title: "It's been an Experience, a Life Learning Experience": A Qualitative Study of Hospitalized Patients with Substance Use Disorders.
abstract: BACKGROUND
  Individuals with substance use disorders (SUD) have high rates of chronic illness and readmission, yet few are engaged in addiction treatment. Hospitalization may be a reachable moment for initiating and coordinating addiction care, but little is known about motivation for change in the inpatient setting.
  
  
  OBJECTIVE
  To explore the experiences of hospitalized adults with SUD and to better understand patient and system level factors impacting readiness for change.
  
  
  METHODS
  We performed a qualitative study using individual interviews. The study was nested within a larger mixed-methods needs assessment.
  
  
  METHODS
  Hospitalized adults admitted to medical or surgical units at an urban academic medical center who reported high-risk alcohol or drug use on AUDIT-C or single-item drug use screener.
  
  
  METHODS
  We conducted a thematic analysis, using an inductive approach at a semantic level.
  
  
  RESULTS
  Thirty-two patients participated. The mean age was 43 years; 75% were men, and 68% identified as white. Participants reported moderate to high-risk alcohol (39%), amphetamine (46%), and opioid (65%) use. Emergent themes highlight the influence of hospitalization at the patient, provider, and health system levels. Many patients experienced hospitalization as a wake-up call, where mortality was motivation for change and hospitalization disrupted substance use. However, many participants voiced complex narratives of social chaos, trauma, homelessness, and chronic pain. Participants valued providers who understood SUD and the importance of treatment choice. Patient experience suggests the importance of peers in the hospital setting, access to medication-assisted treatment, and coordinated care post-discharge.
  
  
  CONCLUSIONS
  This study supports that hospitalization offers an opportunity to initiate and coordinate addiction care, and provides insights into patient, provider, and health system factors which can leverage the reachability of this moment.
authors.affiliation: Clinical Integration, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.|School of Social Work, Portland State University, Portland, OR, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Velez
authors.affiliation: School of Social Work, Portland State University, Portland, OR, USA.|Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Nicolaidis
authors.affiliation: Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.affiliation: Clinical Integration, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA. englandh@ohsu.edu.|Division of Hospital Medicine, Oregon Health & Science University, Portland, OR, USA. englandh@ohsu.edu.
authors.forename: Honora
authors.initials: H
authors.lastname: Englander
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*
keywords: health reform; hospital; motivation; opioid-related disorders; qualitative research; substance-related disorders