Referral for substance abuse treatment and depression improvement among patients with co-occurring disorders seeking behavioral health services in primary care

• Published in: Journal of substance abuse treatment Vol. 46; no. 2; pp. 106 - 112
• Main Authors: Chan, Ya-Fen, Ph.D., M.H.S., M.S.N, Huang, Hsiang, M.D., M.P.H, Bradley, Katharine, M.D., M.P.H, Unützer, Jürgen, M.D., M.P.H., M.A
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2014; Elsevier; Elsevier Limited
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Confidence intervals; Delivery of Health Care, Integrated - organization & administration; Depression; Depressive Disorder - complications; Depressive Disorder - therapy; Desintoxication. Drug withdrawal; Diagnosis, Dual (Psychiatry); Drug addiction; Drug use; Female; Humans; Integrated care; Male; Medical sciences; Mental depression; Middle Aged; Miscellaneous; Patient Acceptance of Health Care; Primary care; Primary health care; Primary Health Care - methods; Propensity Score; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Referral and Consultation - statistics & numerical data; Referrals; Substance abuse; Substance abuse treatment; Substance abuse treatment referral; Substance use disorder; Substance-Related Disorders - complications; Substance-Related Disorders - rehabilitation; Treatment; Treatment Outcome; Treatment Refusal; Treatments; Substance use disorder; Depression; Integrated care; Substance abuse treatment referral; Primary care; Mood disorder; Human; Drug addiction; Poison withdrawal; Managed care; Primary health care; Patient; Substance abuse; Health service; Improvement; Concomitant disease; Addiction; Health behavior; Mental disorder; Healthcare; Drug of abuse; Public health
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2013.08.016

Abstract This study examined the relationship between substance treatment referrals and depression improvement among 2,373 participants with concurrent substance use and depressive disorders enrolled in an integrated behavioral health program. Three groups of substance treatment referral status were identified: accessed treatment ( n = 780), declined treatment ( n = 315), and no referral for treatment ( n = 1278). The primary outcome is improvement in depressive symptoms (PHQ-9 < 10 or ≥ 50% reduction). Using propensity score adjustments, patients accessing substance treatment were significantly more likely to achieve depression improvement than those who declined receiving treatment services (hazard ratio (HR) = 1.82, 95% confidence interval (CI): 1.50–2.20, p < 0.001) and those without a referral for treatment (HR = 1.13, 95% CI: 1.03–1.25, p = 0.014). Each 1 week delay in initiating a referral was associated with a decreased likelihood of depression improvement (HR = 0.97, 95% CI: 0.96–0.98, p < 0.001). Study findings highlight the need of enhancing early treatment contact for co-occurring substance use disorders in primary care.