Published In

Journal of Substance Abuse Treatment

Document Type

Post-Print

Publication Date

2020

Subjects

Substance Abuse -- Analysis, Substance abuse -- Treatment -- Cross-cultural studies, Drug abuse -- Treatment

Abstract

Background and aims

Polysubstance use is common and contributes to morbidity and mortality of hospitalized patients, and yet little is known about patterns of substance use among hospitalized patients, or how an addiction consult service (ACS) might impact polysubstance use after discharge. The objective of this study was to identify patterns of substance use at admission and after discharge among hospitalized patients with substance use disorders who saw an ACS.

Design

Prospective cohort study. We used latent transition analysis of substance use scores at the time of hospital admission and 30 to 90 days posthospitalization.

Setting

Single, academic health center with an ACS in Portland, Oregon, from 2015 to 2018.

Participants/cases

Patients were eligible if they received a consult to the inpatient ACS.

Measurements

We used Addiction Severity Index-Lite scores to capture self-reported substance use at baseline and follow-up for heroin, other opioid, alcohol, amphetamine, and cocaine.

Findings

From 2015 to 2018, 486 individuals consented to participate. More than half of patients used more than one substance at baseline. Of those reporting any baseline opioid use, nearly three-quarters (n=187, 69.5%) had polysubstance use in the previous 30 days, including alcohol (n=80, 29.7%), cocaine (n=25, 9.3%), or amphetamine use (n=142, 52.8%). We identified three patterns of substance use at baseline: 1) alcohol use dominant, 2) polysubstance use dominant, and 3) heroin and other opioid use dominant. Patients transitioned along five trajectories to three different follow-up profiles that showed lower endorsement of all substances used. Slightly more than 40% (40.1%) of patients newly endorsed abstinence of at least one substance at follow-up.

Conclusions

Polysubstance use is common in hospitalized patients with substance use disorders and identifying patterns of polysubstance use can guide clinical management. Hospital providers should prepare to manage polysubstance use during hospitalization and hospitals should broaden care beyond interventions for opioid use disorder.

Rights

NOTICE: this is the author’s final version of a work that was accepted for publication in the journal Journal of Substance Use Treatment. Changes resulting from the publishing process, such as editing, corrections, formatting, and other quality control mechanisms may not be reflected in this document. The final, formatted version of this paper is available at https://doi.org/10.1016/j.jsat.2020.108121.

DOI

10.1016/j.jsat.2020.108121

Persistent Identifier

https://archives.pdx.edu/ds/psu/34193

Share

COinS