Polysubstance use by psychiatry inpatients with co-occurring mental health and substance use disorders.

Timko C, Ilgen M, Haverfield M, Shelley A, Breland JY. Polysubstance use by psychiatry inpatients with co-occurring mental health and substance use disorders. Drug and Alcohol Dependence. 2017 Nov 1; 180:319-322.

Related HSR&D Project(s)

• IIR 05-014 – Dual Diagnosis Self-Help Group Referral: Outcomes and Services Use
• CDA 15-257 – Patient-centered Strategies to Engage Veterans in Behavioral Health Services
• RCS 00-001 – Quality and Care of Substance Abuse and Psychiatric Treatment
• IAC 09-055 – Dual Diagnosis Inpatients: Telephone Monitoring RCT to Improve Outcomes

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Abstract:

BACKGROUND: Polysubstance use, the consumption of more than one substance over a defined period, is common and associated with psychiatric problems and poor treatment adherence and outcomes. This study examined past-month polysubstance use at intake among psychiatry inpatients with co-occurring mental health and substance use disorders, and outcomes 3 months later. METHODS: Participants (n = 406 psychiatry inpatients with documented mental health and substance use disorders) completed a baseline and a 3-month follow-up (84%) interview. With baseline data, a latent class analysis was conducted on substances used in the past 30days. Analyses of covariance tested for differences among classes on outcomes at 3-month follow-up. RESULTS: At baseline, three classes were estimated: Cannabis+Alcohol (35.1%), Alcohol (49.3%), and Polysubstance, notably, cocaine plus alcohol and marijuana (15.7%). At follow-up, the Polysubstance class had more severe alcohol and drug use, support for abstinence, and motivation for help-seeking, but less abstinence self-efficacy; it was most likely to attend 12-step groups. The Cannabis+Alcohol class was least likely to obtain outpatient substance use treatment, and had the lowest percent days abstinent. CONCLUSIONS: Psychiatry inpatients with co-occurring substance use and mental health disorders have varying substance use patterns that correspond to substance-related outcomes concurrently and over time. Many patients achieved abstinence for most days of the 3-month post-hospitalization period. To further increase abstinence, providers could build on polysubstance-using patients'' high motivation to increase self-efficacy. In addition, because patients using mainly cannabis plus alcohol may perceive little harm from cannabis use, providers may consider modifying risk perceptions through effective education.