Treatment use and barriers among adolescents with prescription opioid use disorders

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham 27710, USA.
Addictive behaviors (Impact Factor: 2.76). 08/2011; 36(12):1233-9. DOI: 10.1016/j.addbeh.2011.07.033
Source: PubMed

ABSTRACT This study examined national trends, patterns, correlates, and barriers to substance abuse treatment use by adolescents aged 12-17 years who met at least one of the past-year criteria for prescription opioid abuse or dependence (N=1788).
Data were from the 2005-2008 National Surveys of Drug Use and Health (NSDUH). Past-year substance use disorders, major depression, and treatment use were assessed by audio computer-assisted self-interviewing.
About 17% of adolescents with opioid dependence (n=434) and 16% of those with opioid abuse (n=355) used any substance abuse treatment in the past year compared with 9% of subthreshold users, i.e., adolescents who reported 1-2 prescription opioid dependence criteria but no abuse criteria (n=999). Only 4.2% of adolescents with opioid dependence, 0.5% of those with abuse, and 0.6% of subthreshold users reported a perceived need for treatment of nonmedical opioid use. Self-help groups and outpatient rehabilitation were the most commonly used sources of treatment. Few black adolescents used treatment (medical settings, 3.3%; self-help groups, 1.7%) or reported a need for treatment (1.8%). Talking to parents/guardians about dangers of substance use increased the odds of treatment use. Barriers to treatment use included "wasn't ready to stop substance use," "didn't want others to find out," and "could handle the problem without treatment."
Adolescents with prescription opioid use disorders markedly underutilize treatment. Non-financial barriers are pervasive, including stigma and a lack of perceived treatment need.

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Available from: Li-Tzy Wu, Sep 29, 2015
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    • "Addiction is often attributed to moral or personal failings, and such stigmatization can significantly impede treatment seeking and aggravate substance use (Livingston, Milne, Fang & Amari, 2012). Failure to seek treatment may be attributed to concerns about the negative opinions of others or an inability to recognize the dangers of NMPOU (Wu et al., 2011). Intervention strategies should highlight the harms associated with prescription opioid misuse while reducing stigma surrounding mental health and addiction . "
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    ABSTRACT: Non-medical prescription opioid use (NMPOU) is a growing trend among Canadian adolescent and young adult populations. Research indicates youth are less informed of, and more susceptible to, the risks and harms associated with NMPOU (Canadian Centre on Substance Abuse, 2013). Abuse of prescription opioids is associated with serious negative outcomes such as the development of substance use and psychiatric disorders (Martins, Keyes, Stor, Zhu & Chlcoat, 2009; Schepis and Hakes, 2013). Many report experiencing symptoms of opioid dependence or comorbid mood and anxiety problems yet few perceive a need for treatment (Li-Tzy, Blazer, Li & Woody, 2011). While recent interventions have been effective in reducing opioid use in older populations (Fischer, Lalomiteanu, Kurdyak, Mann & Rehm, 2013), they do not specifically target the needs of young adults. This article reviews prevalence rates and risks faced by young adults who engage in NMPOU with a focus on comorbid mental health conditions. Harm education, stigma reduction, and awareness of treatment resources are identified as areas of focus for prevention strategies.
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    ABSTRACT: To address an urgent need for screening of substance use problems in medical settings, we examined substance-specific dependence criteria as potential brief screeners for the detection of patients with a substance use disorder (SUD). The sample included 920 opioid-dependent adults who were recruited from outpatient treatment settings at 11 programs in 10 U.S. cities and who completed intake assessments of SUDs for a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN003). Data were analyzed by factor analysis, item response theory (IRT), sensitivity, and specificity procedures. Across all substances (alcohol, amphetamines, cannabis, cocaine, sedatives), withdrawal was among the least prevalent symptoms, while taking large amounts and inability to cut down were among the most prevalent symptoms. Items closely related to the latent trait of a SUD showed good-to-high values of area under the receiver operating characteristic curve in identifying cases of a SUD; IRT-defined severe and less discriminative items exhibited low sensitivity in identifying cases of a SUD (withdrawal for all substances; time using for alcohol and sedatives; giving up activities for sedatives). Study results suggest that withdrawal and time using are much less reliable indicators for a SUD than taking larger amounts than intended and inability to cut down and that the latter two items should be studied further for consideration in developing a simplified tool for screening patients for SUDs in medical settings. These findings have implications for the use of common health indicators in electronic health records systems to improve patient care.
    Journal of Psychiatric Research 12/2011; 46(3):360-9. DOI:10.1016/j.jpsychires.2011.12.002 · 3.96 Impact Factor
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    ABSTRACT: While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted.
    02/2012; 3:1-8. DOI:10.2147/SAR.S22575
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