Co-Locating Obstetrics and Addiction Medicine Clinics to Improve Attendance in Services for Pregnant People with Opioid Use Disorder.

Objective: Pregnant people receiving treatment for opioid use disorders (OUD) are at significant risk of return to use during the postpartum period. Recently, practice groups and other national organizations have called for the co-location of addiction medicine and obstetric care to reduce the burden on pregnant and postpartum people with OUD associated with engaging in treatment. This paper examines the effectiveness of co-locating services in retaining pregnant people with OUD in care following childbirth. Methods: A records review of pregnant people receiving medication for OUD between 2012 and 2017 in stand-alone addiction medicine clinic (n = 23) and from 2017 to 2021 following the creation of an integrated addiction medicine-obstetric care clinic (n = 67) was conducted to compared rates of attendance in both obstetric and addiction medicine services. Results: Findings from this study suggest that individuals receiving services in a co-located clinic had significantly fewer missed appointments during the postpartum period relative to individuals who sought care at separate addiction medicine and obstetric care clinics. Conclusions: Results from this study support the potential for co-locating clinics to reduce barriers to accessing obstetric and addiction medicine services, as well as support continued attendance in care across a vulnerable period.

Delay Discounting Interacts with Distress Tolerance to Predict Depression and Alcohol Use Disorders among Individuals Receiving Inpatient Substance Use Services.

Personality-linked psychological factors including distress tolerance and delay discounting have been shown to underlie both Alcohol Use and Major Depressive Disorders. Although these disorders commonly co-occur, especially among individuals seeking in-patient treatment, no study has examined the association between distress tolerance, delay discounting and dual diagnoses. This project evaluated these relations in a sample of 79 low-income adults receiving in-patient substance use treatment. It was hypothesized that individuals with low levels of distress tolerance and elevated discounting would be more likely to report co-occurring disorders. Utilizing structural equation modeling, we found that the interaction between distress tolerance and delay discounting was associated with co-occurring Alcohol Use and Major Depressive Disorders in the expected direction. Findings suggest these constructs could be used for targeting prevention efforts for vulnerable individuals as well as refining current interventions to improve treatment outcomes.