Judith Bernstein1, Taletha M Derrington2, Candice Belanoff3, Howard J Cabral4, Hermik Babakhanlou-Chase5, Hafsatou Diop6, Stephen R Evans7, Hilary Jacobs8, Milton Kotelchuck9. 1. Boston University School of Public Health, Boston, MA, USA. Electronic address: jbernste@bu.edu. 2. Boston University School of Public Health, Boston, MA, USA. Electronic address: taletha.derrington@sri.com. 3. Boston University School of Public Health, Boston, MA, USA. Electronic address: cbelanof@bu.edu. 4. Boston University School of Public Health, Boston, MA, USA. Electronic address: hjcab@bu.edu. 5. Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA. Electronic address: Hermik.Babkhanlou-Chase@state.ma.us. 6. Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA. Electronic address: Hafsatou.Diop@state.ma.us. 7. Boston University School of Public Health, Boston, MA, USA. Electronic address: deeny@bu.edu. 8. Bureau of Substance Abuse Services, Massachusetts Department of Public Health, Boston, MA, USA. Electronic address: Hilary.Jacobs@state.ma.us. 9. Center for Child and Adolescent Health Research and Policy, MassGeneral Hospital for Children, Boston, MA, USA. Electronic address: mkotelchuck@mgh.harvard.edu.
Abstract
INTRODUCTION: Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, 'acute only' (detoxification/stabilization), or 'ongoing' services. METHODS: We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002-2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes. RESULTS: Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15-49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained 'ongoing' treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive 'ongoing' treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received 'acute only' services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving 'ongoing' treatment. CONCLUSIONS: Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. 'Ongoing' services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.
INTRODUCTION: Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, 'acute only' (detoxification/stabilization), or 'ongoing' services. METHODS: We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002-2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes. RESULTS: Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15-49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained 'ongoing' treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive 'ongoing' treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received 'acute only' services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving 'ongoing' treatment. CONCLUSIONS: Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. 'Ongoing' services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.
Authors: Esther K Choo; Gillian Beauchamp; Francesca L Beaudoin; Edward Bernstein; Judith Bernstein; Steven L Bernstein; Kerryann B Broderick; Robert D Cannon; Gail D'Onofrio; Marna R Greenberg; Kathryn Hawk; Rashelle B Hayes; Gabrielle A Jacquet; Melanie J Lippmann; Karin V Rhodes; Susan H Watts; Edwin D Boudreaux Journal: Acad Emerg Med Date: 2014-12-01 Impact factor: 3.451
Authors: Theresa W Kim; Judith Bernstein; Debbie M Cheng; Christine Lloyd-Travaglini; Jeffrey H Samet; Tibor P Palfai; Richard Saitz Journal: Addiction Date: 2017-02-07 Impact factor: 6.526
Authors: Milton Kotelchuck; Erika R Cheng; Candice Belanoff; Howard J Cabral; Hermik Babakhanlou-Chase; Taletha M Derrington; Hafsatou Diop; Stephen R Evans; Judith Bernstein Journal: Matern Child Health J Date: 2017-04