Chartbook on Effective Treatment

Substance Abuse Disorders

• Substance abuse disorders can lead to:
  • Addiction.
  • Increased risk of certain cancers.
  • Damage to the liver, brain, and other organs.
  • Birth defects, such as fetal alcohol spectrum disorders.
  • Increased risk of death from car crashes and other injuries.

Importance of Treatment

• In 2011, about 2.5 million emergency department (ED) visits resulted from medical emergencies involving drug misuse or abuse:
  • 1.25 million involved illicit drugs.
  • 1.24 million involved nonmedical use of pharmaceuticals.
  • 0.61 million involved drugs combined with alcohol (SAMHSA, 2014).
• Substance abuse disorders can be effectively treated at specialty facilities.

Treatment Needs

• In 2013, nearly 23 million Americans age 12 years and over needed treatment for substance abuse.
• An estimated 2.5 million people received treatment at a specialty facility (hospital [inpatient], drug or alcohol rehabilitation [inpatient or outpatient], or mental health center), but more than 20 million people who needed this type of treatment did not receive it (SAMHSA, 2014).

Receipt of Substance Abuse Treatment

People age 12 and over who needed treatment for illicit drug use or an alcohol problem and who received such treatment at a specialty facility in the last 12 months, by race/ethnicity (2002-2012) and age (2008-2012)

Left Chart:

2011 Achievable Benchmark: 15%.

Right Chart:

2011 Achievable Benchmark: 15%.

Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2002-2012.
Denominator: Civilian noninstitutionalized population age 12 and over who needed treatment for illicit drug use or an alcohol problem.
Note: Treatment refers to treatment at a specialty facility, such as a drug and alcohol inpatient and/or outpatient rehabilitation facility, inpatient hospital setting, or mental health center. White and Black are non-Hispanic. Hispanic includes all races.

• Overall Rate: In 2012, only 10.8% of people age 12 and over who needed treatment for illicit drug use or an alcohol problem received such treatment at a specialty facility in the last 12 months.
• Groups With Disparities: From 2002 to 2012, there were no statistically significant differences by race/ethnicity; and from 2008 to 2012, there were no statistically significant differences by age.
• Achievable Benchmark:
  • The 2011 top 5 State achievable benchmark was 15%. The top 5 States that contributed to the achievable benchmark are Alabama, Alaska, Delaware, Maryland, Oregon, and Utah.
  • At the current rate, the total population would need 30 years to achieve this benchmark. People ages 12-17 would take 9 years, while people ages 18-44 would take 49 years. It would take people ages 45-64 less than 1 year to achieve the benchmark. Whites could achieve the benchmark in 15 years while Blacks and Hispanics are moving away from the benchmark.

Process: Completion of Substance Abuse Treatment

• For patients receiving treatment for substance abuse, studies have shown that increased length of treatment correlates with improved outcomes (McLellan, et al., 1996), such as long-term abstinence.
• Dropout from treatment often leads to relapse and return to substance use.

People age 12 and over treated for substance abuse who completed treatment course, by race/ethnicity and education 2005-2011

Left Chart:

2008 Achievable Benchmark: 74%.

Right Chart:

2008 Achievable Benchmark: 74%.

Source: Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set, Discharge Data Set, 2005-2011.
Denominator: Discharges age 12 and over from publicly funded substance abuse treatment facilities.
Note: White and Black are non-Hispanic. Hispanic includes all races.

• Overall Rate: In 2011, 43.7% of people age 12 and over treated for substance abuse completed their treatment course.
• Groups With Disparities:
  • In 4 of 7 years, Blacks who were treated for substance abuse were significantly less likely than Whites to complete treatment.
  • In all years, people with less than a high school education who were treated for substance abuse were less likely than people with any college education to complete treatment.
• Achievable Benchmark:
  • The 2008 top 5 State achievable benchmark was 74%. The top 5 States that contributed to the achievable benchmark are Colorado, Connecticut, District of Columbia, Mississippi, and Texas.
  • No group showed progress toward the benchmark.

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Potentially Avoidable Emergency Department Visits

• About one in three individuals has had a mental health or substance abuse (MHSA) condition within the last 12 months.
• In 2007, 12 million ED visits involved a diagnosis related to MHSA, accounting for 12.5% of all ED visits in the United States.
• Health care providers are concerned about the rise in ED visits for MHSA, as ED overcrowding can reduce quality of care and increase the likelihood of medical error (Owens, et al., 2010).

Outcome: Emergency Department Visits Related to Mental Health and Substance Abuse

Emergency department visits with a principal diagnosis related to mental health, alcohol, or substance abuse, by age and income, 2007-2011

Left Chart:

Right Chart:

Key: Q = quartile.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, and HCUPnet query.

• Overall Rate: From 2007 to 2011, the overall rate of ED visits with a principal diagnosis related to mental health, alcohol, or substance abuse significantly increased from 1,527.8 to 1,766.8 per 100,000 population.
• Groups With Disparities:
  • In all years, individuals ages 0-17 and 65 and over were significantly less likely to have an ED visit with a principal diagnosis related to mental health, alcohol, or substance abuse than individuals ages 18-44.
  • In 2011, individuals in the highest income quartile were less likely to have an ED visit with a principal diagnosis related to mental health, alcohol, or substance abuse than individuals in all other income groups.
  • For more ED measures for mental health and substance use disorders, refer to the 2014 Care Coordination chartbook at https://archive.ahrq.gov/research/findings/nhqrdr/2014chartbooks/carecoordination/index.html.

References

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Burns MN, Montague E, Mohr DC. Initial design of culturally informed behavioral intervention technologies: developing an mHealth intervention for young sexual minority men with generalized anxiety disorder and major depression. J Med Internet Res 2013;15(12):e271,1-9. http://www.ncbi.nlm.nih.gov/pubmed/24311444. Accessed February 20, 2014.

Casey M, Perera D, Clarke D. Psychosocial treatment approaches to difficult-to-treat depression. Med J Aust 2013 Sep 16;199(6 Suppl):S52-5. PMID: 25370289.

Center for Behavioral Health Statistics and Quality. The NSDUH Report: substance use and mental health estimates from the 2013 National Survey on Drug Use and Health: Overview of findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; September 2014. http://www.samhsa.gov/data/sites/default/files/NSDUH-SR200-RecoveryMonth-2014/NSDUH-SR200-RecoveryMonth-2014.htm. Accessed June 29, 2015..

DeVylder J, Lukens E, Link B, et al. Suicidal ideation and suicide attempts among adults with psychotic experiences. JAMA Psychiatry 2015;72(3):219-25.

Final update summary: depression in adults: screening. United States Preventive Services Task Force. July 2015a. http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/depression-in-adults-screening?ds=1&s=Depression-screening.

Final update summary: depression in children and adolescents: screening. U.S. Preventive Services Task Force. July 2015b. http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/depression-in-children-and-adolescents-screening?ds=1&s=Depression-screening.

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Han B, Compton WM, Gfroerer J, et al. Prevalence and correlates of past 12-month suicide attempt among adults with past-year suicidal ideation in the United States. J Clin Psychiatry 2015 Mar;76(3):295-302. PMID: 25830449.

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McLellan AT, Woody GE, Metzger D, et al. Evaluating the effectiveness of addiction treatments: reasonable expectations, appropriate comparisons. Milbank Q 1996;74(1):51-85.

Nordentoft M. Crucial elements in suicide prevention strategies. Prog Neuropsychopharmacol Biol Psychiatry 2011 Jun 1;35(4):848-53. Epub 2010 Dec 2.

Olfson, M, Druss, B, Marcus, S. Trends in mental health care among children and adolescents. New Engl J Med 2015 May 21;372(21):2029-38. PMID: 25992747.

Owens P, Mutter R, Stocks C. Mental health and substance abuse-related emergency department visits among adults, 2007. HCUP Statistical Brief #92. Rockville, MD: Agency for Healthcare Research and Quality; July 2010. http://hcup-us.ahrq.gov/reports/statbriefs/sb92.jsp.

Simon GE, Rutter CM, Peterson D, et al. Does response on the PHQ-9 depression questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv 2013; 64(12):1195-202. http://www.ncbi.nlm.nih.gov/pubmed/24036589. Accessed February 20, 2014.

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Thorndike FP, Ritterband LM, Gonder-Frederick LA, et al. A randomized controlled trial of an Internet intervention for adults with insomnia: effects on comorbid psychological and fatigue symptoms. J Clin Psychol 2013; 69(10):1078-93. http://www.ncbi.nlm.nih.gov/pubmed/24014057. Accessed July 27, 2015.

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