The Legacy of Parental Incarceration, Drug Treatment Interventions, and More

The efficacy of reinforcement-based interventions in decreasing substance use and related problems was supported by preliminary evidence from a comprehensive literature search. The authors identified studies that tested behavioral activation (BA) and behavioral economics (BE) interventions that targeted outcomes or mechanisms of action specific to substance use. All of the outcome studies suggested efficacy of BA and BE in targeting substance use or use-related problems. In 90% of studies, the BA or BE intervention condition evidenced significantly higher abstinence rates compared with controls or significant decreases in substance use from baseline; 83% of studies that assessed substance use-related problems reported significant decreases in the problems. Most studies reported medium to large effect sizes. The authors noted that the mechanisms that drive BA and BE efficacy and the factors that may moderate treatment effects require further examination.

The likelihood of patients with opioid use disorder (OUD) to use long-term buprenorphine treatment is influenced by their perceptions of its accessibility and acceptability, study authors found, noting that many patients with OUD who do receive buprenorphine do not adhere to the therapy long enough to achieve sustained benefits. The investigators used random-intercept modeling to identify factors associated with patients’ buprenorphine treatment utilization over 2 years after first follow-up. About 9.3% to 11.2% of the patients used buprenorphine treatment over the 2 years. Those who perceived buprenorphine to be both accessible and acceptable were most likely to use it. Those who perceived the therapy to be unacceptable were least likely to use it, regardless of the level of perceived access. Utilization of buprenorphine treatment also was negatively associated with Hispanic ethnicity, West coast context, and cumulative months receiving methadone treatment and incarceration during follow-up. The authors concluded that more patients with OUD might use long-term buprenorphine treatment if interventions targeted treatment acceptability, access to buprenorphine were increased, and efforts were tailored to meet the needs of vulnerable populations.

The use of marijuana may have a negative effect on suicidal thoughts and behavior, especially for military personnel who are experiencing elevated PTSD symptoms. Study authors examined the unique and interactive effects of PTSD symptoms and days using alcohol, opioids, and marijuana on PTSD symptoms, suicidal ideation, and suicidal behavior in current and former military personnel who were at risk for suicide but were not active in mental health treatment. PTSD symptoms and marijuana use predicted the likelihood of suicidal ideation 1 month later and suicidal behavior at 11‐month follow‐up. The interaction between PTSD and marijuana use significantly predicted increased PTSD symptoms over time and suicidal behavior. More days using marijuana predicted increased PTSD symptoms over time and the likelihood of suicidal behavior at high, but not low, levels of PTSD symptoms. The authors suggested that their results are relevant to the notion that medical marijuana might be used in treating or augmenting treatment for patients with PTSD.

SUDs and other psychiatric disorders are associated with substantially higher resource utilization and health care costs among patients who have chronic diseases.  Among adults with a chronic disease (eg, asthma, congestive heart failure, diabetes) in a population-based cohort study, 15.8% had a concomitant psychiatric disorder (depression, schizophrenia, alcohol use disorder [AUD], or drug use disorder [DUD]). Depression, present in 11.2% of patients, was most common; in those with depression, 10.3% had a concomitant SUD. The mean total 3-year unadjusted costs of patients with chronic disease were $38 250 for those who had a psychiatric disorder and $20 210 for those who did not. For specific comorbidities, costs were: depression, $34 690; schizophrenia, $50 450; AUD, $42 320, and DUD, $45 260. Higher cost was associated with the presence of a psychiatric disorder, age >65 years, and low income. Costs were $74 119 for older patients who had co-occurring depression and SUD compared with $29 401 for those who did not have a mental health disorder. The mean total hospital length of stay per person over 3 years was 11.6 days for those who had a psychiatric disorder vs 4.7 days for those who did not. Schizophrenia was associated with the highest total costs. AUD and DUD were associated with the highest rates of hospital and ED visits overall and for ambulatory care–sensitive conditions.