The relationship between self-compassion and the risk for substance use disorder

OBJECTIVE

This study explored the relationship between substance use disorder risk and self-compassion and posits a model for how the two are related through the mitigation of suffering.

METHOD

Study participants were recruited using social media to complete an online survey that included a basic socio-demographic survey and two validated instruments, the Self-Compassion Survey and the National Institute on Drug Abuse (NIDA) Alcohol Smoking and Substance Involvement Screening Test (ASSIST), which screens for substance use disorder (SUD) risk. Established cut scores for ASSIST were used to divide participants into low, moderate and high-risk groups.

RESULTS

Participants (n=477) were 31 years old on average, almost evenly split by gender, mostly non-Hispanic white, slightly more likely to be single and to hold an Associate's degree or higher. Overall, 89% of participants reported using drugs and/or alcohol in their lifetime. SUD risk was distributed between low risk (52%), moderate risk (37%) and a smaller percentage of high risk (11%). Self-compassion was inversely related to SUD risk. The low risk group had a higher mean self-compassion score (M=2.86, SD=0.75) than the people who were high risk (M=2.25, SD=0.61) (t(298)=5.58 p<0.0001). Bivariate Pearson correlations showed strong associations between high risk and all self-compassion subscales, as well as low risk and five of the subscales.

CONCLUSIONS

This study suggests SUD risk has an inverse relationship to self-compassion. Raising self-compassion may be a useful addition to substance use disorder prevention and treatment interventions.

The impact of prior authorization on buprenorphine dose, relapse rates, and cost for Massachusetts Medicaid beneficiaries with opioid dependence

OBJECTIVE

To assess the impact of a 2008 dose-based prior authorization policy for Massachusetts Medicaid beneficiaries using buprenorphine + naloxone for opioid addiction treatment. Doses higher than 16 mg required progressively more frequent authorizations.

DATA SOURCES

Mediciaid claims for 2007 and 2008 linked with Department of Public Health (DPH) service records.

STUDY DESIGN

We conducted time series for all buprenorphine users and a longitudinal cohort analysis of 2,049 individuals who began buprenorphine treatment in 2007. Outcome measures included use of relapse-related services, health care expenditures per person, and buprenorphine expenditures.

DATA COLLECTION/EXTRACTION METHODS

We used ICD-9 codes and National Drug Codes to identify individuals with opioid dependence who filled prescriptions for buprenorphine. Medicaid and DPH data were linked with individual identifiers.

PRINCIPAL FINDINGS

Individuals using doses >24 mg decreased from 16.5 to 4.1 percent. Relapses increased temporarily for some users but returned to previous levels within 3 months. Buprenorphine expenditures decreased but total expenditures did not change significantly.

CONCLUSION

Prior authorization policies strategically targeted by dose level appear to successfully reduce use of higher than recommended buprenorphine doses. Savings from these policies are modest and may be accompanied by brief increases in relapse rates. Lower doses may decrease diversion of buprenorphine.