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Increased risk of substance use and health-related problems among male homeless veterans
CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
Cautious use of race in analyses to predict retention in substance abuse treatment Alexandra Duncan 1,∗ , Rashid Ahmed 2 1 IMPAQ International, Washington, DC, United States 2 University of Manitoba, Winnipeg, MB, Canada
Aims: This study examines differences in organizational characteristics and client retention in substance abuse treatment programs serving either predominantly African American or predominantly Non-African American clients. Methods: Wilcoxon Exact Test or the Cochran Mantel-Haenszel Chi-Square was used to compare differences in organizational characteristics. Generalized Estimating Equation was used to consider client- and program-level independent effects and cross level interactions on retention in treatment. Results: The findings show longer retention in predominantly African American programs (ˇ = 2.36, p < 0.01); however, shorter retention among African American clients (ˇ = −0.24, p < 0.01), demonstrating the difficulty in making client level conclusions based on program level data, or vice versa. Mixed model analyses show program directors who had been at the facility for 10 years or less (ˇ = −0.45, p < 0.05), use of client/staff matching (ˇ = 0.43, p < 0.01), and programs with low levels of legal coercion (ˇ = −1.03, p < 0.05) predict longer client retention. Conclusions: The findings suggest organizational factors and race are important predictors of client retention in treatment and have important implications for behavioral health providers seeking to improve client retention. Knowledge of the interaction between racial composition and organizational characteristics can be helpful in improving program retention. Financial support: NIDA T32DA007292. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1083 Increased risk of substance use and health-related problems among male homeless veterans Eugene M. Dunne 1,∗ , Allyson Diggins 1 , Larry Burrell 1 , Nicole E. Whitehead 1 , William W. Latimer 2 1 Clinical and Health Psychology, University of Florida, Gainesville, FL, United States 2 Lehman College, Bronx, NY, United States
Aims: The present study sought to examine whether homeless veterans were more likely to report problems with addictions, mental health, and physical health compared to homeless non-veterans. Additionally, the study sought to compare emergency room utilization among veterans and non-veterans. Methods: Secondary data analyses was conducted on male homeless veterans and non-veterans (N = 372) enrolled in the Alachua County Point in Time (PIT) study in Gainesville, FL. Participants were recruited at a homeless shelter and completed a questionnaire on demographics and health variables, including addictions, mental health, and physical health. Additional questions included recent emergency room visits and whether participants needed treatment services that they were not receiving. The use of this data was approved by the university institutional review board. Results: Homeless veterans were more likely to report problems with addictions compared to homeless non-veterans (AOR = 6.29, 95%CI: 3.43–11.53, p < .001). Veterans were also more likely to report mental health problems (AOR = 4.12, 95%CI: 2.43–6.53,
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p < .001) and physical problems (AOR = 1.83, 95%CI: 1.08–3.09, p < .01). Homeless veterans also had significantly greater odds than non-veterans of visiting a hospital emergency room in the past year (AOR = 1.73, 95%CI: 1.07–2.80, p < .05). Conclusions: While much is known about the susceptibility of veterans for addiction and other health problems, our results reveal that over half of homeless veterans are presenting to hospital emergency rooms. This may be a missed opportunity for providing treatment and support. Financial support: No financial support was required for this study. Travel support sponsored by the University of Florida Substance Abuse Training Center in Public Health (NIDA-T32-035167). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1084 Relationship between changes in cannabis use and anxiety among adolescents Jacqueline C. Duperrouzel ∗ , Jessica M. Ross, Raul Gonzalez Psychology, Florida International University, Miami, FL, United States Aims: Adolescence is a critical period of neural development and is often associated with high levels of stress, anxiety, and initiation of cannabis use. Although cannabis users often cite acute anxiolytic effects, little is known on how levels of anxiety are affected, nonacutely, by changes in cannabis use. In this study, we examined how changes in cannabis use relate to changes in anxiety among adolescents. Methods: We recruited high-risk adolescents (n = 122) from South Florida via in-school presentations/informational fliers. Participants with significant mental health issues, neurological or developmental problems, and significant use of alcohol or drugs other than cannabis were excluded at baseline. All participants completed a baseline visit consisting of a structured clinical interview (SCID), drug use history questionnaire, and the depression, anxiety, and stress scale (DASS-21). A 6-month follow-up visit was conducted via phone survey, which included drug use history since the prior visit and a re-evaluation with the DASS-21. A participant was classified as “escalater” (n = 20) if their cannabis use increased significantly from baseline to follow-up. For example, someone who went from “weekend use” to “daily use;” otherwise, they were classified as “non-escalater” (n = 102). Results: User status (escalater vs non-escalater) and baseline anxiety subscale scores from the DASS-21 were regressed on anxiety scores at follow-up using multiple linear regression. Being classified as an “escalater,” was associated with greater increases in anxiety from baseline to follow-up ( = .17, p = .03) compared to the “non-escalater” group. Conclusions: In contrast to the reported acute subjective effects of cannabis as an anxiolytic, our results suggest that increases in cannabis use over a 6-month period were associated with increases in anxiety among adolescents. Although causality could not be established, we speculate that CB1 receptor down regulation from increasing cannabis use could be a plausible mechanism for subjective ratings of increased anxiety among adolescents in our sample. Financial support: R01 DA033156 & R01 DA031176 to Raul Gonzalez, PhD. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1085
Cautious use of race in analyses to predict retention in substance abuse treatment Alexandra Duncan 1,∗ , Rashid Ahmed 2 1 IMPAQ International, Washington, DC, United States 2 University of Manitoba, Winnipeg, MB, Canada
Aims: This study examines differences in organizational characteristics and client retention in substance abuse treatment programs serving either predominantly African American or predominantly Non-African American clients. Methods: Wilcoxon Exact Test or the Cochran Mantel-Haenszel Chi-Square was used to compare differences in organizational characteristics. Generalized Estimating Equation was used to consider client- and program-level independent effects and cross level interactions on retention in treatment. Results: The findings show longer retention in predominantly African American programs (ˇ = 2.36, p < 0.01); however, shorter retention among African American clients (ˇ = −0.24, p < 0.01), demonstrating the difficulty in making client level conclusions based on program level data, or vice versa. Mixed model analyses show program directors who had been at the facility for 10 years or less (ˇ = −0.45, p < 0.05), use of client/staff matching (ˇ = 0.43, p < 0.01), and programs with low levels of legal coercion (ˇ = −1.03, p < 0.05) predict longer client retention. Conclusions: The findings suggest organizational factors and race are important predictors of client retention in treatment and have important implications for behavioral health providers seeking to improve client retention. Knowledge of the interaction between racial composition and organizational characteristics can be helpful in improving program retention. Financial support: NIDA T32DA007292. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1083 Increased risk of substance use and health-related problems among male homeless veterans Eugene M. Dunne 1,∗ , Allyson Diggins 1 , Larry Burrell 1 , Nicole E. Whitehead 1 , William W. Latimer 2 1 Clinical and Health Psychology, University of Florida, Gainesville, FL, United States 2 Lehman College, Bronx, NY, United States
Aims: The present study sought to examine whether homeless veterans were more likely to report problems with addictions, mental health, and physical health compared to homeless non-veterans. Additionally, the study sought to compare emergency room utilization among veterans and non-veterans. Methods: Secondary data analyses was conducted on male homeless veterans and non-veterans (N = 372) enrolled in the Alachua County Point in Time (PIT) study in Gainesville, FL. Participants were recruited at a homeless shelter and completed a questionnaire on demographics and health variables, including addictions, mental health, and physical health. Additional questions included recent emergency room visits and whether participants needed treatment services that they were not receiving. The use of this data was approved by the university institutional review board. Results: Homeless veterans were more likely to report problems with addictions compared to homeless non-veterans (AOR = 6.29, 95%CI: 3.43–11.53, p < .001). Veterans were also more likely to report mental health problems (AOR = 4.12, 95%CI: 2.43–6.53,
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p < .001) and physical problems (AOR = 1.83, 95%CI: 1.08–3.09, p < .01). Homeless veterans also had significantly greater odds than non-veterans of visiting a hospital emergency room in the past year (AOR = 1.73, 95%CI: 1.07–2.80, p < .05). Conclusions: While much is known about the susceptibility of veterans for addiction and other health problems, our results reveal that over half of homeless veterans are presenting to hospital emergency rooms. This may be a missed opportunity for providing treatment and support. Financial support: No financial support was required for this study. Travel support sponsored by the University of Florida Substance Abuse Training Center in Public Health (NIDA-T32-035167). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1084 Relationship between changes in cannabis use and anxiety among adolescents Jacqueline C. Duperrouzel ∗ , Jessica M. Ross, Raul Gonzalez Psychology, Florida International University, Miami, FL, United States Aims: Adolescence is a critical period of neural development and is often associated with high levels of stress, anxiety, and initiation of cannabis use. Although cannabis users often cite acute anxiolytic effects, little is known on how levels of anxiety are affected, nonacutely, by changes in cannabis use. In this study, we examined how changes in cannabis use relate to changes in anxiety among adolescents. Methods: We recruited high-risk adolescents (n = 122) from South Florida via in-school presentations/informational fliers. Participants with significant mental health issues, neurological or developmental problems, and significant use of alcohol or drugs other than cannabis were excluded at baseline. All participants completed a baseline visit consisting of a structured clinical interview (SCID), drug use history questionnaire, and the depression, anxiety, and stress scale (DASS-21). A 6-month follow-up visit was conducted via phone survey, which included drug use history since the prior visit and a re-evaluation with the DASS-21. A participant was classified as “escalater” (n = 20) if their cannabis use increased significantly from baseline to follow-up. For example, someone who went from “weekend use” to “daily use;” otherwise, they were classified as “non-escalater” (n = 102). Results: User status (escalater vs non-escalater) and baseline anxiety subscale scores from the DASS-21 were regressed on anxiety scores at follow-up using multiple linear regression. Being classified as an “escalater,” was associated with greater increases in anxiety from baseline to follow-up ( = .17, p = .03) compared to the “non-escalater” group. Conclusions: In contrast to the reported acute subjective effects of cannabis as an anxiolytic, our results suggest that increases in cannabis use over a 6-month period were associated with increases in anxiety among adolescents. Although causality could not be established, we speculate that CB1 receptor down regulation from increasing cannabis use could be a plausible mechanism for subjective ratings of increased anxiety among adolescents in our sample. Financial support: R01 DA033156 & R01 DA031176 to Raul Gonzalez, PhD. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1085