Medical and Mental Health Status among Drug Dependent Patients Participating in a Smoking Cessation Treatment Study
Lima, Jennifer E., Reid, Malcolm S., Smith, Jennifer L., Zhang, Yulei, Jiang, Huiping, Rotrosen, John, Nunes, Edward, Journal of Drug Issues
Substance abusers have a large number of medical and psychiatric problems, and 70-90% are smokers. The aim of this analysis was to examine the prevalence and correlates of medical and psychiatric problems in this sample of drug dependent patients who were participants in a multi-site study of smoking cessation interventions while engaged in substance abuse treatment. Descriptive analyses showed 72.8% of participants had at least one medical problem at baseline and 64.1% had at least one psychiatric diagnosis. Medical problems correlated strongly with age, smoking severity, and pack-years; psychiatric problems correlated with gender and ethnicity. Smoking cessation treatment was associated with a moderate reduction in the ASI Medical composite score. More research is needed on the possible effects of combined treatment of substance abuse and concurrent medical and psychiatric problems. Offering smoking cessation in conjunction with primary care may be a way to address the health needs of this population.
In 2005, the National Institute on Drug Abuse (NIDA), Clinical Trials Network (CTN) completed a multi-site clinical trial looking at smoking cessation interventions in substance abuse treatment programs (Reid, Fallon, Sonne, Flammino et al., 2007; Reid, Fallon, Sonne, Nunes, et al., 2007). Though the treatment study achieved modest results, the clinic staff conducting the trial began to see the unique opportunity this trial presented in increasing participants' exposure to medical care and addressing various health problems that are endemic to the substance abusing population. The impact of addiction on various body systems is well known. The effects of alcohol on the liver (Diehl, 1998) and the brain (e.g., Wernicke-Korsakov syndrome), stimulant and opioid use on the brain (NIDA, 2008), and tobacco on the respiratory and cardiovascular systems (Centers for Disease Control, 2003), have been well documented. The complex health needs of substance users with HIV and tuberculosis, has also been well documented (Hermann & Gourevitch, 1997), as well as increased the number of emergency room visits and hospitalizations among this population (Byrne et al., 2003; Freidmann, Zhang, Henrickson, Stein & Gerstein, 2003). The health effects, however, of living a chronic lifestyle of addiction without regular access to primary care, is less well documented. Several recent studies discuss the broader health issues faced by substance abusers (DeAlba, Samet, & Saitz, 2004; Druss & von Esenwein, 2006; Friedmann et al., 2006) and their access to primary medical care. A clear picture of the broader health care needs of substance abusers and how to address these as part of their substance abuse treatment is lacking in the current literature. Features of the lifestyle of chronic drug dependence that would be expected to adversely impact health include poor self-care (e.g., poor nutrition, poor general hygiene, poor dental hygiene, and poor sleep hygiene), exposure to trauma (both psychological and physical), and failure to access health care. Chronic stress and intermittent trauma typical of the addict lifestyle are also likely to promote psychiatric problems, including depression and anxiety, both through direct effects (e.g., depression is now an established risk factor for coronary vascular disease; Williams & Steptoe, 2007) and by interfering with self-care. Those with addictions tend to seek medical or psychiatric treatment primarily in crisis situations (Byrne et al., 2003), when health care providers can focus only on the emergent medical issues, and not on other less urgent health needs.
In order to better present the medical and mental health problems experienced by persons in substance abuse treatment, we performed a secondary analysis of medical and psychiatric health status and health outcomes among patients in treatment for drug dependence who enrolled in a clinical trial of a smoking cessation intervention. …