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Diffe r e nc e s in substanc e - r e late d r isk be havior be twe e n dual and tr iple e ly me ntally ill adults diagnose d se ve r Mic he lle De Co ux Ha mpto n, RN, PhD, L inda Cha fe tz, RN, DNSc , Ca rme n Po rtillo , PhD, RN, F

SLIDE 1

Diffe r e nc e s in substanc e - r e late d r isk be havior be twe e n dual and tr iple diagnose d se ve r e ly me ntally ill adults

Mic he lle De Co ux Ha mpto n, RN, PhD, L inda Cha fe tz, RN, DNSc , Ca rme n Po rtillo , PhD, RN, F AAN Unive rsity o f Ca lifo rnia , Sa n F ra nc isc o , De pa rtme nt o f Co mmunity He a lth Syste ms

SLIDE 2

Ob je c tive

 Altho ug h it is we ll e sta b lishe d tha t SMI a dults

e ng a g e in hig h-risk b e ha vio rs, it is unkno wn if the re a re diffe re nc e s in the type o f sub sta nc e - re la te d risk b e ha vio rs in whic h a dults with dua l a nd triple dia g nose s e ng a g e . T he purpo se o f this study wa s to e xa mine sub sta nc e use b e ha vio rs b e twe e n b o th g ro ups a nd to c o mpa re the m with re g a rd to the type s o f sub sta nc e s a nd ro ute s o f a dministra tio n use d in the 30 da ys prio r to study e nro llme nt.

SLIDE 3

Ba c kg ro und

Pre va le nc e a mong SMI:

Dua l dia g no sis (50-60%) (Dixon, 1999; Levin & Hennessy, 2004)
HI

V (1.7-5.0%)

HCV (19%) (Rosenberg et al, 2001)
HI

V/ HCV c o -infe c tio n (1.7%) (Rosenberg et al, 2005)

Prima ry Substa nc e - Re la te d Risk F a c tors:

DU (17-20%) (Osher et al, 2003; Strauss et al, 2006)

Sha ring no n-I

DU pa ra phe rna lia , i.e . sno rting o r sniffing e q uipme nt (Tortu et al, 2004)

Se xua l Risk Se c onda ry T

Substa nc e Use :
I

nc re a se d sub sta nc e use se ve rity is a sso c ia te d with multiple se x pa rtne rs, se x tra ding fo r drug s, a lc o ho l, o r mo ne y (Meade & Sikkema, 2007)

Hig h risk se xua l ne two rks inc lude pa rtne rs who inje c t drug s, e xc ha ng e se x

fo r g o o ds o r mo ne y, a nd/ o r a re HI V po sitive (Wright & Gayman, 2005)

SLIDE 4

Me tho ds



De sign: Se c o nda ry a na lysis o f da ta fro m a RCT

. Cro ss-se c tio na l da ta utilize d we re c o lle c te d a t e nro llme nt.



Sample (Inc lusion/ E xc lusion Cr ite r ia):

e nt Study (N=309): Included participants ≥18yo, admitted to residential crisis a program, English-spe a king

r e nt study (N=252): Excluded participants who denied any lifetime history of substance use or spent ≥3

we e ks in the ho spita l in the 30 da ys prio r to e nro llme nt



Data and Me asur e me nt:

Standar

dize d, se lf-r e po r t instr ume nts inc lude d:

Addic tio n Se ve rity I

nde x – life time a nd pre vio us 30 da ys sub sta nc e use

Qua lity o f L

ife I nte rvie w – so c io -de mo g ra phic c ha ra c te ristic s, i.e . a g e , ra c e , ho me le ssne ss, e tc .

Clinic al and Billing Re c o r

ds:

Me dic a l re c o rds fro m re side ntia l c risis pro g ra ms inc lude d c o mpre he nsive he a lth a sse ssme nt a nd

dia g no stic da ta

Me nta l he a lth se rvic e utiliza tio n re c o rds to de te rmine e lig ib ility



Analysis:

Utilize d SPSS, ve rsio n 11.0 to c o mpa re sub je c ts with dua l a nd triple dia g no se s using de sc riptive (t-te sts a nd

c hi-sq ua re ) a nd lo g istic re g re ssio n a na lyse s

SLIDE 5

Re sults

 Prima ry Sa mple Cha ra c te ristic s

 White (n=113, 44.8%)  Ma le (n=175, 69.4%)  Me a n a g e 38±9.8  No n-sc hizo phre nia dx (n=176, 69.8%)

 HI

V a nd HCV Dia g no se s

 HI

V o r HCV (triple dx’ d): n=64 (25.4%)

 HI

V o nly: n=15(6.0%)

 HCV o nly: n=38 (15.1%)  HI

V a nd HCV: n=11 (4.4%)

SLIDE 6

Re sults:

L ife time a nd Re c e nt I DU b y HI V/ HCV Sta tus

No HIV (N=237) HIV (N=15) χ2 p n(%) n(%) IDU 30 6.54 .03 No 211(89.0) 10(66.7) Yes 26(11.0) 5(33.3) IDU lifetime 7.72 .01 No 174(73.4) 6(40.0) Yes 63(26.6) 9(60.0) No HCV (N=214) HCV (N=38) χ2 p n(%) n(%) IDU 30 4.98 .03 No 192(89.7) 39(79.6) Yes 22(10.3) 10(20.4) IDU lifetime 49.98 <.0001 No 171(79.9) 9(23.7) Yes 43(20.1) 29(76.3)

SLIDE 7

Re sults:

 L

gistic Re gr

e ssion: Substanc e s Use d

 Amphe ta mine s (a OR 2.6,

p=.05)

 *Numb e r o f drug s use d

ve r life time (a OR 1.6,

p<.0001)

 L

gistic Re gr

e ssion: Route s

f Administr

ation

 I

DU (a OR 3.9, p=.001)

 *Ag e (a OR 1.04, p=.03)

*Co ntinuo us va ria b le

SLIDE 8

Co nc lusio ns

Adults with T

D e ngage d in mor e se ve r e substanc e - r e late d r isk be havior s than those with DD

ndividua ls with T D we re 3.9 time s mo re like ly to re po rt re c e nt I DU a nd 2.6 time s mo re like ly to use a mphe ta mine s. T he y we re a lso sig nific a ntly o lde r a nd use d mo re drug s o ve r the life time .

ndividua ls with T D a nd DD did no t diffe r with re g a rd to the ir use o f a lc o ho l to into xic a tio n, c o c a ine , c ra c k, o r ma rijua na , no r b y use o f no n-inje c tio n ro ute s inc luding smo king c ra c k a nd na sa l ro ute s.

he re fo re , the re re ma ins a hig h risk fo r tra nsmissio n o f HI V/ HCV a mo ng T D to

the rs a nd a hig h risk fo r e xpo sure a mo ng DD individua ls a s we ll.



HIV and HCV Pr e ve ntion Studie s T ar ge ting SMI:

Of 8 studie s lo c a te d tha t a ddre ss HI

V/ HCV pre ve ntio n a mo ng SMI , 2 ide ntifie d sub sta nc e use b e ha vio r c ha ng e wa s a c o mpo ne nt o f the inte rve ntio n, b ut a ll fo c use d prima rily o n se xua l risk b e ha vio r a s the prima ry o utc o me .

Due to the hig h ra te o f dua l dia g no sis a mo ng SMI

a nd the po te ntia l e xpo sure to HI V a nd HCV tha t re sults fro m o ng o ing sub sta nc e use , pre ve ntio n e ffo rts tha t e mpha size o nly se xua l risk will like ly b e ine ffe c tive . E vide nc e -b a se d me tho ds a ime d a t a ddre ssing the risks/ ne e ds o f sub sta nc e using po pula tio ns mig ht b e mo re e ffe c tive if imple me nte d with this g ro up.

SLIDE 9

Re c o mme nda tio ns

De ve lop inte rve ntions to a ddre ss the unique ne e ds/ risks of SMI by:
I

nte g ra ting me nta l he a lth a nd sub sta nc e use tre a tme nt stra te g ie s (Drake, 2007)

Utilizing o r a da pting e vide nc e -b a se d inte rve ntio ns de ve lo pe d fo r sub sta nc e using

individua ls o r pe o ple living with HI V/ AI DS fo r individua ls with SMI (Hampton et al, 2012)

nc o rpo ra ting stra te g ie s tha t ha ve b e e n e ffe c tive in sub sta nc e using po pula tio ns inc luding : inte nsive c o unse ling , e duc a tio n, a nd ha rm re duc tio n (Drake, O’Neal, & Wallace, 2008)

Ha rm re duc tion stra te g ie s mig ht inc lude :
E

duc a tio n to pre ve nt initia tio n a nd/ o r tra nsitio n to I DU (Bravo eta l, 2003)

Outre a c h to me tha mphe ta mine use rs who mig ht no t utilize ne e dle -syring e pro g ra ms (Cao

& Treolar, 2006)

Aug me nt ne e dle -syring e pro g ra ms with sa fe smo king a nd/ o r sno rting de vic e s (Leonard et al,

2008)