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Tables
- Table 1. Select Baseline Characteristics of Participants Overall and By 10-Item Drug Abuse Screening Test Drug Use Severity Subcategories
Characteristics Overall (N = 868) DAST-10 Drug Use Severity Subcategory* P Value† Low (n = 278) Intermediate (n = 328) Substantial/Severe (n = 262) Demographics Age, mean years (SD) 47.76 (10.89) 48.73 (11.69) 48.28 (10.83) 46.09 (9.89) .01 Male sex 604 (70) 183 (66) 235 (72) 186 (71) .25 Race‡ .01 White 386 (45) 143 (52) 132 (41) 111 (43) Black 320 (37) 82 (30) 126 (39) 112 (43) Other 150 (18) 49 (18) 65 (20) 36 (14) Hispanic 72 (9) 19 (7) 25 (8) 28 (12) .16 Marital status .04 Married/living with partner 161 (19) 51 (18) 73 (22) 37 (14) Divorced/separated/widowed 348 (40) 99 (36) 132 (40) 117 (45) Never married 357 (41) 126 (46) 123 (38) 108 (41) Education <.001 High school or less 166 (19) 38 (14) 66 (20) 62 (24) High school graduate 254 (29) 70 (25) 98 (30) 86 (33) Beyond high school 447 (52) 170 (61) 163 (50) 114 (44) Employment status .01 Working 78 (9) 35 (13) 31 (9) 12 (5) Unemployed/retired/in school/ homemaker/other 238 (27) 84 (30) 89 (27) 65 (25) Disabled and unable to work 551 (64) 159 (57) 208 (63) 184 (70) Homeless in shelter or on street ≥1 night in the past 90 days 263 (30) 42 (15) 91 (28) 130 (50) <.001 Substance use/treatment ASI days most frequently used drug, mean (SD)§ 13.82 (11.00) 12.25 (11.00) 14.35 (11.08) 14.84 (10.77) .01 ASI drug use composite score, mean (SD)§‖ 0.11 (0.10) 0.06 (0.05) 0.10 (0.09) 0.19 (0.12) <.001 ASI drug use, any in the past 30 days¶ Marijuana 656 (76) 243 (87) 249 (76) 164 (63) <.001 Stimulants¶ 362 (42) 40 (14) 141 (43) 181 (69) <.001 Cocaine 325 (37) 34 (12) 130 (40) 161 (61) <.001 Amphetamines 63 (7) 7 (3) 20 (6) 36 (14) <.001 Opiates¶ 228 (26) 33 (12) 93 (28) 102 (39) <.001 Heroin 59 (7) 1 (0) 13 (4) 45 (17) <.001 Methadone and other opiates/analgesics not prescribed 208 (24) 33 (12) 86 (26) 89 (34) <.001 Sedatives/hypnotics/tranquilizers 72 (8) 7 (3) 28 (9) 37 (14) <.001 Other drugs§# 51 (6) 9 (3) 19 (6) 23 (9) .02 ≥2 Drugs used in the past 30 days§ 389 (45) 63 (23) 152 (46) 174 (66) <.001 Intravenous drug use in the past 30 days 72 (8) 5 (2) 15 (5) 52 (20) <.001 Goal of total abstinence from drugs§** 323 (37) 40 (14) 124 (38) 159 (61) <.001 ASI alcohol use composite score, mean (SD)‖ 0.15 (0.20) 0.08 (0.13) 0.13 (0.18) 0.25 (0.25) <.001 ASI alcohol use, any in the past 30 days 598 (69) 182 (65) 220 (67) 196 (75) .04 Nicotine use, any in the past 30 days 620 (72) 169 (61) 242 (74) 209 (80) <.001 CD treatment services†† Admitted to CD treatment 147 (17) 17 (6) 44 (14) 86 (34) <.001 Detoxification (not followed by CD treatment) 65 (8) 9 (3) 14 (4) 42 (17) <.001 Other Psychosocial ≥1 Arrest for felony or gross misdemeanor†† 122 (14) 17 (6) 45 (14) 60 (24) <.001 HIV risk-taking score, mean (SD)§§ 3.35 (4.21) 2.57 (3.16) 3.12 (3.67) 4.46 (5.45) <.001 ASI family/social composite score, mean (SD)§ 0.17 (0.22) 0.12 (0.18) 0.17 (0.21) 0.22 (0.25) <.001 Data are reported as no. (%) of participants unless otherwise indicated. Missing values are not included in this table.
↵* Of 10,337 individuals screened, 1,621, or about 16%, were eligible. Of these, 520 declined to participate and 154 were excluded for other reasons (eg, left during the consent process). The remaining 947 provided consent. Of these 947, 79 were excluded (22 because of current participation in chemical dependency (CD) treatment, 9 because they had acute suicidality or psychosis, 8 because they had no drug use in the past 3 months, 3 because they were not a primary care patient, and 2 because they had insufficient contact information); 32 declined to participate; and 3 were excluded for other reasons, leaving 868 as the final sample.
↵† P value based on χ2, analysis of variance, or Kruskal-Wallis test.
↵‡ Assessed by self-report using National Institutes of Health reporting categories for federally funded clinical research.
↵§ Excludes use of alcohol or nicotine.
↵‖ Addiction Severity Index-Lite (ASI) composite scores range from 0 to 1, with 1 indicating greatest problem severity.
↵¶ ASI drug use groups reported are not mutually exclusive.
↵# “Other drugs” can include all other abused medications (eg, antihistamines, antidepressants) or drugs of abuse (eg, hallucinogens, inhalants) not included in the existing categories.
↵** From the Thoughts about Abstinence measure, which is used to assess one's goal for changing drug use (no goal; controlled use; occasional use; temporary abstinence; total abstinence, slip is possible; total abstinence, never use again). The reported “goal of total abstinence from drugs” includes “total abstinence, never use again” and “total abstinence, slip is possible.”
↵†† Administrative data were available for 848 participants in the 2 years before study enrollment.
↵§§ Human immunodeficiency virus (HIV) risk-taking score ranges from 0 to 50, with 50 indicating greatest HIV risk.
DAST-10, 10-item Drug Abuse Screening Test; SD, standard deviation.
- Table 2. Medical and Psychiatric Characteristics of Participants Overall and By 10-Item Drug Abuse Screening Test Drug Use Severity Subcategories
Characteristics Overall (N = 868) DAST-10 Drug Use Severity Subcategory* P Value† Low (n = 278) Intermediate (n = 328) Substantial/Severe (n = 262) Medical CDPS medical conditions, mean (SD) 7.42 (3.78) 7.26 (3.86) 7.54 (3.52) 7.45 (4.00) .66 Emergency department ≥1 visit 528 (62) 140 (51) 208 (64) 180 (71) <.001 Mean visits (SD) 2.52 (4.27) 1.49 (2.11) 2.26 (3.40) 3.94 (6.20) <.001 Mean cost (SD), US$ 1,347.69 (2,436.81) 847.87 (1,641.90) 1,203.20 (2,152.93) 2,069.52 (3,212.05) <.001 Median visits 1.00 (3.00) 1.00 (2.00) 1.00 (3.00) 2.00 (5.00) Median cost, US$ 363.81 (1,565.18) 56.12 (1,006.36) 265.76 (1,502.64) 896.02 (2,792.61) Outpatient medical ≥1 visit 780 (92) 245 (90) 307 (95) 228 (90) .04 Mean visits (SD) 18.94 (17.98) 21.22 (18.62) 19.25 (17.37) 16.08 (17.72) .004 Mean cost (SD), US$ 7,114.62 (8,918.87) 7,752.36 (8,694.52) 6,826.72 (6,964.86) 6,796.55 (11,110.28) .36 Median visits 14.00 (22.00) 17.00 (25.00) 15.00 (21.00) 10.00 (18.00) Median cost, US$ 4,563.84 (8,060.05) 5,417.63 (8,647.68) 4,677.26 (7,146.79) 3,911.40 (6,509.43) Inpatient preceded by an ED visit ≥1 Inpatient admission 227 (27) 63 (23) 73 (22) 91 (36) <.001 Mean admissions (SD) 0.44 (0.94) 0.34 (0.77) 0.37 (0.87) 0.62 (1.14) .001 Mean cost (SD), US$ 6,055.14 (22,329.21) 4,788.08 (17,591.21) 4,128.98 (13,675.27) 9,876.45 (32,908.00) .005 Median admissions 0.00 (1.00) 0.00 (0.00) 0.00 (0.00) 0.00 (1.00) Median cost, US$ 0.00 (2,928.17) 0.00 (0.00) 0.00 (0.00) 0.00 (5,990.48) Psychiatric High psychiatric severity, ASI psychiatric status composite score >0.38‡ 470 (54) 114 (41) 175 (53) 181 (69) <.001 ASI psychiatric status composite score, mean (SD)‡§‖ 0.38 (0.24) 0.30 (0.24) 0.38 (0.24) 0.47 (0.21) <.001 ≥1 Mental illness ICD-9 diagnosis 542 (64) 160 (59) 210 (65) 172 (68) .08 Prescribed medication for psychological or emotion problems, over lifetime‡ 619 (71) 181 (65) 231 (70) 207 (79) <.001 Data are reported as no. (%) of participants unless otherwise indicated. Missing values are not included in this table.
↵* Administrative data were available for 848 participants for the 2 years before study enrollment unless otherwise noted.
↵† P value is based on χ2, analysis of variance, or Kruskal-Wallis test.
↵‡ Data were available for 868 participants.
↵§ ASI composite scores range from 0 to 1, with 1 indicating greatest problem severity.
↵‖ A score >0.38 was defined as high psychiatric severity14 and represents a value of 1 standard deviation (SD) (0.22) above the mean (0.16) of the psychiatric severity composite score for nearly 3900 outpatients receiving chemical dependency treatment and assessed by the ASI.19 The 0.38 cutoff exceeds the 0.22 cutoff identified by Cacciola et al20 as the level likely to be associated with a psychiatric disorder among patients admitted to chemical dependency treatment.
ASI, Addiction Severity Index; CDPS, Chronic Illness and Disability Payment System;DAST-10, 10-item Drug Abuse Screening Test; ED, emergency department; SD, standard deviation; ICD-9, International Classification of Diseases, Ninth Revision.
Diagnosis Category Participants, n (%) Hypertension, not otherwise specified 397 (47) Tobacco use disorder 388 (46) Depressive disorder, not elsewhere classified 361 (43) Pain in limb 296 (35) Chronic pain, not elsewhere classified 256 (30) Lumbago 244 (29) Cough 217 (26) Hyperlipidemia, not elsewhere classified/not otherwise specified 207 (24) Vaccine for influenza 201 (24) Physical therapy, not elsewhere classified 195 (23) Abdominal pain (unspecified site) 193 (23) Chest pain, not otherwise specified 192 (23) Viral hepatitis C (unspecified without mention of hepatic coma) 187 (22) Lack of housing 184 (22) Diabetes mellitus (without mention of complication, type 2 or unspecified, not stated as controlled) 180 (21) Esophageal reflux 179 (21) Backache, not otherwise specified 175 (21) Anxiety state, not otherwise specified 151 (18) Palpitations 146 (17) Acute upper respiratory infection, not otherwise specified 141 (17) ↵* Diagnosis categories are based on 2927 distinct International Classification of Diseases, Ninth Revision, codes, based on data collected for 848 participants in the 2 years before study enrollment.
- Table 4. Post Hoc Results for Statistically Significant Baseline Characteristics in Table 1
Characteristic Post Hoc P Value Substantial/Severe vs Low Substantial/Severe vs Intermediate Intermediate vs Low Demographics Age* .01 .04 ns Race† .02 ns .05 Marital status† ns ns ns Education† <.001 ns .04 Employment status† .002 ns ns Homeless in shelter or on the street ≥1 night in the past 90 days† <.001 <.001 <.001 Substance use/treatment ASI days most frequently used drug* .02 ns ns ASI drug use composite score‡ <.001 <.001 <.001 ASI drug use, any in the past 30 days† Marijuana <.001 .001 <.001 Stimulants <.001 <.001 <.001 Cocaine <.001 <.001 <.001 Amphetamines <.001 .005 .10 Opiates <.001 .02 <.001 Heroin <.001 <.001 <.001 Methadone and other opiates <.001 ns <.001 Sedatives/hypnotics/tranquilizers <.001 ns .005 Other drugs .019 ns ns ≥2 Drugs used in the past 30 days† <.001 <.001 <.001 Intravenous drug use in past 30 days† <.001 <.001 ns Goal of total abstinence from drugs† <.001 <.001 <.001 ASI alcohol use composite score‡ <.001 <.001 .001 Alcohol use, any in the past 30 days† .05 ns ns Nicotine use, any in the past 30 days† <.001 ns .002 CD treatment services† Admitted to CD treatment <.001 <.001 .009 Detoxification (not followed by CD treatment) <.001 <.001 ns Other Psychosocial ≥1 Arrest for felony or gross misdemeanor † <.001 .008 .007 HIV risk-taking score‡ <.001 .002 ns ASI family/social composite score‡ <.001 .02 .01 - Table 5. Post Hoc Results for Statistically Significant Medical and Psychiatric Characteristics in Table 2
Characteristics Post Hoc P Values Substantial/Severe vs Low Substantial/Severe vs Intermediate Intermediate vs Low Medical ED ≥1 ED visit* <.001 ns .004 Mean visits† <.001 <.001 .002 Mean costs† <.001 .001 ns Outpatient medical ≥1 Outpatient visit* ns ns ns Mean visits‡ .004 ns ns Inpatient preceded by an ED visit ≥1 Inpatient admissions* .003 .001 ns Mean admissions† .003 .01 ns Mean costs† ns .03 ns Psychiatric High psychiatric severity, ASI psychiatric status composite score >0.38* <.001 <.001 .007 ASI psychiatric status composite score† <.001 <.001 <.001 Prescribed medication for psychological or emotional problems, over lifetime* <.001 <.001 ns
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