Substance Use and Mental Health Disorders Prevalent Among Patients with High-Risk Diabetes

• The majority of health care resources in the U.S. are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions).
• Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional health care costs, but they are understudied among high-need patients.
• This study, part of CTN-0057 (SBIRT in Primary Care) is the first to document a comprehensive pattern of SUD and MHD prevalence among adults with high-risk diabetes. In the study, researchers examined the how common SUD and MHD were in this population, and what patient characteristics seemed related to their presence, among adults with high-risk diabetes.

A risk algorithm developed from Duke University Health System electronic health records (EHRs) data was used to identify patients with high-risk diabetes for targeting home-based primary care. The EHR data of the 263 patients identified were analyzed to understand patterns of SUDs and MHDs to better inform care-coordinating efforts.

Both SUDs and MHDs were prevalent in this patient group, with 81.7% of the sample having SUD or MHD. A few of the numbers:

Substance use disorders:

48.3% any SUD

12.5%  alcohol

38.8% tobacco

23.2% drug

Mental health disorders:

74.9% any MHD

53.2% mood

37.3% sleep

32.7% anxiety

14.8% schizophrenia/psychotic/delusional

14.4% dementia/delirium/amnestic/cognitive

9.1% adjustment

Elevated odds of SUD were noted among men (tobacco, alcohol) and those who were never married (alcohol, cannabis). African American race (vs. other race/ethnicity) was associated with lower odds of anxiety disorders.

Conclusions: While data are limited to one large academic health system, they provide clinical evidence revealing that 82% of patients with high-risk diabetes had SUD and/or MHD recorded in their health records, highlighting a need for developing service models to optimize high-risk care. With policy shifts toward value-based care, the time is right for allocating resources to investigate the magnitude of SUDs and associated comorbidities, and implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) approaches, as well as office-based treatment of alcohol and opioid use disorders for high-need, high-risk patients with diabetes.

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