(13 citation statements)

References 27 publications

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“…This study employs a new SUD identification algorithm, the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), adapted from the Substance Need Index (McAuliffe et al, 1999 a , 1999 b ; 2002) to enhance capture of SUD from women’s own substance-related health conditions and those of their neonates. We classified women as affected by SUD based on 1) specific ICD-9 codes for women or their neonates included in EMSANT-W (code list available on request), 2) birth certificate/fetal death record mention of a positive toxicology screen, or 3) a BSAS treatment system record.…”

Section: Methodsmentioning

confidence: 99%

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

Bernstein

Derrington

Belanoff

et al. 2015

Drug and Alcohol Dependence

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Introduction Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, ‘acute only’ (detoxification/stabilization), or ‘ongoing’ services. Methods We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002–2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes. Results Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15–49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained ‘ongoing’ treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive ‘ongoing’ treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received ‘acute only’ services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving ‘ongoing’ treatment. Conclusions Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. ‘Ongoing’ services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.

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Section: Methodsmentioning

confidence: 99%

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

Bernstein

Derrington

Belanoff

et al. 2015

Drug and Alcohol Dependence

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“…EMSANT-W is built on a methodologically rigorous measure of variation in the rates of substance abuse/dependence and unmet treatment need among the general population, the Substance Need Index. This index was developed by McAuliffe and colleagues 26–28 using multiple years of inpatient hospital discharge data mortality data and arrest records.…”

Section: Methodsmentioning

confidence: 99%

The Association of Injury With Substance Use Disorder Among Women of Reproductive Age: An Opportunity to Address a Major Contributor to Recurrent Preventable Emergency Department Visits?

Bernstein

Belanoff

et al. 2014

Acad Emerg Med

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Objectives: Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used.Methods: This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates.Results: Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost twothirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (AESD) number of events also differed (2.27 AE 4.1 for SUD-positive women vs. 0.73 AE 1.3 for SUDnegative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (AESD) number of events was more than double (0.72 AE 0.9 vs. 0.26 AE 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean AE SD events = 0.19 AE 0.9 vs. 0.009 AE 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean AE SD events = 0.18 AE 0.1 vs. 0.02 AE 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean AE SD = 3.67 AE 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor.

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“…A set of studies by McAuliffe and colleagues (McAuliffe et al. , ; McAuliffe and Dunn ) examined state differences in SUD treatment utilization and need and found that Southern and Southwestern states had the largest SUD treatment gaps (McAuliffe et al. ; McAuliffe and Dunn ).…”

Section: Geographic Variation In Treatment Availabilitymentioning

confidence: 99%

Geographic Disparities in Availability of Opioid Use Disorder Treatment for Medicaid Enrollees

Abraham

Andrews

Yingling

et al. 2017

Health Services Research

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Identifying substance abuse treatment gaps in substate areas

Cited by 18 publications

References 27 publications

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

The Association of Injury With Substance Use Disorder Among Women of Reproductive Age: An Opportunity to Address a Major Contributor to Recurrent Preventable Emergency Department Visits?

Geographic Disparities in Availability of Opioid Use Disorder Treatment for Medicaid Enrollees

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