Literature Collection

ObjectiveThis paper summarizes methods and initial overdose-related results from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) project. ROAR CANADA is a longitudinal observational study of individuals with severe concurrent substance use and mental disorders (also called dual disorders or dual diagnosis). The study sampled patients treated at two tertiary treatment centres in British Columbia, Red Fish Healing Centre and Heartwood Centre, along with a concurrent treatment unit at St. Joseph's in Ontario. These facilities have implemented evidence-based integrated treatment programs. Our first analysis explores selected baseline characteristics as potential risk factors for drug overdose in this population.MethodSociodemographic factors, trauma history, and impulsivity were part of a more comprehensive longitudinal assessment. In this first investigation, we use bivariate analysis and logistic and linear regression modelling to examine these variables in relation to overdose history.ResultsOverall, 291 of 450 participants (64.7%) reported a history of ≥1 overdose. Across the three centres, patients had a lifetime average of 7.6 (SD = 12.9) overdoses. The prevalence and mean number of overdoses were somewhat higher among Red Fish patients (74.5% and 8.5, respectively). Adverse childhood events, lifetime trauma history, and impulsivity were all high, but only lifetime trauma history emerged as significantly associated with overdose across all treatment centres. Impulsivity indicators were selectively associated with overdose by site, but not consistently within the overall sample.ConclusionsThese results highlight the importance of prioritizing trauma-informed care in the treatment of individuals with severe concurrent substance use and mental disorders, who are at high risk of overdose. The integration of trauma treatment into existing programs may enhance patient outcomes and contribute to the ongoing evolution of effective care strategies for this complex population. These findings are particularly relevant in light of the overdose crisis.Plain Language Summary TitleEnhancing Integrated Treatment Programs for Severe Concurrent Substance Use and Mental Disorders: Insights on Overdose from the ROAR CANADA Project.; OBJECTIVE: This paper presents the methods and initial findings from the Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction (ROAR CANADA) project. ROAR CANADA is a longitudinal study of individuals with severe substance use and severe mental disorders (concurrent or dual disorders). The study included patients from two BC treatment centers, Red Fish Healing Centre and Heartwood Centre, as well as a treatment unit at St. Joseph's in Ontario, all of which use a comprehensive integrated treatment program. Our initial analysis focused on identifying transdiagnostic risk factors for drug overdose. METHOD: We assessed sociodemographic factors, trauma history, and impulsivity as part of a broader longitudinal evaluation. Using bivariate analysis and logistic and linear regression models, we examined the relationship between these factors and overdose history. RESULTS: Out of 450 participants, 291 (64.7%) reported having experienced one or more overdoses, with an average of 7.6 overdoses per person. Patients at Red Fish had a slightly higher average (8.5 overdoses) and prevalence (74.5%) of overdoses. High rates of adverse childhood events, lifetime trauma, and impulsivity were observed. However, only lifetime trauma was consistently associated with overdose risk across all treatment centers. Impulsivity was linked to overdose risk in some locations but not across the entire sample. CONCLUSIONS: The findings underscore the importance of trauma-informed care in treating individuals with severe concurrent substance use and severe mental disorders.; eng

OBJECTIVES: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. METHODS: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. RESULTS: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). CONCLUSIONS: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.

INTRODUCTION: Older adults face significant health risks owing to gaps in the management of polypharmacy and medication adherence, as well as the integration of physical and mental health needs. Current models do not fully address these challenges. This study introduced the Safety, Efficacy, and Adherence (SEA) model designed to enhance interdisciplinary collaboration, improve medication management, and integrate care for older adults. This model addresses the core drivers of poor health outcomes: (1) medication adherence challenges, (2) social determinants of health, (3) polypharmacy, (4) team-based care with family support for deprescribing, and (5) psychosocial factors related to aging. METHODS: The SEA model was developed through a structured literature review focusing on medication safety, polypharmacy, behavioral health integration, home safety inspections and adherence. It draws on frameworks such as the Chronic Care Model, Interprofessional Collaborative Care for Older Adults, and Consolidated Framework for Implementation Research. This model fosters interdisciplinary collaboration by integrating pharmacists, primary care providers, mental health professionals, substance use treatment, and family suppowrt, and it is adaptable to diverse clinical settings. RESULTS: The SEA model assessed short- and long-term outcomes. Potential short-term effects included improved medication adherence, enhanced team coordination, and reduced occurrence of adverse drug events. Long-term goals and possible effects included better chronic disease management, fewer hospitalizations, and improved quality of life for older adults. The model's scalability allows for application across various healthcare settings, although further testing is required for validation. CONCLUSION: The SEA model provides a comprehensive framework for addressing the complex needs of older adults by focusing on medication SEA. Two vignettes, one clinical and one organizational, demonstrate the practical application of the model in patient care and implementation science. By improving interdisciplinary collaboration and addressing social and behavioral factors, in home safety for medications, this model aims to reduce polypharmacy and hospitalization. Based on existing evidence-based frameworks, this model would benefit from future studies to validate its effectiveness in diverse settings.

The United States Preventive Services Task Force (USPSTF) recommends routine screening for alcohol use disorders in adults 18 years or older using one to three validated tools. One favored tool is the Alcohol Use Disorders Identification Test-Concise (AUDIT-C), a brief three-item questionnaire noted for its ease of implementation, sensitivity, and specificity. A positive screen on the AUDIT-C should prompt brief behavioral health counseling to help reduce harmful drinking patterns. Before this quality improvement project, the Texas Tech University Health Sciences Center (TTUHSC) El Paso Internal Medicine Residency Clinic did not routinely use the AUDIT-C and its residents had not received training in alcohol-related behavioral health counseling. In response, the AUDIT-C was integrated into the clinic's electronic medical record (EMR), and residents received instruction on alcohol use disorder counseling from a certified physician in Addiction Medicine. This intervention enhanced compliance with USPSTF recommendations and provided an opportunity to evaluate alcohol use in a primarily Hispanic border population. A total of 39 patients reporting alcohol use were screened with the AUDIT-C; 34 screened positive and five screened negative. Among the patients who received behavioral health counseling, 12 completed a post-counseling survey to assess their drinking habits. The survey revealed that 10 (83%) of these patients had never previously received counseling. Furthermore, nine (75%) found the counseling helpful, eight (67%) were surprised by the unhealthiness of their drinking habits, and nine (75%) felt comfortable during the session. Additionally, eight (67%) expressed a willingness to consider changing their drinking behaviors. Among those unwilling to change, five patients did not perceive a problem with their drinking, while one patient did not wish to reduce alcohol consumption. These findings demonstrate a strong willingness among El Paso residents to discuss problematic alcohol use within the clinical setting. The positive patient responses support the broader implementation of the AUDIT-C in practice and underscore the importance of training clinicians in effective intervention techniques.