Utilization of mental health and substance abuse services among homeless adults in Los Angeles

OBJECTIVES: Even though psychiatric disorders are disproportionately present among the homeless, little is known about the extent to which homeless people receive treatment for those problems or the factors that are associated with receiving treatment. This article examines utilization and predictors of mental health and substance abuse treatment among a community-based probability sample of homeless adults. METHODS: The data analyzed here were collected through face-to-face interviews with 1,563 homeless individuals. Bivariate analyses examined differences between homeless men and women in (1) the prevalence of major mental illnesses and substance dependence and (2) utilization of inpatient and outpatient treatment services for those with specific diagnoses. Logistic regression analyses identified predictors of mental health treatment among those with chronic mental illness and substance abuse treatment among those with recent substance dependence. RESULTS: Two-thirds of these homeless adults met criteria for chronic substance dependence, whereas 22% met criteria for chronic mental illness, with substantial overlap between those two disorders: 77% of those with chronic mental illness were also chronic substance abusers. Only one-fifth of each of those two groups reported receiving treatment for those disorders within the last 60 days. Mental health service utilization was predicted largely by factors related to need (eg, diagnosis, acknowledgment of a mental health problem), whereas substance abuse service utilization was predicted by myriad additional factors, reflecting, in part, critical differences in the organization and financing of these systems of care. CONCLUSIONS: More attention must be directed at how to better deliver appropriate mental health and substance abuse services to homeless adults.     

Prevalence,risk and protective factors for substance abuse among homeless males living in Tehran

Background: Substance use is significantly more prevalent among the homeless, compared to the general population. However, the risk and protective factors for substance abuse among homeless population have not been well defined. Objectives: We examined risk and protective factors for substance abuse among homeless in Tehran. Methods: A total of 193 homeless people from Tehran were interviewed during the autumn 2015 about substance and alcohol use and other social factors associated with drug use disorders. A binary logistic regression model was used to examine the relationship between substance abuse and a set of predictive variables. Results: Prevalence of drug abuse was 61.14% (95% CI: 55.20, 68.8). The most frequent used drugs were recognized to be: heroin, methamphetamine, and opium with prevalence rates of 51.54%, 36.08%, and 16.49%, respectively. Having a stronger social network and being married were of protective factors, while smoking and having history of incarceration turned out to be the risk factors for substance abuse among Iranian homeless people. Conclusion: Results suggested that risk and protective factors may be substantial mechanisms by which to improve substance abuse consequences and apply better contextualize prevention as well as planning early intervention policies for the homeless men.     

Acute pain and substance abuse in surgical patients

Studies have determined that nurses and physicians undermedicate patients for postoperative pain as a result of inadequate knowledge and erroneous attitudes. Fear of addiction seems to be the major reason for this undertreatment. A patient who abuses drugs requires larger than usual doses of narcotics postoperatively; however, larger doses are rarely given. This article emphasizes factors influencing the postoperative pain experience and presents 3 case studies to illustrate pain management in patients who abuse substances.     

Acute septic cholecystitis in patients with burn injuries

Acute cholecystitis continues to be a life-threatening complication in patients after trauma. In an 18-month period we have recognized and treated five patients with burn injuries who had acute cholecystitis. They ranged in age from 13 to 40 years. Four of the five patients had positive blood cultures and all five patients had positive bile cultures. The diagnosis was made on the basis of unexplained sepsis and an abnormal sonogram or hepatobiliary scan. Four patients underwent cholecystectomy and one patient underwent a cholecystostomy. Four patients survived and were discharged from the hospital. All five patients were receiving nutritional support. Factors such as prolonged fasting, dehydration, narcotic administration, and sepsis have been suggested as contributing factors in the development of acute cholecystitis. Acute cholecystitis is a serious complication in such patients and must be considered and treated promptly. Serial ultrasound studies have been helpful in managing patients suspected of having acute septic cholecystitis.     

Tobacco cessation with patients recovering from alcohol and other substance abuse.

This article focuses on the problem of tobacco cessation in the patient recovering from alcohol or other substance abuse. The authors review the epidemiology of the problem, specific health risks to this population from continued tobacco use, and recent research findings that address previous treatment concerns. Recommendations for counseling by physicians are made. These include an algorithm for determining the patient's stage of readiness for making a quit attempt, specific counseling tasks based on the patients stage, and motivational counseling strategies aimed at increasing the patients motivation to quit.     

Infection prevention and treatment in patients with major burn injuries

Infection is a significant challenge in burn care, particularly for those patients who have major burn injuries. This article aims to review the literature and establish best practice in prevention and treatment of infection in patients with major burns. The article considers the causes and clinical features of wound infection, and examines systemic and local methods of prevention and treatment.     

Assault injuries in the Gold Coast region

Assault is a major cause of preventable morbidity in our community. This survey of 154 victims of assault attending the Gold Coast Hospital examines the circumstances of assault injuries in the local community, and demonstrates that emergency departments have a role in gathering useful data for public health initiatives.     

Medical complications of substance abuse.

Substance abuse is involved in many instances of intentional and unintentional injury. It can also cause medical complications that affect various organ systems--among them, the cardiac, vascular, neurologic, pulmonary, gastrointestinal, immunologic, and reproductive systems. Even though there is pressure to create a new medical specialty to specifically address substance-abuse issues, the truth is that any physician, regardless of specialty, may encounter patients with substance-abuse problems. Alcoholism and drug abuse, with their associated psychosocial and clinical ramifications and complications, cut across all specialty fields. Consequently, all physicians need to be familiar with the spectrum of clinical problems associated with substance abuse and comfortable with addressing these problems prudently and promptly.     

Nurses respond to substance abuse.

Because of their close contact with the community, nurses are vital in caring for substance abusers and in preventing addiction. And their roles in community and national programmes in this area are increasing. Below, an overview of the problems associated with substance abuse and how nurses are needed to provide effective care, prevention and education.     

Post-traumatic stress disorder in hospitalized patients with burn injuries

The degree to which patients hospitalized for a major burn displayed symptoms of post-traumatic stress disorder or met the full criteria for this disorder was assessed during the course of hospitalization. Fifty-four consecutive patients were screened weekly for symptoms of post-traumatic stress disorder. Sixty-three percent showed intrusive recollections of the initial trauma (partial diagnostic criteria) and 16 (29.6%) of the sample met full criteria for post-traumatic stress disorder at some point during the hospitalization. None of the patients met the full diagnostic criteria at discharge from the hospital, although one did at follow-up. Post-traumatic stress disorder was found to be related to patients' total body surface area burn, length of hospital stay, sex (female patients), and lack of responsibility for the injury. The results suggest that although post-traumatic stress disorder in patients with burn injuries generally resolves without interventions other than standard hospital care, it might be preventable if patients who are at risk for developing it receive appropriate psychologic treatment soon after the injury.     

Alcohol and substance abuse

Substance abuse and dependence is a public health problem with far-reaching societal implications. The acute toxicity of substances of abuse and medical consequences of chronic use are substantial. On a more optimistic note, a great deal of progress has been made in understanding and treating substance use disorders. Expanding knowledge concerning the neurobiology of substances of abuse and substance use disorders has led to a growth in pharmacotherapeutic treatment options. A growth in understanding of behavioral processes, motivational issues, and processes of behavioral change has been important in designing new and increasingly more effective psychosocial treatments. A growing body of evidence indicates that the treatment of substance use disorders can be effective, making early diagnosis and treatment or referral increasingly important.