Ethan Sahker

Evaluating racial disparity in referral source and successful completion of substance abuse treatment

Health disparity is a significant problem in the United States, and particularly for substance abuse treatment programs. A better understanding of racial differences in treatment pathways associated with successful treatment completion is needed to reduce the existing health disparities. Referral source is a strong predictor of treatment success and most research on health disparities has focused on the criminal justice referrals. However, little research has examined other types of referral sources, and the interaction with race. The current study sought to compare the effect of referral sources on national substance abuse successful treatment completion rates between Black clients (n=324,625) and White clients (n=1,060,444) by examining the interaction of race on referral source and successful treatment completion. Race significantly moderated the difference between referral source and successful treatment completion (Wald χ(2)=1477.73, df=6, p<0.0001). Employment referral was associated with the greatest percentage of successful treatment completion for Black clients. Criminal justice referral was associated with the greatest percentage of successful treatment completion for White clients. Results from the present study support a reevaluation of incentives leading to successful treatment completion with a multicultural perspective.

Religion and Spirituality as Important Components of Men’s Health and Wellness An Analytic Review

Men’s health has been receiving increased attention in health care research and practice because of associated negative outcomes and men’s reluctance to seek help. Religion or religiosity, defined as involvement in an organized, structured community focused on moral code, and spirituality, defined as the subjective, mystical, and holistic interpretation of personal beliefs and behaviors, have been associated with positive health outcomes. Specifically, religion and spirituality mediate an increase in positive health outcomes and a decrease in risk factors through social and existential well-being. However, men seem to be less religious and spiritual compared with women, a potential problem as men may be missing an important pathway to health and wellness. This state-of-the-art review examines the intersections of religion, spirituality, and health and focuses on how religion and spirituality relate specifically to men’s health and health behaviors. Subsequently, 4 health problems with religious and spiritual implications are examined that have been identified in the literature as pertinent to men’s health: (a) prostate cancer screening and coping, (b) HIV/AIDS prevention and coping, (c) addictions, and (d) palliative care. Finally, suggestions are offered for clinicians to incorporate an understanding of religion and spirituality into their patient encounters.

Use of a machine learning framework to predict substance use disorder treatment success

There are several methods for building prediction models. The wealth of currently available modeling techniques usually forces the researcher to judge, a priori, what will likely be the best method. Super learning (SL) is a methodology that facilitates this decision by combining all identified prediction algorithms pertinent for a particular prediction problem. SL generates a final model that is at least as good as any of the other models considered for predicting the outcome. The overarching aim of this work is to introduce SL to analysts and practitioners. This work compares the performance of logistic regression, penalized regression, random forests, deep learning neural networks, and SL to predict successful substance use disorders (SUD) treatment. A nationwide database including 99,013 SUD treatment patients was used. All algorithms were evaluated using the area under the receiver operating characteristic curve (AUC) in a test sample that was not included in the training sample used to fit the prediction models. AUC for the models ranged between 0.793 and 0.820. SL was superior to all but one of the algorithms compared. An explanation of SL steps is provided. SL is the first step in targeted learning, an analytic framework that yields double robust effect estimation and inference with fewer assumptions than the usual parametric methods. Different aspects of SL depending on the context, its function within the targeted learning framework, and the benefits of this methodology in the addiction field are discussed.

How Religious Beliefs and Practices Influence the Psychological Health of Catholic Priests

Roman Catholic diocesan priests are a subgroup of men with unique religious and spiritual roles, beliefs, and practices. This qualitative study of 15 priests from the mid-Atlantic area of the United States focused on how priests’ relationship with God and promises of celibacy and obedience influenced their psychological health. Using a consensual qualitative research (CQR) design, the analysis revealed that participants described their relationship with God as central to their health and contributing to positive outcomes (e.g., sense of connection and support). The influence of their promises of celibacy and obedience were linked to both positive outcomes (e.g., decreased stress, improved relationships) and negative outcomes (e.g., internal conflict, depression/loneliness). This study highlighted the central role that priests’ relationship with God has on positive psychological health. Future research is necessary to understand how to maximize the positive effects and minimize the negative effects of priests’ promises of celibacy and obedience, which would benefit programs aimed at supporting priests’ psychological health.

National Analysis of Differences Among Substance Abuse Treatment Outcomes: College Student and Nonstudent Emerging Adults

Abstract Objective: To discover differences between student and nonstudent substance abuse treatment demographics, treatment characteristics, and outcomes. Participants: Conducted February 2014, clients without prior treatment admissions, aged 18–24, not in methadone maintenance therapy, and in nonintensive and ambulatory intensive outpatient treatment settings (N = 467,233). Methods: Chi-square was used to analyze differences. Multivariate logistic regression including covariates and the student status predicted successful completion with risk differences (RD). Results: Students were more likely to successfully complete treatment than nonstudents (56.15% vs 41.96%; χ2 = 1355.04, df = 1, p < .0001, RD = 14.19, 95% confidence interval [CI] [13.43, 14.95]), and students were 6.92 (95% CI [6.26, 7.58]) percentage points less likely than nonstudents to remain in treatment for longer than 4 months (χ2 = 367.24, df = 1, p < .0001). Conclusions: Treatment providers seem to have greater results retaining students in shorter periods. Suggestions for higher education treatment engagement are discussed.

Referrals and Treatment Completion for Prescription Opioid Admissions: Five Years of National Data.

This study examines sources of referral for prescription opioid admission to substance use disorder treatment facilities and their relative completion success rates using secondary analysis of an existing data set (treatment episode datasets-discharge). Five years of data from public and private treatment facilities were extracted for client discharges with no prior treatment (N=2,909,884). Healthcare professionals account for very few referrals to treatment (<10%). Prescription opioid clients referred into treatment had lower treatment success compared to other substance clients and when referred by healthcare providers had lower success rates (OR=0.72, 95% CI 0.70-0.75) than clients from other referral sources. Fewer treatment referrals for prescription opioid misuse by healthcare providers and lower success rates are significant and timely findings due to the prevalence of prescription opioid misuse. Healthcare providers are well positioned to refer early for prescription opioid misuse and continue support of their patients during treatment.

Alcohol use screening and intervention by American primary care providers

BACKGROUND Regular/chronic drinking, defined by five or more drinks in one sitting on each of five or more occasions in the past 30 days, is a significant problem contributing to negative health outcomes, morbidity, and mortality. Regular/chronic and heavy episodic drinking largely goes undetected by primary care providers due to a lack of screening and intervention. The present study explores the extent to which healthcare practitioners screen for alcohol use, provide interventions, and refer to treatment across different types of drinkers. METHODS A retrospective analysis of the 2014 National Survey on Drug Use and Health was analysed in 2016. Respondents who visited primary care settings were asked if healthcare providers queried them about their drinking, amount they drank, frequency of drinking, and if they received interventions. Simple tests among proportions and logistic regression were used to analyse these data. RESULTS Healthcare professionals asked 76.5% of patients if they drank alcohol at all in the past year, and only 11.8% were asked if they had a drinking problem. The chance of being asked increased for heavy episodic and regular/chronic drinkers (F[1.97, 98.38]=44.81, p<0.001). Healthcare providers infrequently suggested cutting down on drinking (5.5% overall), but the chance of receiving a suggestion increased across heavy episodic and regular/chronic drinkers (F[1.92,96.02]=196.22, p<0.001). Information about alcohol treatment referral was rarely given (7.3% of regular/chronic drinkers). Moreover, minority, older, male, and uninsured patients were queried about alcohol use less often. CONCLUSION Healthcare practitioners in primary care are screening for alcohol use at moderate rates, yet follow-up questions, brief advice, and treatment referrals are inconsistently targeted. There is a need for consistent screening of all patients and systematic follow-up protocols in primary care delivery.

Age moderates the association of depressive symptoms and unhealthy alcohol use in the National Guard

Unhealthy drinking is a significant problem contributing to poor health and performance of military personnel. The Iowa Army National Guard and the Iowa Department of Public Health have collaborated with the Substance Abuse and Mental Health Administration to better identify unhealthy substance use via Screening, Brief Intervention, and Referral to Treatment program (SBIRT). Yet, little research has been conducted on the Guards use of SBIRT. This study examined depression, age, deployment status, and sex as factors contributing to unhealthy drinking. Of the Guardsmen who took part in SBIRT, 3.7% (n=75) met the criteria for unhealthy drinking and 3.9% (n=78) had some level of depression. The overall multivariate model significantly predicted unhealthy drinking (χ(2)(5)=41.41, p<0.001) with age moderating the association of depressive symptoms and unhealthy alcohol (Wald χ(2)(1)=7.16, p=0.007). These findings add to the existing understanding of factors contributing to unhealthy drinking suggesting the association between the presence of depression and unhealthy drinking depends on age of the Guradsman. This age and depression interaction may be an important diagnostic feature to consider for unhealthy drinking in the Guard. Furthermore, previous research on the general military population finds similar percentages, providing support for SBIRT as an effective screening tool in the Guard.

Treatment of Substance Use Disorders in Older Adults: Implications for Care Delivery.

To compare substance use treatment differences of individuals aged 65 and older with that of those younger than 65 by analyzing smaller age groupings.

Stability of the alcohol use disorders identification test in practical service settings

Objective The purpose of the present study is to explore the stability of the Alcohol Use Disorders Identification Test (AUDIT) in a clinical setting by comparing prescreening heavy drinking questions and AUDIT scores over time. Because instrument stability is equal to test–retest reliability at worst, investigating the stability of the AUDIT would help better understand patient behavior change in context and the appropriateness of the AUDIT in a clinical setting. Methods This was a retrospective exploratory analysis of Visit 1 to Visit 2 AUDIT stability (n=1,099; male [75.4%], female [24.6%]) from all patients with first-time and second-time records in the Iowa Screening, Brief Intervention, and Referral to Treatment project, October 2012 to July 7, 2015 (N=17,699; male [40.6%], female [59.4%]). Results The AUDIT demonstrated moderate stability (intraclass correlation=0.56, 95% confidence interval: 0.52–0.60). In a multiple regression predicting the (absolute) difference between the two AUDIT scores, the participants’ age was highly significant, t(1,092)=6.23, p<0.001. Younger participants clearly showed less stability than their older counterparts. Results are limited/biased by the observational nature of the study design and the use of clinical service data. Conclusion The present findings contribute to the literature by demonstrating that the AUDIT changes are moderately dependable from Visit 1 to Visit 2 while taking into account patient drinking behavior variability. It is important to know the stability of the AUDIT for continued use in Screening, Brief Intervention, and Referral to Treatment programming.