Substance use disorders (SUD) are among the most common and costly conditions in the VA. In FY09, over 410,000 VA patients had a SUD diagnosis and approximately 34% received any specialized SUD treatment services. Conventional treatment approaches have emphasized SUD as an acute condition managed with time-limited interventions, but there is growing evidence that for a subset of treated patients addiction is a chronic condition, characterized by multiple SUD episodes. Little attention has been devoted to characterizing the subset of VA SUD patients with multiple treatment initiations.
The objectives of this study are to: 1) estimate the prevalence of multiple addiction specialty-care episodes, occurring over 24 months for patients initiating care in FY05 and FY06; 2) compare demographic, clinical and service utilization characteristics of SUD patients with multiple SUD episodes to those with a single episode of treatment; and 3) evaluate utilization of other VA health care services including patterns of re-initiation among SUD patients with multiple SUD episodes.
This retrospective longitudinal study used VISN 20 administrative data to identify 1,640 patients who initiated addiction specialty-care at the VA Puget Sound between October 1, 2004 and September 30, 2006. Administrative data provided sociodemographic, diagnostic, and service utilization data for the 24 months following the index admission for addiction specialty care. Patients were categorized into two groups to reflect initiation of 1 or >= 2 episodes of SUD treatment in the 24-months following index admission.
The 12-month and 24-month prevalence of multiple SUD episodes for the sample was 23% (CI: 20 - 25) and 40% (37 - 42), respectively. Compared to patients with an index episode only, patients with post-index SUD episodes had significantly longer index episode duration [Mdn = 50 days vs. 36 days, p < 0.001], but two weeks difference has questionable clinical importance this early in recovery. Intensity of index episodes was also somewhat greater among those with multiple episodes. Multivariable logistic regression found the risk of multiple SUD episodes during the 24 month follow-up was higher among men, patients divorced/separated and those with a documented alcohol use disorder, cocaine use disorder, bipolar disorder, or psychotic disorder [range of Adjusted Odds Ratios = 1.48-2.53]; however the full model accounted for only 5% of the variance in risk of multiple SUD treatment episodes. The median interval between episode 1 and episode 2 was 184 days. Although patients with multiple episodes were not engaged in SUD care for the majority of the post index period, 84.3% received VA outpatient services and 20.8% were hospitalized, highlighting clinical need and opportunities for re-engagement.
Given the high risk of subsequent SUD episodes, programs should develop routine practices for initial engagement, treatment response monitoring and re-engagement. Support was limited for continued efforts to improve predictive models that initially target chronic care services to a subset of complex patients.
- Hawkins EJ, Malte CA, Baer JS, Kivlahan DR. Prevalence, predictors, and service utilization of patients with recurrent use of Veterans Affairs substance use disorder specialty care. Journal of substance abuse treatment. 2012 Sep 1; 43(2):221-30.
- Hawkins EJ, Lapham GT, Kivlahan DR, Bradley KA. Recognition and management of alcohol misuse in OEF/OIF and other veterans in the VA: a cross-sectional study. Drug and Alcohol Dependence. 2010 Jun 1; 109(1-3):147-53.
- Hawkins EJ, Malte CA, Baer JS, Smucker-Barnwell SV, Kivlahan DR. Prevalence and Characteristics of Patients with Multiple Substance Use Disorder Treatment Episodes. Poster session presented at: Addiction Health Services Research Conference; 2009 Oct 29; San Francisco, CA.
- Hawkins EJ, Malte C, Baer J, Kivlahan DR. Prevalence and Characteristics of Patients with Multiple Alcohol Use Disorder Treatment Episodes. Presented at: Research Society on Alcoholism Annual Scientific Meeting; 2009 Jun 21; San Diego, CA.