Substance Abuse Survey (Fall 2002)


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  • Using PracticeNet TM , a unique internet-based data collection infrastructure, the APA Practice Directorate conducted a survey of practicing psychologists regarding assessment and treatment of substance use. The survey was conducted September 17 - October 16, 2002.
  • Substance Abuse Survey (Fall 2002)

    1. 1. <ul><ul><li>Computerized Assessment of Clinical Practice: Substance Use Survey </li></ul></ul>
    2. 2. Suggested Citation <ul><li>American Psychological Association Practice Directorate. (2003). PracticeNet survey: Computerized Assessment of Clinical Practice: Substance Use Survey. Retrieved Month, Day, Year from: </li></ul>
    3. 3. Acknowledgements <ul><li>PracticeNet’s original development was underwritten by the Center for Substance Abuse Treatment (CSAT) as part of the agency’s effort to learn more about the ways in which psychologists are encountering and treating problems related to substance use. </li></ul>
    4. 4. Substance Abuse Survey Design <ul><li>Substance Abuse treatment experts and PracticeNet Advisory Group met to develop survey algorithm </li></ul><ul><li>Goals: </li></ul><ul><ul><li>Fidelity to RTBS methodology </li></ul></ul><ul><ul><li>Smooth, logical flow of questions </li></ul></ul><ul><ul><li>Incorporate branching, skip patterns </li></ul></ul><ul><ul><li>Ensure relevance of questions for practitioners who may or may not specialize in substance abuse treatment </li></ul></ul>
    5. 5. PracticeNet Substance Abuse Survey <ul><li>PRN II - Substance Abuse Survey II Administered September 17 - October 16, 2002 </li></ul><ul><li>Total valid responses N = 291 (app. 75% response rate) </li></ul><ul><ul><li>Providing direct clinical services to an individual within 72 hours of selected date n = 267 (90%) </li></ul></ul>
    6. 6. Invitation to Participate <ul><li>Email invitations were sent to PracticeNet members with instructions to : </li></ul><ul><ul><li>Click on embedded link </li></ul></ul><ul><ul><li>Enter Username and Password to enter survey </li></ul></ul>
    7. 7. Completing the Survey <ul><li>Participants asked to enter information about a single, recent episode of care </li></ul><ul><li>One question presented per page </li></ul>
    8. 8. Survey Monitor Information <ul><ul><li>Completed Surveys </li></ul></ul><ul><ul><li>296 Valid surveys completed </li></ul></ul><ul><ul><ul><li>158 Surveys completed before reminder sent  (within 24 hours)  </li></ul></ul></ul><ul><ul><ul><li>86 Completed after 1st Reminder (within 24-48 hours) </li></ul></ul></ul><ul><ul><ul><li>52 Surveys completed after 2nd Reminder (within 48-72 hours) </li></ul></ul></ul><ul><ul><li>Completion Time </li></ul></ul><ul><ul><li>Average Time to Open Survey: 21 hr(s) 58 min(s) 33 sec(s) (Average calculated based on the time elapsed between sample time and the time the survey was initially opened) </li></ul></ul><ul><ul><li>Average Completion Time: 0 hr(s) 12 min(s) 33 sec(s) ( 89 Completion times were excluded from the average because their completion times were greater than 1 hour) </li></ul></ul>
    9. 9. Participating Psychologist Demographics <ul><ul><li>54% Female </li></ul></ul><ul><ul><li>46% Male </li></ul></ul><ul><ul><li>Average age 50, Range 24-77 </li></ul></ul><ul><ul><li>2% Hispanic </li></ul></ul><ul><ul><ul><li>95% White </li></ul></ul></ul><ul><ul><li>Primary Employment Setting </li></ul></ul><ul><ul><li>141 private practice ONLY </li></ul></ul><ul><ul><li>48 organizational setting ONLY </li></ul></ul><ul><ul><li>102 divide practice time between private and organizational settings </li></ul></ul>
    10. 10. Clinical Encounter Settings and Services <ul><li>Independent/private practice – solo 49% or group 25% </li></ul><ul><li>Organizational health care setting – 19% </li></ul><ul><ul><li>Mental health services setting – 39% </li></ul></ul><ul><ul><ul><li>85% Outpatient, 10% Residential, 5% Inpatient </li></ul></ul></ul><ul><ul><li>Substance abuse specialty program n=1, Outpatient </li></ul></ul><ul><ul><li>Primary or other health care setting – 30% </li></ul></ul><ul><ul><li>Other- university medical centers, long term care facilities, etc.- 30% </li></ul></ul><ul><li>Individual therapy or counseling – 79% </li></ul><ul><li>Formal assessment or evaluation – 24% </li></ul><ul><li>Providing educational information and/or materials – 19% </li></ul><ul><li>Medication evaluation/management – 3% </li></ul>
    11. 11. Primary Source of Payment 52% of self-pay clients have insurance but are not using it
    12. 12. Client Demographics <ul><li>Gender </li></ul><ul><ul><li>61% Female </li></ul></ul><ul><ul><li>39% Male </li></ul></ul><ul><li>Average age 37, Range 3 - 98 </li></ul><ul><li>Race/Ethnicity </li></ul><ul><ul><li>5% Hispanic </li></ul></ul><ul><ul><ul><li>80% White </li></ul></ul></ul><ul><ul><ul><li>7% Black/African American </li></ul></ul></ul><ul><ul><ul><li>5% Not specified </li></ul></ul></ul><ul><li>Marital Status </li></ul><ul><ul><li>40% Married </li></ul></ul><ul><ul><li>41% Never married </li></ul></ul><ul><ul><li>12% Divorced </li></ul></ul>
    13. 13. DSM-IV Diagnosis <ul><li>84% of clients have been diagnosed </li></ul><ul><ul><li>Predominantly Mood, Anxiety and Adjustment disorders </li></ul></ul><ul><ul><li>n=10 Axis I Primary Substance Abuse disorder </li></ul></ul><ul><ul><li>11% Axis II diagnosis </li></ul></ul><ul><li>9% diagnosis not yet completed </li></ul><ul><li>6% no diagnosis </li></ul><ul><li>1% not assessed </li></ul>
    14. 14. Primary Axis I Diagnoses of All Clients <ul><li>Diagnosis N= 264 </li></ul><ul><li>Mood Disorders 87 33.0% </li></ul><ul><ul><li>MDD (n=36), Dysthymia (n=30) </li></ul></ul><ul><li>Anxiety Disorders 57 21.6% </li></ul><ul><ul><li>PTSD (n=20), GAD (n=12) </li></ul></ul><ul><li>Adjustment Disorders 30 11.4% </li></ul><ul><li>Childhood Onset Disorders 18 6.8% </li></ul><ul><li>Substance Use Disorders 10 3.8% </li></ul><ul><li>Psychotic Disorders 7 2.7% </li></ul>
    15. 15. Primary Axis I Diagnoses, cont . <ul><li>Cognitive Disorders 3 1.1% </li></ul><ul><li>Eating Disorders 2 0.8% </li></ul><ul><li>Impulse Control Disorders 2 0.8% </li></ul><ul><li>Pervasive Developmental Disorder 2 0.8% </li></ul><ul><li>Sexual Disorders 2 0.8% </li></ul><ul><li>Somatoform Disorders 2 0.8% </li></ul><ul><li>Other 2 0.8% </li></ul><ul><li>Diagnosis not yet completed 23 8.7% </li></ul><ul><li>No DSM-IV diagnosis assigned 17 6.4% </li></ul>
    16. 16. Client Presentation for Services <ul><li>Forms of external pressure to use services </li></ul><ul><ul><li>Legal issues (e.g. court mandate for services, legal restrictions, potential or actual loss of driver’s, occupational, or other licenses) </li></ul></ul><ul><ul><li>Family or concerned others in social network encouraged use of services </li></ul></ul><ul><ul><li>Employer or other work-related mandates or contingencies encouraged use of services </li></ul></ul><ul><ul><li>Health care provider or other medical personnel encouraged use of services </li></ul></ul>
    17. 17. Client Presentation for Services, cont. Clients most often encouraged to seek services by family and health care personnel
    18. 18. Private Practice Settings (n=196) <ul><li>Practitioners are… </li></ul><ul><ul><li>56% female </li></ul></ul><ul><ul><li>Average age of 52 years </li></ul></ul><ul><ul><li>Providing clinical services for 19 years </li></ul></ul><ul><ul><li>No differences from larger sample in terms of ethnicity </li></ul></ul><ul><li>Clients are not demographically different from larger sample but... </li></ul><ul><ul><li>77% have insurance benefits or self pay </li></ul></ul><ul><ul><li>Common diagnoses include mood, anxiety and adjustment disorders (67%) </li></ul></ul><ul><li>Treatment of longer duration </li></ul><ul><ul><li>median number of sessions is 18, 75% seen for 56 or fewer sessions </li></ul></ul>
    19. 19. Mental Health Settings (n=21) <ul><li>Practitioners are… </li></ul><ul><ul><li>71% male </li></ul></ul><ul><ul><li>Average age of 43 years </li></ul></ul><ul><ul><li>Providing clinical services for 11 years </li></ul></ul><ul><ul><li>No differences from larger sample in terms of ethnicity </li></ul></ul><ul><li>Clients are not demographically different from larger sample but... </li></ul><ul><ul><li>21% have insurance benefits or self pay, 57% have publicly funded treatment </li></ul></ul><ul><ul><li>Common diagnoses include MDD (28%) and PTSD (14%) </li></ul></ul><ul><ul><li>1/3 in intake and not yet diagnosed </li></ul></ul><ul><li>Treatment of briefer duration </li></ul><ul><ul><li>median number of sessions is 3, 75% seen for less than 12 sessions </li></ul></ul>
    20. 20. Client Substance Use Substance use discussed by more than 1/3 of psychologists in current session, more than 2/3 in current or previous sessions 18% of clients identified as having substance use problem - an additional 6% with suspected but unconfirmed problem
    21. 21. Client Social Network and Substance Use <ul><ul><li>Psychologists had discussed substance use within social network of 63% of clients </li></ul></ul><ul><li>During this clinical encounter, did you discuss substance use within your client’s social network? </li></ul><ul><ul><li>Yes – 21% </li></ul></ul><ul><ul><li>If No: </li></ul></ul><ul><ul><li>Have you ever discussed substance abuse within your client’s social network? </li></ul></ul><ul><ul><ul><li>Yes – 42% </li></ul></ul></ul>
    22. 22. Client Social Network and Substance Use <ul><li>Substance use discussed in current or previous session(s) among clients’ significant other, parent or friend </li></ul>
    23. 23. Substance Identification <ul><li>Which of the following substances is/are part of the client’s substance use problem? (Y/N/DK for each) </li></ul><ul><ul><li>Nicotine – cigarettes </li></ul></ul><ul><ul><li>Other tobacco products </li></ul></ul><ul><ul><li>Nicotine replacement products </li></ul></ul><ul><ul><li>Alcohol </li></ul></ul><ul><ul><li>Marijuana/Hashish/THC </li></ul></ul><ul><ul><li>Cocaine/Crack </li></ul></ul><ul><ul><li>Methamphetamine (Crystal) </li></ul></ul><ul><ul><li>Other amphetamines </li></ul></ul><ul><ul><li>Heroin </li></ul></ul><ul><ul><li>Other opiates/Analgesics (e.g. Codeine, Oxycodone) </li></ul></ul><ul><ul><li>Sedative tranquilizers (e.g. Valium, Xanax, Barbituates) </li></ul></ul><ul><ul><li>Inhalants (e.g. glue, gasoline, spray paint) </li></ul></ul><ul><ul><li>Hallucinogens (e.g. LSD, PCP, angel dust, mushrooms, peyote) </li></ul></ul><ul><ul><li>Club drugs (GHB, Ecstasy, Nitrous Oxide, Ketamine/Special K) </li></ul></ul><ul><ul><li>Steroids </li></ul></ul><ul><ul><li>Other (specify) </li></ul></ul>
    24. 24. Substance Distribution Most Reported Substances
    25. 25. High Risk Behavior <ul><li>Frequency of high risk behaviors associated with substance use discussed during the specified clinical encounter (51 clients identified as having substance use problem or suspected of having one) </li></ul><ul><ul><li>Injection drug use n=2 </li></ul></ul><ul><ul><li>Sexual behavior n=6 </li></ul></ul><ul><ul><li>Driving while intoxicated n=4 </li></ul></ul><ul><ul><li>Violence or harmful behavior to self or others n=11 </li></ul></ul><ul><ul><li>Combining use of multiple drugs/drug classes, </li></ul></ul><ul><ul><li> including prescription medications n=7 </li></ul></ul>
    26. 26. Clinical Interventions <ul><ul><li>Clinical Interventions During Clinical Encounter to Address Substance Related Problems (Not Mutually Exclusive) </li></ul></ul>% n = * Often cited in clinical and scientific literature 15.8 6 * Harm Reduction strategies 23.7 9 Psychodynamic/Insight oriented counseling 31.6 12 * Relapse Prevention Counseling 39.5 15 * Cognitive Behavioral Therapy 42.1 16 * Motivational Interviewing
    27. 27. Continuing Education and Its Impact <ul><li>Psychologists averaged almost 32 hours of CE credits in the past 12 months (median 25 hours) </li></ul><ul><ul><li>Private practice average 30, median 25 </li></ul></ul><ul><ul><li>Organizational settings average 43.5, median 40 </li></ul></ul><ul><li>118 psychologists had obtained CEs in substance abuse in the past 12 months (average 8.64, median 5 hours) </li></ul><ul><ul><li>Private practice (n=77) average 8.5, median 5 </li></ul></ul><ul><ul><li>Organizational settings (n=12) average 14, median 10 </li></ul></ul><ul><li>Psychologists with substance abuse CEs were more likely to discuss substance use with their clients and were more likely to be treating someone with a substance use problem </li></ul>
    28. 28. Substance Abuse Survey II <ul><li>Psychologists are utilizing current substance use interventions, though sample was not selected for substance use specialists </li></ul><ul><li>In a randomly selected clinical encounter, 38% of practitioners reported discussing substance use, and almost 70% indicated they had discussed substance use with the client at some point during treatment </li></ul><ul><li>Results are being compared with 2001 pilot survey results </li></ul><ul><li>For next survey, questions will be slightly modified for appropriateness/applicability for practitioners who primarily see children </li></ul>
    29. 29.