“It’s been an Experience, a Life Learning Experience”: A Qualitative Study of Hospitalized Patients with Substance Use Disorders

Abstract

BACKGROUND: Individuals with substance use disorders (SUD) have high rates of chronic illness and readmission, yet few are engaged in addiction treatment. Hospitalization may be a reachable moment for initiating and coordinating addiction care, but little is known about motivation for change in the inpatient setting. OBJECTIVE: To explore the experiences of hospitalized adults with SUD and to better understand patient and system level factors impacting readiness for change. DESIGN: We performed a qualitative study using individual interviews. The study was nested within a larger mixed-methods needs assessment. PARTICIPANTS AND SETTING: Hospitalized adults admitted to medical or surgical units at an urban academic medical center who reported high-risk alcohol or drug use on AUDIT-C or single-item drug use screener. APPROACH: We conducted a thematic analysis, using an inductive approach at a semantic level. KEY RESULTS: Thirty-two patients participated. The mean age was 43 years; 75% were men, and 68% identified as white. Participants reported moderate to high-risk alcohol (39%), amphetamine (46%), and opioid (65%) use. Emergent themes highlight the influence of hospitalization at the patient, provider, and health system levels. Many patients experienced hospitalization as a wake-up call, where mortality was motivation for change and hospitalization disrupted substance use. However, many participants voiced complex narratives of social chaos, trauma, homelessness, and chronic pain. Participants valued providers who understood SUD and the importance of treatment choice. Patient experience suggests the importance of peers in the hospital setting, access to medication-assisted treatment, and coordinated care post-discharge. CONCLUSIONS: This study supports that hospitalization offers an opportunity to initiate and coordinate addiction care, and provides insights into patient, provider, and health system factors which can leverage the reachability of this moment.

Planning and Designing the Improving Addiction Care Team (IMPACT) for Hospitalized Adults with Substance Use Disorder

“…In qualitative interviews, participants described inadequately treated withdrawal, the importance of trust and choice, and long wait times as a barriers to entering treatment after hospital discharge. 20 …”

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

“…However, these hospitalizations serve as a "reachable moment" to engage patients with OUD into medical care and initiate holistic treatment of their infection and underlying substance use disorder. 28,50 Significant systems-level barriers remain to comprehensive management of the overlapping infectious disease and opioid epidemics. Nevertheless, it is critical to acknowledge that the infections are a symptom of an underlying substance use disorder, a key first step in improving the care of patients hospitalized with infectious complications of OUD.…”

“…Extended hospitalization for patients with IDU-associated infections-often not receiving evidence-based treatment for their addiction-can be a harrowing experience and may be antitherapeutic. 15,28 Disposition decisions for patients with IDU-associated infections should involve risk stratification to assess addiction disease activity and take into account inpatient addiction treatment resources and patient preference, culture/availability of skilled nursing facilities (SNFs), and safety of the home environment. 29 Some emerging models of care take advantage of long hospitalizations by engaging patients with comprehensive addiction services including substance use group meetings, counseling, and social resources.…”

Opioid and cocaine use among primary care patients on buprenorphine—Self-report and urine drug tests

“…Although this study does not explicitly examine patient intent, it is possible that patients may be more willing to disclose use as they are in treatment longer. This could be explained by anticipated stigma at the beginning of treatment becoming less of an issue over time as a trusting relationship develops with providers (Merrill et al, 2002; Velez et al, 2017). …”