Receipt of pharmacotherapy for alcohol use disorder by justice-involved women in the Veterans Health Administration

Abstract

BackgroundAlcohol use disorder (AUD) and unhealthy drinking are prevalent among women involved in the criminal justice system and women military veterans. Pharmacotherapy—including naltrexone, topiramate, acamprosate, and disulfiram—for AUD is one form of effective treatment that is associated with better health and criminal justice outcomes. The current study examined the association of justice involvement with receipt of pharmacotherapy for AUD, as well as other patient factors that may explain variation in receipt of pharmacotherapy for AUD among women veterans who receive care at Veterans Health Administration (VHA) facilities. MethodsUsing national VHA clinical records, we examined all women VHA patients who received an AUD diagnosis during an outpatient or inpatient visit in fiscal years (FY) 2014–2017. We compared patient characteristics by justice status, defined as contact with one of the VHA’s justice outreach programs, and used a mixed-effects logistic regression model to test whether justice involvement was independently associated with odds of receiving pharmacotherapy for AUD.ResultsOf 10,511 women veterans diagnosed with AUD in FY2017, 852 (8%) met our definition of justice-involved. Since FY2014, the percentage of women veterans who received pharmacotherapy for AUD increased (14–21%). Women justice-involved veterans and those who were homeless had higher odds of receiving pharmacotherapy for AUD (OR 1.29, CI 1.15–1.45; OR 1.35, CI 1.25–1.47). Women veterans age 55 or older or who were African-American had lower odds of receiving pharmacotherapy (OR 0.74, CI 0.67–0.82; OR 0.73, CI 0.68–0.79).ConclusionsWhile women involved in the criminal justice system face many barriers to accessing health and social services, women justice-involved veterans had higher odds of receiving pharmacotherapy for AUD at VHA facilities compared to women veterans with no justice involvement. Legal mandates and supportive programming directed towards veterans in the criminal justice system may explain the higher rate of receipt of pharmacotherapy observed among justice-involved women veterans. Women veterans who are homeless may also have more opportunities to access and use pharmacotherapy for AUD compared to their housed counterparts.

Introduction to the special issue

“…Implementation efforts to improve uptake of evidencebased substance use disorder treatment will need to tackle these barriers to ensure criminal justice involved [17] demonstrated that people with both a substance use disorder and an incarceration history had higher odds of utilizing substance use disorder treatment compared to people who had a substance use disorder without a history of incarceration. Consistent with Tsai and Gu's results are the findings of Taylor et al 's [18] national study of women with alcohol use disorder who used the Veterans Health Administration for care. Receipt of pharmacotherapy for alcohol use disorder was more frequent among women veterans with recent criminal justice involvement compared to women veterans with no known justice involvement.…”

“…Relationships between criminal justice and community agencies should be strengthened to ensure substance use disorder treatment is available immediately following exit from incarceration and responsive to individuals' lived experience. Finally, although patients with a criminal justice history engaged in more substance use disorder treatment than their non-involved counterparts [17,18], the high prevalence of substance use disorders suggests that…”

A Bibliometric Review of Research on International Students’ Mental Health: Science Mapping of the Literature from 1957 to 2020

“…The first cluster represents a school of thought named Community, which focused on research topics related to the mental/behavioral issues of international students within their community. Researchers in this field often examined a certain group of international students, such as Asian students in Japan [ 35 ], Italian students [ 36 ], and American students [ 37 , 38 ]. Furthermore, within this school of thought, risky behaviors (e.g., alcoholic problems) as well as helpful behaviors creativity in Ballentine [ 39 ], that happened within the international students’ community were also being investigated.…”

“…As international students’ mental health is influenced by the interaction between the students’ mindset and the surrounding environment, this science mapping showed that recent research is focusing more on investigating these specific interactions, that have not been explored before. Secondly, the newer keywords on the science mapping also showed a stronger emphasis on modern issues that students are facing during their study: the focus on changes in the environment and behavioral problems such as problematic social media use [ 2 , 92 , 93 ], social drinking and gambling [ 38 ], [ 90 , 94 ] has increased in recent years. Environmental changes and adaptation problems such as COVID-19 [ 9 , 91 , 95 ], coping strategies [ 96 , 97 , 98 ], and homesickness [ 68 , 99 ] are also being emphasized.…”

Implementation of peer recovery coach services for opioid overdose patients in emergency departments in Indiana: findings from an informal learning collaborative of stakeholders

“…The need to maintain program sustainability prompted vendors serving patients in rural areas to make interinstitutional connections with criminal justice agencies, while an urban vendor engaged with law enforcement officers to bring opioid offenders to ED for PRC contact and treatment rather than arresting and jailing them and to develop continued MOUD delivery through billing. Importantly, such connections may be preventive of opioid overdose and fatalities, given high rates of these among newly released inmates [ 27 ]. Having PRCs work with jail inmates with OUD also fits philosophically with PRC work with ED overdose patients in that jail inmates, like overdose patients, have experienced a dramatic negative event (being jailed) and may be particularly receptive to MOUD and other treatment services.…”