OHSU addiction researchers find opportunity for intervention

Honora EnglanderPatients with substance use disorders often suffer from and are hospitalized due to chronic illnesses that cause medical conditions such as abscesses and cardiovascular disease. Hospitalization temporarily disrupts drug use and can bring patients an increased awareness of mortality, the harmful effects of substance use, and its costs on relationships, including parenting.

Some evidence also suggests that initiating medication-assisted treatment during these hospitalizations can increase the likelihood of patients engaging in substance use disorder treatment after discharge. However, these interventions have shown high rates of attrition in treatment. Little research has been conducted on factors associated with these individuals’ readiness to change.

Now, a team of OHSU addiction medicine researchers has published in the Journal of General Internal Medicine findings that provide insights into the patient, provider, and health system factors that can be used to initiate and coordinate addiction care.

Addiction medicine specialist Honora Englander, M.D., associate professor in the School of Medicine Division of Hospital Medicine and medical director of the OHSU Community & Clinical Integration Medicine Teaching Service, led the research, which was designed to better understand factors that impact readiness to change.

The study used patient perspectives to identify influences on their motivation to change and to engage in treatment during hospitalization. Researchers interviewed hospitalized adults admitted to OHSU medical or surgical units who reported as high-risk for alcohol or drug use. The team found that while many participants were interested in treatment, the participants also saw significant barriers to obtaining care after discharge, including homelessness and trauma. Patients suggested higher success rates could be influenced by improved care coordination and more timely transition from inpatient to outpatient treatment. Participants valued providers who understood substance use disorders and the importance of treatment choice.

The research found that hospitalization provides an excellent opportunity for treatment of substance use disorders, and that understanding patient perspectives on treatment options might improve the outcomes of these interventions. The researchers reported that the patient’s voice is critical in shaping system improvements and best practices.

As part of the Springer Nature SharedIt initiative, the paper is available to the public.
In addition to Englander, the study was conducted by Todd Korthuis, M.D., M.P.H., associate professor in the OHSU-PSU School of Public Health and in the School of Medicine Division of Internal Medicine; Christine Velez Klug, M.S.W., instructor in Community & Clinical Integration and the PSU School of Social Work; and Christina Nicolaidis, M.D., M.P.H., professor and senior scholar in the PSU Social Determinants of Health Initiative and associate professor in the School of Medicine Division of Internal Medicine and OHSU-PSU School of Public Health.