Health care cost trajectories in the year prior to and following intake into Veterans Health Administration outpatient substance use disorders treatment

Costs, benefits, and net benefit of 13 inpatient substance use treatments for 14,947 women and men

In an attempt to replicate earlier findings that substance use disorder treatment (SUDTx) has monetary outcomes (benefits) for taxpayers that exceed treatment costs several times over for the average participant, costs of SUDTx were contrasted to observed costs of healthcare, criminal justice services, and economic assistance, plus potential increases in earned income, for 14,947 substance-using individuals treated at 13 intensive inpatient programs varying in gender sensitivity. Those who received higher levels of gender-sensitive treatment were expected to better offset treatment costs through greater reductions in subsequent service costs and economic assistance, and greater increases in earned income. Compared to the 24 months preceding treatment, archival data from state databases showed that use of health and criminal justice services, and receipt of economic assistance, actually increased during the 24 months following treatment, and that earned income decreased, resulting in unexpectedly negative net benefits, i.e., a net loss, from a taxpayer perspective. More gender-sensitive treatment was less costly per participant, however, making the net loss less for persons receiving more gender-sensitive treatment. Alternative explanations for these findings are explored, including utilization of archival records of service use rather than the more bias-sensitive self-reports of service use that others have examined previously. The importance of evaluating nonmonetary, as well as monetary, outcomes of substance use disorder (SUD) treatment is noted as well.

Increased medical utilization and psychiatric comorbidity following a new diagnosis of methamphetamine use disorder

BACKGROUND

Evidence of patterns of medical utilization and distribution of comorbidities among individuals using methamphetamine remains limited.

OBJECTIVE

This study aims to investigate changes in medical utilization and comorbidities before and after a diagnosis of methamphetamine use disorder.

METHODS

A total of 3321 cases (79% were male) of methamphetamine use disorder between January 1, 1996, and December 31, 2012, were identified from Psychiatric Inpatient Medical Claims database in Taiwan. Information was collected on demographics, diagnoses, and medical utilizations. The date of newly diagnosed with methamphetamine use disorder was defined as the baseline. Mirror-image study design was used to compare changes in medical utilization and comorbidities between the pre-baseline period (within 1 year before diagnosis) and the post-baseline period (within 1 year after diagnosis). Conditional logistic regression was used to estimate changes in medical utilization and comorbidities.

RESULTS

Most cases (77%) were first identified in a psychiatric department. There is a significant increase (P < .001) in psychiatric admission (odds ratio[OR] = 2.19), psychiatric emergency visits (OR = 1.31), and psychiatric outpatient visits (OR = 1.15) after diagnosis. Multivariable analysis revealed significantly increased risks (P < .001) of non-methamphetamine drug induced mental disorders (adjusted OR[aOR] = 29.47), schizophrenia (aOR = 2.62), bipolar disorder (aOR = 2.14), organic mental disorder (aOR = 1.82), and upper respiratory tract infection (aOR = 2.03) after diagnosis.

CONCLUSIONS

We found significant increases of medical utilization and psychiatric comorbidities after diagnosed with methamphetamine use disorder. These findings may reflect the problem of delayed diagnosis and treatment. Enhancement of early identification of methamphetamine use disorder in general practice is required for early intervention and decreased subsequent morbidities.

Substance Use Relapse Among Veterans at Termination of Treatment for Substance Use Disorders

INTRODUCTION

Military veterans continue to struggle with addiction even after receiving treatment for substance use disorders (SUDs). Identifying factors that may influence SUD relapse upon receiving treatment in veteran populations is crucial for intervention and prevention efforts. The purpose of this study was to examine risk factors that contribute to SUD relapse upon treatment completion in a sample of U.S. veterans using logistic regression and classification tree analysis.

MATERIALS AND METHODS

Data from the 2017 Treatment Episode Data Set-Discharge (TEDS-D) included 40,909 veteran episode observations. Descriptive statistics and multivariable logistic regression analysis were conducted to determine factors associated with SUD relapse after treatment discharge. Classification trees were constructed to identify high-risk subgroups for substance use after discharge from treatment for SUDs.

RESULTS

Approximately 94% of the veterans relapsed upon discharge from outpatient or residential SUD treatment. Veterans aged 18-34 years old were significantly less likely to relapse than the 35-64 age group (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.66, 0.82), while males were more likely than females to relapse (OR 1.55, 95% CI: 1.34, 1.79). Unemployed veterans (OR 1.92, 95% CI: 1.67, 2.22) or veterans not in the labor force (OR 1.29, 95% CI: 1.13, 1.47) were more likely to relapse than employed veterans. Homeless vs. independently housed veterans had 3.26 (95% CI: 2.55, 4.17) higher odds of relapse after treatment. Veterans with one arrest vs. none were more likely to relapse (OR 1.52, 95% CI: 1.19, 1.95). Treatment completion was critical to maintain sobriety, as every other type of discharge led to more than double the odds of relapse. Veterans who received care at 24-hour detox facilities were 1.49 (95% CI: 1.23, 1.80) times more likely to relapse than those at rehabilitative/residential treatment facilities. Classification tree analysis indicated that homelessness upon discharge was the most important predictor in SUD relapse among veterans.

CONCLUSION

Aside from numerous challenges that veterans face after leaving military service, SUD relapse is intensified by risk factors such as homelessness, unemployment, and insufficient SUD treatment. As treatment and preventive care for SUD relapse is an active field of study, further research on SUD relapse among homeless veterans is necessary to better understand the epidemiology of substance addiction among this vulnerable population. The findings of this study can inform healthcare policy and practices targeting veteran-tailored treatment programs to improve SUD treatment completion and lower substance use after treatment.