Development of a Needs-Based Planning Model to Estimate Required Capacity of a Substance Use Treatment System

Patient characteristics associated with their level of twelve-step attendance prior to entry into treatment for substance use disorders

BACKGROUND

The availability of the fellowships of Alcoholics Anonymous and Narcotics Anonymous in community settings is extensive and patients admitted to treatment programs for substance use disorder may therefore have previously attended meetings of these two Twelve Step (TS) programs. Data on such prior attendance and related clinical findings, however, are not typically available. They can, however, be relevant to how ensuing treatment is planned. We therefore undertook this study to ascertain the feasibility of evaluating how the level of TS attendance prior to treatment entry can be evaluated, and to determine clinically relevant findings that are associated with such attendance.

METHODS

Over the course of 2022, 3,125 patients were admitted to a large urban multimodal United States-based treatment center. All patients were administered the structured interview-based Global Appraisal of Individual Needs upon admission. This instrument is employed to evaluate substance use, demographics, and related psychosocial variables. Clinically related variables were analyzed relative to whether given respondents have a history of any TS group attendance prior to admission.

RESULTS

Distinctions were found between the 57.3% of respondents who had previously attended any TS meetings and the 42.6% who had not attended any meetings. Compared to respondents who had never attended TS meetings, those who had ever attended scored higher on emotional problems (p <.001, d = -0.58), and had more likely undergone previous SUD treatment (p <.001, d = 0.80). They were less likely to use substances in unsafe situations (p <.001, d = -0.55) and were less likely to express reluctance to remain abstinent (p <.001, d = -0.50). The 11% of respondents who considered themselves regular TS members reported a lower frequency of recent substance use (p <.001, d = -0.80) and were more likely to have attended intensive outpatient (p <.001, 0.46) and residential (p <.001, 0.44) treatment than patients who did not consider themselves regular attenders.

CONCLUSIONS

Examination of TS attendance prior to treatment admission is feasible. Findings can be clinically relevant for differential treatment planning and can also serve as a basis for further research into the role of TS participation in community settings.

The Implementation of Integrated Youth Services in Canada: Planning and Costing of a Pan-Canadian Model: La mise en œuvre des services intégrés pour les jeunes au Canada : planification et établissement des coûts d'un modèle pancanadien

OBJECTIVE

The implementation of Integrated Youth Services (IYS) can help ensure that youth are adequately supported. The objective of this analysis was to provide a model for the planning and costing of IYS throughout Canada over a 15-year period.

METHODS

To estimate resource allocation for IYS, we determined the number of hubs and hub staffing requirements by service level and jurisdiction, backbone support and infrastructure requirements by jurisdiction. A needs-based analytic framework for planning was employed to estimate the number of hubs required. The optimal mix of hub staffing requirements was determined based on prior literature. The costs of running each hub were estimated using publicly available data and internal documents from existing IYS agencies. Finally, the cost of setting up IYS hubs, IYS virtual care and respective backbone support throughout Canada was estimated and projected over 15 years and the cost-savings of IYS were calculated.

RESULTS

At maturity, it was estimated that 399 hubs-188 small, 43 medium, 168 large-across Canada would be required to address youth mental health and substance use needs. The cost of implementing IYS initiatives across Canada would vary between $4,349,126 (for less populous jurisdictions) and $248,950,524 (for more populous jurisdictions), for a total annual cost of $676,633,388 (excluding costs of infrastructure). It was estimated that the implementation of IYS hubs would lead to cost-savings of $2.1 billion annually and have the potential to be cost-effective.

CONCLUSION

The implementation of IYS hubs can provide good value for money, in the form of high client satisfaction, earlier supports with improved youth outcomes and decreased health care costs. Future work should address gaps in data availability on mental health and substance use-related needs of youth with neurodevelopmental disorders, youth experiencing homelessness, youth in congregate living and foster care, and Indigenous youth.

Racial and Ethnic Differences in Heroin, Methamphetamine, and Cocaine Use, Treatment, and Mortality Trends in 3 National Data Sources-United States, 2010-2019

BACKGROUND

As overdose deaths continue to rise, public health officials need comprehensive surveillance data to design effective prevention, harm reduction, and treatment strategies. Disparities across race and ethnicity groups, as well as trends in substance use, treatment, or overdose deaths, have been examined individually, but reports rarely compare findings across multiple substances or data sources.

OBJECTIVE

To provide a broad assessment of the overdose crisis, we describe trends in substance use, treatment, and overdose mortality across racial and ethnic groups for multiple substances.

RESEARCH DESIGN

We conducted a longitudinal, cross-sectional analysis comparing trends.

SUBJECTS

We identified self-reported use from the National Survey on Drug Use and Health, substance use treatment admissions from the Treatment Episode Data Set-Admissions, and overdose deaths from the CDC's Multiple Cause of Death files.

MEASURES

We measured rates of substance use, treatment, and deaths involving heroin, methamphetamine, and cocaine among United States adults from 2010 to 2019.

RESULTS

Heroin, methamphetamine, and cocaine use increased, though not all changes were statistically significant. Treatment admissions indicating heroin and methamphetamine increased while admissions indicating cocaine decreased. Overdose deaths increased among all groups: methamphetamine (257%-1,115%), heroin (211%-577%), and cocaine (88%-259%). Changes in rates of use, treatment, and death for specific substances varied by racial and ethnic group.

CONCLUSIONS

Substance use, treatment, and overdose mortality changed considerably, though not always equivalently. Identifying diverging trends in substance-related measures for specific substances and racial and ethnic groups can inform targeted investment in treatment to reduce disparities and respond to emerging changes in the overdose crisis.

Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia

BACKGROUND

The aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State.

METHODS

The activity and capacity of Tasmania's 2018-19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development.

RESULTS

Bed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services.

CONCLUSIONS

This study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.

The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review

BACKGROUND

The aim of this paper was to examine the early impact of COVID-19 on substance use to assess implications for planning substance use treatment and support systems.

METHOD

A systematic review of literature published up to March 2021 was conducted to summarize changes in prevalence, incidence, and severity of substance use associated with COVID-19 and the accompanying public health measures, including lockdown, stay-at-home orders, and social distancing.

RESULTS

We identified 53 papers describing changes to substance use at the population level. The majority of papers described changes related to alcohol use and most relied on self-reported measures of consumption during the COVID-19 pandemic, compared with pre-pandemic use. There was less evidence to support changes in non-alcohol substance use. In general, risky pre-pandemic alcohol use, caregiving responsibilities, stress, depression, anxiety, and current treatment for a mental disorder were found to be associated with increased substance use.

CONCLUSION

This review provides preliminary data on changes in substance use, indicating that certain segments of the population increased their alcohol use early on in the COVID-19 pandemic and may be at greater risk of harm and in need of additional services. There is a need for additional population-level information on substance use to inform evidence-based rapid responses from a treatment system perspective.

Rural citizen-patient priorities for healthcare in British Columbia, Canada: findings from a mixed methods study

BACKGROUND

The challenge of including citizen-patient voices in healthcare planning is exacerbated in rural communities by regional variation in priorities and a historical lack of attention to rural healthcare needs. This paper aims to address this deficit by presenting findings from a mixed methods study to understand rural patient and community priorities for healthcare.

METHODS

We conducted a provincial survey of rural citizens-patients across British Columbia, Canada to understand their most pressing healthcare needs, supplemented by semi-structured interviews. Survey and interview participants were asked to articulate, in their own words, their communities' most pressing healthcare needs, to explain the importance of these priorities to their communities, and to offer possible solutions to address these challenges. Open-text survey responses and interview data were analyzed thematically to elicit priorities of the data and their significance to answer the research questions.

RESULTS

We received 1,287 survey responses from rural citizens-patients across BC, 1,158 of which were considered complete. We conducted nine telephone interviews with rural citizens-patients. Participants stressed the importance of local access to care, including emergency services, maternity care, seniors care, specialist services and mental health and substance use care. A lack of access to primary care services was the most pronounced gap. Inadequate local health services presented geographic, financial and social barriers to accessing care, led to feelings of vulnerability among rural patients, resulted in treatment avoidance, and deterred community growth.

CONCLUSIONS

Two essential prongs of an integration framework for the inclusion of citizen-patient voices in healthcare planning include merging patient priorities with population needs and system-embedded accountability for the inclusion of patient and community priorities.

A systematic review and meta-analysis of the efficacy of the long-term treatment and support of substance use disorders

RATIONALE

The reconceptualization of substance use disorders (SUD) as a chronic phenomenon calls for a paradigm shift in service provision, particularly by way of long-term treatment and support. Studies that have evaluated the efficacy of long-term treatment models seem to indicate that they are an improvement on more standard short-term treatments, even though these studies do not take the durations into consideration.

OBJECTIVE

Measure the efficacy of SUD treatments and support lasting 18 months or more regarding their ability to decrease substance use as compared to shorter treatments.

METHODS

A meta-analysis based on a systematic literature review was conducted. Eight databases were consulted for peer-reviewed studies. Certain variables were coded as moderators: intervention length, participant characteristics, and treatment characteristics.

RESULTS

The main results suggest that the people who received a planned long-term treatment or support had a 23.9 % greater chance of abstaining or consuming moderately than did people who received a shorter standard treatment (OR = 1.347 [CI 95 % = 1.087-1.668], p < .006, adjusted OR = 1.460 [CI 95 % = 1.145-1.861]). None of the moderation analyses revealed any variation in the efficacy of the long-term treatments and support.

CONCLUSIONS

The reconceptualization of the SUD as a chronic disorder among people with this problem leads us to reconsider both the length of the services provided and the paradigms underlying their organization.

Examining untreated and treated alcohol problem resolution in an Australian online survey sample

INTRODUCTION

While treatment is an effective way to resolve alcohol problems, many people resolve their alcohol problems in the absence of treatment. Just how many do so is not known and may vary based on the definition of treatment. Various estimates of untreated alcohol problem resolution were calculated in this study, and the differences between people who resolve their alcohol problems with or without treatment were explored in relation to sociodemographic variables, levels of alcohol consumption in the past 12 months and lifetime alcohol problem severity.

METHODS

A cross-sectional online survey was administered to 719 people who had resolved an alcohol problem in Australia. Convenience sampling was used through a recruitment strategy targeted towards the general population via Facebook.

RESULTS

Almost half (49.8%) of all people who resolved their alcohol problem did so in the absence of alcohol treatment, whether specialist alcohol treatment, mutual-aid services or digital support services. When accessing mental health treatment is included under the scope of 'treatment', this estimate dropped to 12.8%. The estimated odds of having accessed treatment increased with age and lifetime alcohol problem severity. Other sociodemographic variables, or levels of alcohol consumption in the past 12 months, were not significantly associated with treatment status.

DISCUSSION AND CONCLUSIONS

It might be beneficial to expand the scope of 'treatment' to include mental health services and focus on the development of cost-effective and less intrusive standalone activities, which can expedite and support alcohol problem resolution for those who choose not to access specialist treatment.

Redressing responses to the treatment gap for people with alcohol problems: The overlooked role of untreated remission from alcohol problems

Abstract. Aims: The “treatment gap” for people with alcohol problems has been identified as very large in the literature. An array of responses to the treatment gap have been focussed upon, including changing the perceptions of untreated people in order to make them want treatment more. A separate approach identifies the treatment system itself as the cause of the treatment gap. The aim of this paper was to consider research on untreated remission from alcohol problems to better understand responses to the treatment gap. Methodology: Three areas of existing published literature were thematically reviewed and synthesised: treatment gap research, untreated remission from alcohol problems research, and treatment planning and system design research. Results: Including rates of untreated remission from alcohol problems reduces the size of the treatment gap considerably. Treatment planning models which estimate unmet demand are better suited than unmet need when identifying gaps in service provision. Responding to the treatment gap requires broadening the treatment system beyond the specialised setting, and the assumptions associated with the process and expected outcomes of remission may need revisiting. Conclusions: Treatment planning models are useful when identifying gaps in service provision, but more sophisticated inclusion of untreated remission data is required. The treatment response may need to be diversified to support the life circumstances and perspectives of people with alcohol problems, with one example (outlined in this paper) being the provision of digital support services.

Estimation of Needs for Addiction Services: A Youth Model

OBJECTIVE

In the field of health care services, resource allocation is increasingly determined based on a population needs model. Although service needs models have been developed for adults with substance use problems, it would seem inappropriate to apply them indiscriminately to young people.

METHOD

The method used proposes six steps: (1) targeting the population, (2) estimating the proportion of the population affected by substance misuse and (3) the proportion of youths who should receive services, (4) identifying categories of services, (5) estimating the proportions of youths who should have access to each category of services, and (6) applying the model to real use of services by youths to recalibrate it.

RESULTS

Youths ages 12-17 from the Province of Québec were classified within a tiered model comprising four levels of substance use severity. Youths in need of services varied from 38% (weak response) to 95% (high response) for the highest severity cases. Service categories retained are detoxification/intoxication, outpatient, and residential, with each one being subdivided into four categories. The proportion of youths from each tier who should access categories and subcategories of services varied widely. After a pre-experimentation, the model was adjusted.

CONCLUSIONS

The model can be applied in different jurisdictions, with the caution of adjusting prevalence to local reality. Further improvement will be based on more accurate information concerning the path of clients through services, better strategies to reach youths in need of services, and increased knowledge of optimal service categories. Models adapted to low- or moderate-income countries, where the health care system has minimal services in the areas of mental health and addiction, should be developed.