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Comparison of Health Service Use Among Veterans With Methamphetamine Versus Alcohol Use Disorders

Morasco, Benjamin J. PhD; O'Neil, Maya E. PhD; Duckart, Jonathan P. MPS; Ganzini, Linda MD, MPH

doi: 10.1097/ADM.0000000000000005
Original Research

Objectives: Methamphetamine use disorders (MUD) are associated with severe health effects and psychiatric comorbidities, but little is known about the health care utilization of patients with MUD. The goal of this study was to describe health service use among veterans with MUD relative to a group of veterans with an alcohol use disorder (AUD).

Methods: Using Veterans Affairs (VA) administrative data, we identified 718 patients who were diagnosed with MUD and had confirmatory drug testing. Data were compared with those of 744 patients who had diagnoses of an AUD also with confirmatory testing. We examined diagnoses and medical utilization for 5 years after their index date.

Results: Patients with MUD and laboratory-confirmed recent use were younger and more likely to be diagnosed with a mood disorder, posttraumatic stress disorder, and a psychotic-spectrum disorder (all P values < 0.05). After statistical controls, patients with MUD were more likely to have an inpatient hospitalization (80% vs 70%, odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.4-2.3), discharge from an inpatient admission against medical advice (23.4% vs 8.3%, OR = 2.6, 95% CI = 1.9-3.7), receive care at 3 or more VA medical centers (13.1% vs 5.4%, OR = 2.3, 95% CI = 1.5-3.5), have a behavioral flag in the medical record (5.6% vs 1.1%, OR = 4.6, 95% CI = 2.1-10.6), and have more total missed appointments in the 5-year study period (M = 33.1 vs M = 23.5, P < 0.001).

Conclusions: Among veterans with substance use disorders, those with MUD and laboratory-confirmed recent use have additional behavioral, health care utilization, and psychiatric characteristics that need to be considered in developing programs of care.

From the Mental Health and Clinical Neurosciences Division (BJM, MEO, LG), Portland VA Medical Center, Portland, Oregon; Department of Psychiatry (BJM, MEO, LG), Oregon Health & Science University, Portland, Oregon; Portland Center for the Study of Chronic Comorbid Mental and Physical Disorders (BJM, MEO, JPD, LG), Health Services Research and Development, Portland VA Medical Center, Portland, Oregon.

Send correspondence and reprint requests to Benjamin Morasco, PhD, Portland VA Medical Center (R&D99), 3710 SW US Veterans Hospital Road, Portland, OR 97239. E-mail: benjamin.morasco@va.gov.

Supported in part by award 018165 from the National Institute on Drug Abuse to Drs. Ganzini and Morasco, as part of the Methamphetamine Research Center at the Portland VA Medical Center and Oregon Health & Science University. Dr Ganzini, Dr O'Neil, and Mr Duckart were supported in part by grant REA 06-174 from the VA Health Services Research and Development service. Dr Morasco received funding from grant K23DA023467 from the National Institute on Drug Abuse.

The authors declare no conflicts of interest.

The content of this manuscript is solely the responsibility of the authors anddoes not necessarily represent the official views of the Department of Veterans Affairs or the National Institute on Drug Abuse.

Received May 24, 2013

Accepted October 12, 2013

© 2014 American Society of Addiction Medicine