title: A Post-Hurricane Katrina Examination of Substance Abuse Treatment Discharges With Co-Occurring Psychiatric and Substance Use Disorders.
abstract: OBJECTIVE
  There is increasing literature supporting the adverse effects of disasters on substance use and psychiatric disorders. The co-occurrence of psychiatric disorders with substance use intensifies the challenge of treatment delivery. Thus the aim of this study was to examine the prevalence of substance use, treatment characteristics, and demographics of discharges from substance abuse treatment in New Orleans, post-Hurricane Katrina. Trends associated with discharges that have a co-occurring psychiatric and substance use disorder (COD) were also assessed. The secondary aim of this study was to examine the association of successful substance abuse treatment completion among those with a COD post-Hurricane Katrina.
  
  
  METHODS
  Substance abuse treatment discharge data (N = 16,507) from New Orleans, Louisiana, for years 2006 through 2011 were obtained from the Treatment Episode Data Set-Discharge. Multiple logistic regression analysis was employed to examine the association of discharges with a COD and completion of substance abuse treatment. Demographic, psychiatric, and treatment characteristics of discharges in 2006 were compared to characteristics in 2011. Trends of characteristics were also assessed through the study period.
  
  
  RESULTS
  Roughly a third (35.2%) of all discharges in New Orleans from 2006 to 2011 had a COD. After controlling for race, employment, treatment service setting at discharge, primary substance problem, and the discharge's principal source of referral, discharges with a COD were 29% less likely to complete treatment as compared to those with no COD (AOR = 0.71, 95% CI [0.56, 0.90], p = .004). Treatment completion among discharges with a COD has significantly declined from 36.8% in 2006 to 18.7% in 2011 (p < .0001). Notable significant trends in homelessness, criminality, and heroin use were identified among discharges with a COD.
  
  
  CONCLUSIONS
  Substance abuse treatment undergoes various changes in the event of a natural disaster. These changes may increase challenges for successful treatment completion for vulnerable populations such as those with a COD. Results of this study demonstrate that discharges with a COD are less likely to complete treatment as compared to those with no COD disorder. Unmet treatment needs may also increase odds of criminalization and homelessness.
authors.affiliation: a Department of Biostatistics & Epidemiology , School of Public Health, University of North Texas Health Science Center , Fort Worth , Texas , USA.
authors.forename: Monique
authors.initials: M
authors.lastname: Shuler
authors.affiliation: a Department of Biostatistics & Epidemiology , School of Public Health, University of North Texas Health Science Center , Fort Worth , Texas , USA.
authors.forename: Sumihiro
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: b Podesta Psychiatry , New Orleans , Louisiana , USA.
authors.forename: Arwen
authors.initials: A
authors.lastname: Podesta
authors.affiliation: c Epidemiology Division, Bureau of Population Health , Metro Public Health Department , Nashville , Tenneesee , USA.
authors.forename: Raquel
authors.initials: R
authors.lastname: Qualls-Hampton
authors.affiliation: d Lombardi Comprehensive Cancer Center , Georgetown University Medical Center , Washington , DC , USA.
authors.forename: Sherrie Flynt
authors.initials: SF
authors.lastname: Wallington
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003415:Crime / Q000706:statistics & numerical data; D055867:Cyclonic Storms; D017831:Diagnosis, Dual (Psychiatry); D004190:Disasters; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D055820:New Orleans / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hurricane Katrina; New Orleans; Substance use; co-occurring; disaster; psychiatric; treatment