Substance Use and Acute Inpatient Psychiatry: Identifying Factors Associated with Receipt of Addiction Care

Abstract

Integrated care models are evidence-based approaches that advocate for identifying and simultaneously treating mental illness and problematic substance use. However, in psychiatric settings, current literature suggests that mental illnesses are often recognized and managed, whereas problematic substance and/or alcohol use may not always be addressed, often requiring care elsewhere. This pattern of care is concerning as individuals with concurrent conditions report higher rates of unmet care needs. Little research has examined the factors which allow for better detection and treatment of substance use for patients with concurrent mental illness and problematic substance and/or alcohol use. This thesis aims to explore the receipt of addiction care for patients with identified substance use within inpatient psychiatry. In particular this thesis will (i) examine the proportion of patients with first time admission to inpatient psychiatry who used substance and/or alcohol, (ii) identify the characteristics of patients admitted for an addiction and, (iii) identify the factors associated with receipt addiction care within acute psychiatry. This study utilized data from the Ontario Mental Health Reporting System (OMHRS) which is based on the Resident Assessment Instrument for Mental Health (RAI-MH). The analytic sample included 21946 inpatients with identified substance and/or alcohol use, admitted between 2006 and 2018. Prevalence and demographic characteristics of those with substance and/or alcohol use were established. The variables significantly associated with the addiction reason for admission were identified. Independent variables were separated into blocks and modelled independently by the dependent variable, receipt of addiction care. The variables from independent block models were used in multivariable logistic regression analyses that were developed to examine factors associated with addiction care receipt during an acute episode of care in inpatient psychiatry. Of the 21946 individuals with current problematic substance and/or alcohol use, 46.4% were admitted for addiction and 48.4% received addiction care during their acute stay. The majority of patients admitted for addiction were 25 to 44 years old, male, had completed greater than high school, were unemployed and, were never married. The multivariable logistic regression model identified several variables associated with receiving addiction care in acute psychiatry. Having a pre-existing substance use disorder, a CAGE score of 1+, addiction reason for admission and, displaying withdrawal symptoms increased the odds of addiction care receipt. Alternatively, patients that were involuntarily admitted to inpatient psychiatry or those at risk of self-harm (identified though SoS scale) had decreased odds of receiving addiction care. While half of all of those admitted for the first time to inpatient psychiatry had problematic substance use, only a quarter received addiction care. Care providers should consider withdrawal symptoms and the CAGE questionnaire to identify patients with an addiction treatment need. Indicators of severe mental illness and self-harm reduced the odds of receiving addiction care. There is a need for integrated addiction care that can support patients who use substances and have severe conditions.