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What medical care needs of homeless and housed veterans are served by the VA?
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Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Substance use and PTSD among smokers with serious mental illness K.C. Young-Wolff 1 , S. Fromont 2 , K. Delucchi 2 , S. Hall 2 , S. Hall 2 , J. Prochaska 1 1
Stanford University, Stanford, CA, United States University of California, San Francisco, San Francisco, CA, United States 2
Aims: Epidemiological studies indicate Posttraumatic Stress Disorder (PTSD) frequently co-occurs with substance use and abuse, particularly among women. This study examined the PTSDsubstance use relation in a sample of men and women smokers with serious mental illness. Methods: 733 adult smokers (51% male) aged 18–73, were recruited from 5 acute inpatient psychiatry units. The e-MINI measured PTSD. Past 30-day substance use and readiness to change were assessed for heavy alcohol use (ALC), stimulants (STIM), sedatives (SED), hallucinogens (HAL), opiates (OP), and marijuana (MJ). The SF-12 assessed physical and mental health functioning. Logistic regression analyses tested for women and men separately the relation of PTSD with substance use and readiness to change. Results: 44% of women and 36% of men had PTSD. Past 30 day use of ALC, STIM, SED, OP and MJ was high (women range: 21.5–39.6%, men range: 24.9–47.1%). HAL use was lower (women: 3.9%, men: 5.9%). On average, women used 1.6 (sd = 1.2) and men used 1.7 (sd = 1.2) substances, during the past 30 days. Adjusting for covariates, use of OP (OR = 2.1, p = .01), SED (OR = 1.8, p = .02), and MJ (OR = 1.9, p = .01) predicted PTSD in women. Use of STIM (OR = 1.8, p = .04) and MJ (OR = 1.7, p = .04) predicted PTSD in men. Number of substances used predicted PTSD in women (OR = 1.5, p < .01), but not men. PTSD was unrelated to motivation to quit ALC/drugs. PTSD and # of substances used were associated with poorer mental health functioning, and a significant interaction indicated mental health functioning was the worst among those with both PTSD and greater substance use (b = 2.1, p = .03). Conclusions: Among smokers with serious mental illness, recent heavy alcohol, illicit drug use, and PTSD were common, found to co-occur, and predictive of worse mental health functioning. Integrative treatments for PTSD and substance abuse, with attention to sex-specific drugs of abuse, appear warranted. Financial support: Funding: K23MH083684, K05DA01869, P50DA09253, TRDRP#23BT-0018, T32HL007034. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.685 What medical care needs of homeless and housed veterans are served by the VA? Anita H. Yuan 1 , Sonya Gabrielian 1 , R. Andersen 2 , J. McGuire 1 , L. Rubenstein 1 , Lillian Gelberg 2 1 2
Veterans Affairs, Los Angeles, CA, United States UCLA, Los Angeles, CA, United States
Aims: Homeless persons have multidimensional medical needs and high rates of substance use disorders (SUD) and mental illness. Housing first models can improve homeless persons’ treatment engagement and SUD outcomes. The Department of Housing and Urban Development (HUD) – Veterans Affairs (VA) Supportive Housing (HUD-VASH) Program provides housing vouchers and case management to homeless Veterans. We apply the Behavioral Model for Vulnerable Populations to understand differences in diagnoses for which Veterans receive care across four groups: HUDVASH, currently homeless, housed low-income and other housed. To describe and contrast VA patients according to their housing and income status and their diagnoses. We hypothesize that HUD-
VASH Veterans receive more diagnoses for SUD, mental illness and chronic physical illness than all other Veterans. Methods: We analyzed the Veterans Health Administration Outpatient Medical SAS Data restricted to outpatient ambulatory care medical visits made at the VA Greater Los Angeles Healthcare System between 10/1/2010 and 9/30/2011. The analyses are based on 74,858 unique patients with a total of 938,259 visits. We used the 2 test and multivariate logistic regression models. Results: SUD, mental illness and multi-morbidities were more common in both homeless Veteran groups (VASH, homeless) than for housed (low income, other). HUD-VASH Veterans had the highest % reporting ≥ 1 of the following: SUD (31%, 16%, 6%, 3%), mental illness (54%, 28%, 19%, 23%), chronic physical illness (70%, 38%, 57%, 52%), tri-morbidity (20%, 6%, 2%, 1%), respectively. Controlling for demographics, HUD-VASH Veterans had higher odds of drug disorders (AOR = 8.78) and alcohol disorders (AOR = 6.07) than general housed Veterans. Conclusions: HUD-VASH Veterans are treated for different diagnoses than currently homeless Veterans. There are two possible explanations: HUD-VASH Veterans may be sicker or they may utilize the VA more for their illnesses. Financial support: This work was supported in part by the Department of Veterans Affairs Center for the Study of Health Care Provider Behavior. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.686 Association of the prodynorphin gene promoter repeat polymorphism with basal prolactin level in normal human male volunteers Vadim Yuferov, A.J. Brownstein, E. Ducat, M. Randesi, A. Ho, M.J. Kreek The Rockefeller University, New York, NY, United States Aims: Prolactin secretion is solely under inhibitory hypothalamic tuberoin-fundibular dopaminergic control in humans. Dynorphin is a powerful regulator of basal and drug-induced dopaminergic tone and therefore prolactin levels. The number of 68-bp repeats in the PDYN promoter has an effect on gene promoter activity in vitro; also, this gene polymorphism was reported to be associated with cocaine/alcohol codependence. In this study we evaluated the effect of PDYN 68-bp repeat variants on prolactin release in normal male human volunteers. Methods: Fifty three Caucasian and 39 African American healthy normal male volunteers, consecutively ascertained from 1995 to 2011, who participated in neuroendocrine studies in the Rockefeller University Hospital and gave consent for genetic studies were examined. The region of the PDYN gene containing the 68-bp repeats was amplified and analyzed by gel electrophoresis. PDYN genotypes were grouped into short (SS, one or two copies), long (LL, three, four, or five copies), and short/long (S/L, heterozygous). Levels of serum prolactin were determined by immunoradiometric assays from blood samples drawn between 9 and 10 AM on the study day at two baseline time points 10 min apart. Two-way analysis of variance, Genotype × Ethnicity, was used to examine differences in mean basal levels of prolactin. Results: There was a significant main effect of genotype F(2,86) = 6.31, p < 0.005 in prolactin levels, with no significant interaction. There was no effect of ethnicity. Higher prolactin levels were found in subjects with SS genotype (n = 18) compared to SL genotype (n = 37; p < 0.05) or LL genotype (n = 37; p < 0.001). Conclusions: The higher prolactin levels found in subjects with the short SS genotype, who presumably had higher PDYN expres-
Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Substance use and PTSD among smokers with serious mental illness K.C. Young-Wolff 1 , S. Fromont 2 , K. Delucchi 2 , S. Hall 2 , S. Hall 2 , J. Prochaska 1 1
Stanford University, Stanford, CA, United States University of California, San Francisco, San Francisco, CA, United States 2
Aims: Epidemiological studies indicate Posttraumatic Stress Disorder (PTSD) frequently co-occurs with substance use and abuse, particularly among women. This study examined the PTSDsubstance use relation in a sample of men and women smokers with serious mental illness. Methods: 733 adult smokers (51% male) aged 18–73, were recruited from 5 acute inpatient psychiatry units. The e-MINI measured PTSD. Past 30-day substance use and readiness to change were assessed for heavy alcohol use (ALC), stimulants (STIM), sedatives (SED), hallucinogens (HAL), opiates (OP), and marijuana (MJ). The SF-12 assessed physical and mental health functioning. Logistic regression analyses tested for women and men separately the relation of PTSD with substance use and readiness to change. Results: 44% of women and 36% of men had PTSD. Past 30 day use of ALC, STIM, SED, OP and MJ was high (women range: 21.5–39.6%, men range: 24.9–47.1%). HAL use was lower (women: 3.9%, men: 5.9%). On average, women used 1.6 (sd = 1.2) and men used 1.7 (sd = 1.2) substances, during the past 30 days. Adjusting for covariates, use of OP (OR = 2.1, p = .01), SED (OR = 1.8, p = .02), and MJ (OR = 1.9, p = .01) predicted PTSD in women. Use of STIM (OR = 1.8, p = .04) and MJ (OR = 1.7, p = .04) predicted PTSD in men. Number of substances used predicted PTSD in women (OR = 1.5, p < .01), but not men. PTSD was unrelated to motivation to quit ALC/drugs. PTSD and # of substances used were associated with poorer mental health functioning, and a significant interaction indicated mental health functioning was the worst among those with both PTSD and greater substance use (b = 2.1, p = .03). Conclusions: Among smokers with serious mental illness, recent heavy alcohol, illicit drug use, and PTSD were common, found to co-occur, and predictive of worse mental health functioning. Integrative treatments for PTSD and substance abuse, with attention to sex-specific drugs of abuse, appear warranted. Financial support: Funding: K23MH083684, K05DA01869, P50DA09253, TRDRP#23BT-0018, T32HL007034. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.685 What medical care needs of homeless and housed veterans are served by the VA? Anita H. Yuan 1 , Sonya Gabrielian 1 , R. Andersen 2 , J. McGuire 1 , L. Rubenstein 1 , Lillian Gelberg 2 1 2
Veterans Affairs, Los Angeles, CA, United States UCLA, Los Angeles, CA, United States
Aims: Homeless persons have multidimensional medical needs and high rates of substance use disorders (SUD) and mental illness. Housing first models can improve homeless persons’ treatment engagement and SUD outcomes. The Department of Housing and Urban Development (HUD) – Veterans Affairs (VA) Supportive Housing (HUD-VASH) Program provides housing vouchers and case management to homeless Veterans. We apply the Behavioral Model for Vulnerable Populations to understand differences in diagnoses for which Veterans receive care across four groups: HUDVASH, currently homeless, housed low-income and other housed. To describe and contrast VA patients according to their housing and income status and their diagnoses. We hypothesize that HUD-
VASH Veterans receive more diagnoses for SUD, mental illness and chronic physical illness than all other Veterans. Methods: We analyzed the Veterans Health Administration Outpatient Medical SAS Data restricted to outpatient ambulatory care medical visits made at the VA Greater Los Angeles Healthcare System between 10/1/2010 and 9/30/2011. The analyses are based on 74,858 unique patients with a total of 938,259 visits. We used the 2 test and multivariate logistic regression models. Results: SUD, mental illness and multi-morbidities were more common in both homeless Veteran groups (VASH, homeless) than for housed (low income, other). HUD-VASH Veterans had the highest % reporting ≥ 1 of the following: SUD (31%, 16%, 6%, 3%), mental illness (54%, 28%, 19%, 23%), chronic physical illness (70%, 38%, 57%, 52%), tri-morbidity (20%, 6%, 2%, 1%), respectively. Controlling for demographics, HUD-VASH Veterans had higher odds of drug disorders (AOR = 8.78) and alcohol disorders (AOR = 6.07) than general housed Veterans. Conclusions: HUD-VASH Veterans are treated for different diagnoses than currently homeless Veterans. There are two possible explanations: HUD-VASH Veterans may be sicker or they may utilize the VA more for their illnesses. Financial support: This work was supported in part by the Department of Veterans Affairs Center for the Study of Health Care Provider Behavior. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.686 Association of the prodynorphin gene promoter repeat polymorphism with basal prolactin level in normal human male volunteers Vadim Yuferov, A.J. Brownstein, E. Ducat, M. Randesi, A. Ho, M.J. Kreek The Rockefeller University, New York, NY, United States Aims: Prolactin secretion is solely under inhibitory hypothalamic tuberoin-fundibular dopaminergic control in humans. Dynorphin is a powerful regulator of basal and drug-induced dopaminergic tone and therefore prolactin levels. The number of 68-bp repeats in the PDYN promoter has an effect on gene promoter activity in vitro; also, this gene polymorphism was reported to be associated with cocaine/alcohol codependence. In this study we evaluated the effect of PDYN 68-bp repeat variants on prolactin release in normal male human volunteers. Methods: Fifty three Caucasian and 39 African American healthy normal male volunteers, consecutively ascertained from 1995 to 2011, who participated in neuroendocrine studies in the Rockefeller University Hospital and gave consent for genetic studies were examined. The region of the PDYN gene containing the 68-bp repeats was amplified and analyzed by gel electrophoresis. PDYN genotypes were grouped into short (SS, one or two copies), long (LL, three, four, or five copies), and short/long (S/L, heterozygous). Levels of serum prolactin were determined by immunoradiometric assays from blood samples drawn between 9 and 10 AM on the study day at two baseline time points 10 min apart. Two-way analysis of variance, Genotype × Ethnicity, was used to examine differences in mean basal levels of prolactin. Results: There was a significant main effect of genotype F(2,86) = 6.31, p < 0.005 in prolactin levels, with no significant interaction. There was no effect of ethnicity. Higher prolactin levels were found in subjects with SS genotype (n = 18) compared to SL genotype (n = 37; p < 0.05) or LL genotype (n = 37; p < 0.001). Conclusions: The higher prolactin levels found in subjects with the short SS genotype, who presumably had higher PDYN expres-