Changing Characteristics of Individuals Admitted to Residential Treatment for Opioid Use and Mental Health Disorders

BACKGROUND AND PURPOSE: Few studies have examined differences between baseline characteristics of opioid and nonopioid users with co-occurring disorders entering residential treatment. To date, no studies have explored how these baseline characteristics may have changed as the opioid epidemic worsened between 2013 and 2017. It is important to understand baseline characteristics because they highlight key risk and protective factors for individuals entering treatment, such as medical conditions, legal problems, employment status, and whether individuals in treatment have supportive family or social relationships. Such baseline characteristics can allow treatment to be tailored to individuals’ specific needs, and are predictive of retention or dropout from treatment. Being able to tailor treatment for individuals with co-occurring disorders is especially important because this population has greater risk of polysubstance use, suicide, illnesses, violence, victimization, and early death.

Filling gaps in the literature that can help inform treatment protocols is critical as society grapples with an intensifying epidemic. In 2016, 11.8 million individuals misused opioids, and 2.1 million people had an opioid use disorder. Each day over 115 people in the United States overdose on opioids, a number that far exceeds annual car accident fatalities. In 2015 alone, the opioid epidemic cost $504 billion. Recognizing the mounting crisis, President Trump declared that opioid misuse is a public health emergency in 2017.

METHODS: Data were drawn from 1535 individuals treated during 2013 and 2017 at one of three private residential treatment centers that provide integrated treatment for co-occurring substance use and mental disorders. The Addiction Severity Index (ASI) measured substance use behaviors, mental health indicators, and addiction severity across the following seven areas: (1) medical, (2) employment, (3) alcohol consumption, (4) drug use, (5) legal problems, (6) family or social support, and (7) psychiatric outcomes. Using t-tests for continuous variables and Chi-square tests for categorical variables, we compared ASI scores on each of the indices between 2013 and 2017 for both opioid and non-opioid users. Analyses were conducted in SPSS 25.

RESULTS: Our study found that 2017 opioid users’ baseline ASI scores indicated a more severe clinical profile in the following areas: employment, alcohol, and drugs. Both opioid and non-opioid users had less severe medical and legal problems, and more severe psychiatric problems in 2017 than 2013. Non-opioid users only experienced less family support in 2017 than 2013. In 2017, opioid users had higher rates of alcohol consumption, alcohol intoxication, cocaine use, and other opiate use. Both opioid and non-opioid users had higher rates of polysubstance use, depression, anxiety, hallucinations, and suicidal ideation in 2017 compared to 2013.

IMPLICATIONS: This study’s findings have important implications for treatment providers and policy makers alike. The more severe clinical presentation of opioid users in 2017 underscores the need for more substance use treatment programs to address both co-occurring disorders and polysubstance use.