Risk factors for symptom exacerbation among treated patients with substance use disorders

FRANÇAIS :
Des données issues d'une enquête nationale (système de contrôle de la qualité des soins chez les usagers de drogues) montrent que 2809 patients traités ont connu une exacerbation de leur symptômes. Les facteurs de risque mis en évidence sont : un jeune âge, un statut de célibataire, une instabilité de résidence, un usage à long terme de drogues, des antécédents d'arrestation ou de traitement pour alcoolisme, un diagnostic de dépendance ou d'abus, une gravité des problèmes liés à l'usage de drogues ainsi que des problèmes psychiatriques. Cependant, les patients à haut risque, qui ont suivi de longues périodes de soins psychiatriques diminuent leur risque de connaître une exacerbation de symptômes.
ENGLISH :
Aims: The purpose of this study was to develop an index of risk factors to identify patients prospectively with substance use disorders whose substance use symptoms exacerbate during or shortly after treatment, and to identify characteristics of care that may reduce the likelihood of exacerbation. Design, setting, participants: On the basis of data obtained from a nation-wide outcomes monitoring system, a group of 2809 treated patients experienced an exacerbation of their substance use symptoms. These patients were matched on baseline substance abuse problems with 5618 patients who remained stable or improved. Measurements and findings: Risk factors for substance use symptom exacerbation included younger age, non-married status and residential instability; long-term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence and more severe self-rated drug problems; and psychiatric problems. High-risk patients who obtained a longer episode of mental health care were less likely to experience an exacerbation of symptoms. Conclusions: Clinicians can identify at treatment entry patients whose substance use symptoms are likely to exacerbate and, by providing these patients a longer duration of care, may reduce the likelihood of symptom exacerbation. (Author' s abstract)