Individual factors predict substance use treatment course patterns among patients in community-based substance use disorder treatment.

BACKGROUND AND OBJECTIVES: Substance use disorders (SUDs) usually involve a complex natural trajectory of recovery alternating with symptom reoccurrence. This study examined treatment course patterns over time in a community SUD clinic. We examined depressive symptoms level, primary SUD assigned at each admission, and lifetime misuse of multiple substances as potential risk factors for premature treatment termination and subsequent treatment readmission. METHODS: De-identified longitudinal data were extracted from charts of 542 patients from an SUD treatment center. Survival analysis methods were applied to predict two time-to-event outcomes: premature treatment termination and treatment readmission. RESULTS: Primary opioid (vs alcohol) use disorder diagnosis at admission was associated with higher hazard of premature termination (HR = 1.91, p<0.001). The interaction between depressive symptoms level and substance use status (multiple vs single use) on treatment readmission was significant (p = 0.024), such that higher depressive symptoms level was predictive of readmission only among those with a history of single substance use (marginally significant effect). Lifetime use of multiple (vs single) substances (HR = 1.55, p = 0.002) and age (HR = 1.01, p = 0.019) predicted increased hazard of readmission. CONCLUSIONS: Findings did not support a universal role for depressive symptoms level in treatment course patterns. Primary SUD diagnosis, age, and history of substance misuse can be easily assessed and incorporated into treatment planning to support SUD patients and families. This study is the first to our knowledge that afforded a stringent test of these relationships and their interactions in a time-dependent, recurrent event, competing risks survival analysis examining both termination and readmission patterns utilizing a real-world clinic-based sample.

Mixed methods prospective findings of the initial effects of the U.S. COVID-19 pandemic on individuals in recovery from substance use disorder.

The beginning of the U.S. COVID-19 pandemic interrupted integral services and supports for those in recovery from substance use disorders. The current study used qualitative and quantitative data to identify 1) pandemic-related barriers/stressors, 2) coping strategies employed, and 3) how the stressors and strategies predicted subsequent substance use frequency. Participants were 48 adults (40.5% female; 90.2% White) between 26 and 60 years old (M = 42.66, SD = 8.44) who were part of a larger, multi-year longitudinal study of individuals in recovery from substance use disorders. Individuals completed two interviews, one during the six weeks of initial stay-at-home orders in the state in which data were collected and the second within six to twelve months of their initial interview. Common barriers to recovery included cancelled support meetings, changes in job format (i.e., being fired or furloughed), and lack of social support. Common coping strategies included self-care, leisure activities/hobbies, taking caution against exposure, and strengthening personal relationships. The relationship between cravings at baseline and substance use at follow up was stronger for those who experienced worsening of their mental health (B = 21.80, p < .01) than for those who did not (B = 5.45, p = 0.09), and for those who were taking caution against exposure (B = 24.57, p < .01) than for those who were not (B = 1.87, p = 0.53). Those who engaged in self-care (B = 0.00, p>.99) had lower rates of substance use at follow-up than those who did not employ self-care as a coping mechanism (B = 16.10, p < .01). These findings inform research priorities regarding prospective effects of the pandemic on treatment endeavors, particularly emphasizing treating mental health and encouraging self-care strategies.

Mapping recovery: A qualitative node map approach to understanding factors proximal to relapse among adolescents in a recovery high school.

INTRODUCTION: Despite data suggesting that recovery high schools are largely effective in reducing substance use, relapse in these settings is common. The goal of the current study was to characterize factors proximal to relapse among adolescents in a local recovery high school. METHOD: Data for this study were 200 de-identified node maps (i.e., graphical break downs of a relapse event; randomly chosen from 600 available node maps) from the charts of students at a local recovery high school in a large Midwest city (Mean Age = 16.8 ± 1.9 years, 64.1% male, 89.1% White). A four-phase process of qualitative data sorting examined features most frequently described in relapse episodes. RESULTS: The most common elements reported were using with others (n = 153, 76.5%), away from home (n = 156, 78.0%), and in response to negative affect (n = 93, 48.4%). Six relapse pathways emerged: coping (n = 30), acting out (n = 15), unexpected temptation (n = 30), planned lapse (n = 19), resistant to recovery (n = 27), and passive agency (n = 30). The pathways identified represent three critical failures in the recovery system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these system failures can contribute to increased rapport and engagement, as well as planning for detailed and specific factors proximal for relapse for any given individual, both on the individual and system levels. CONCLUSION: The use of node maps aligned with previous work, showed good face and content validity, can be used to reduce blame and increase engagement in substance use treatment among adolescents, and produced novel micro-frames with new vocabulary to accurately understand common factors associated with relapse among adolescents.

Advancing health equity by addressing social determinants of health: Using health data to improve educational outcomes.

Data from two social determinants of health-access to health care and access to a quality education-are combined to examine the impact of health on student achievement. Data from a high poverty, high performing K-8 school revealed a significant negative correlation between the number of visits to a school-based nurse and standardized academic assessments. Fixed effect regression confirmed the effect of total number of visits to the school-based nurse on performance on standardized assessments, and also revealed that two types of visits, neurological and gastrointestinal, were predictive of student performance. Taken together, these results suggest that when students are suffering from ill health their academic performance is negatively impacted. Implications for improving health equity through data-driven educational interventions are discussed.