Annals of Emergency Medicine
Volume 41, Issue 5 , Pages 659-667 , May 2003

Emergency department use of persons with comorbid psychiatric and substance abuse disorders

Presented in poster format at the Research Society on Alcoholism annual meeting, Denver, CO, June 2000.

Received 18 January 2002 ,Revised 26 September 2002 ,Accepted 9 November 2002.

References 

  1. Hansagi H, Edhag O, Allebeck P. High consumers of health care in emergency units: how to improve their quality of care. Qual Assur Health Care. 1991;3:51–62
  2. Spillane LL, Lumb EW, Cobaugh DJ, et al.  Frequent users of the emergency department: can we intervene?. Acad Emerg Med. 1997;4:574–580
  3. Padgett DK, Brodsky B. Psychosocial factors influencing non-urgent use of the emergency department: a review of the literature and recommendations for research and improved service delivery. Soc Sci Med. 1992;35:1189–1197
  4. Andren KG, Rosenqvist U. Heavy users of an emergency department: psycho-social and medical characteristics, other health care contacts and the effect of a hospital social worker intervention. Soc Sci Med. 1985;21:761–770
  5. Malone RE. Heavy users of emergency services: social construction of a policy problem. Soc Sci Med. 1995;40:469–477
  6. Kne T, Young R, Spillane L. Frequent ED users: patterns of use over time. Am J Emerg Med. 1998;16:648–652
  7. Dhossche DM, Ghani SO. A study of recidivism in the psychiatric emergency room. Ann Clin Psychiatry. 1998;10:59–67
  8. Hansen TE, Elliott KD. Frequent psychiatric visitors to a veterans affairs medical center emergency care unit. Hosp Community Psychiatry. 1993;44:372–375
  9. Andren KG, Rosenqvist U. Heavy users of an emergency department: a two-year follow-up study. Soc Sci Med. 1987;25:825–831
  10. Cherpitel CJ. Alcohol and violence-related injuries: an emergency room study. Addiction. 1993;88:79–88
  11. Regier DA, Farmer ME, Rae DS, et al.  Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiological Catchment Area (ECA) study. JAMA. 1990;264:2511–2518
  12. Kessler RC, Crum RM, Warner LA, et al.  Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Cormorbidity Survey. Arch Gen Psychiatry. 1997;54:313–321
  13. Schuckit M. Alcohol, anxiety, and depression disorders. Alcohol Health Res World. 1996;20:81–85
  14. Curran GM, Booth BM. Longitudinal changes in predictor profiles of abstinence from alcohol use among male veterans. Alcohol Clin Exp Res. 1999;23:141–143
  15. Hoff RI, Rosenheck RA. The cost of treating substance abuse patients with and without comorbid psychiatric disorders. Psychiatr Serv. 1999;50:1309–1315
  16. Garnick DW, Hendricks AM, Drainoni M, et al.  Private sector coverage of people with dual diagnoses. J Ment Health Admin. 1996;23:317–328
  17. Dickey B, Azeni H. Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care. Am J Public Health. 1996;86:973–977
  18. Haywood TW, Kravitz HM, Grossman LS, et al.  Predicting the “revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry. 1995;156:856–861
  19. Schiller MJ, Shumway M, Batki SL. Patterns of substance use among patients in an urban psychiatric emergency service. Psychiatr Serv. 2000;51:113–115
  20. Dhossche D, Rubinstein J. Drug detection in a suburban psychiatric emergency rooms. Ann Clin Psychiatry. 1996;8:59–69
  21. Sanguinetti V, Brooks M. Factors related to emergency commitment of chronic mentally ill patients who are substance abusers. Hosp Community Psychiatry. 1992;43:237–241
  22. Elangovan N, Berman S, Meinzer A, et al.  Substance abuse among patients presenting at an inner-city psychiatric emergency room. Hosp Community Psychiatry. 1993;44:782–784
  23. Breslow RE, Klinger BI, Erickson BJ. Acute intoxication and substance abuse among patients presenting to a psychiatric emergency service. Gen Hosp Psychiatry. 1996;18:183–191
  24. Strakowski SM, Lonczak H, Sax KW, et al.  The effects of race on diagnosis and disposition from a psychiatric emergency service. J Clin Psychiatry. 1995;56:101–107
  25. Bartels SJ, Teague GB, Drake RE, et al.  Substance abuse in schizophrenia: service utilization and costs. J Nerv Ment Dis. 1993;181:227–232
  26. Barbee JG, Clark PD, Crapanzano MS, et al.  Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service. J Nerv Ment Dis. 1989;177:400–407
  27. Dixon L. Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophr Res. 1999;35:93–100
  28. Berkson J. Limitations of the application of fourfold table analysis to hospital data. Biomet Bull. 1946;2:47–53
  29. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1987;
  30. Kosten TR, Ziedonis DM. Substance abuse and schizophrenia. Editors' introduction. Schizophr Bull. 1997;23:181–186
  31. Ries RK, Comtois KA. Illness severity and treatment services for dually-diagnosed mentally ill outpatients. Schizophr Bull. 1997;23:239–246
  32. Buckley PF. Substance abuse in schizophrenia: a review. J Clin Psychiatry. 1998;59:26–30
  33. Ries RK, Russo J, Wingerson D, et al.  Shorter hospital stays and more rapid improvement among patients with schizophrenia and substance disorders. Psychiatr Serv. 2000;51:210–215
  34. Olfson M, Mechanic D, Hansell S, et al.  Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatr Serv. 2000;51:216–222
  35. Owen RR, Fischer EP, Booth BM, et al.  Medication noncompliance and substance abuse among patients with schizophrenia. Psychiatr Serv. 1996;41:853–858
  36. Kivlahan DR, Heiman JR, Wright RC, et al.  Treatment cost and rehospitalization rate in schizophrenic outpatients with a history of substance abuse. Hosp Community Psychiatry. 1991;42:609–614
  37. Kales HC, Blow FC, Copeland LA, et al.  Health care utilization by older patients with coexisting dementia and depression. Am J Psychiatry. 1999;156:550–556
  38. Cherpitel CJ. Alcohol-related health services use and identification of patients in the emergency department. Ann Emerg Med. 1996;28:418–423
  39. Booth BM, Blow FC, Cook CAL, et al.  Relationship between inpatient alcoholism treatment and longitudinal changes in health care utilization. J Stud Alcohol. 1997;58:625–637
  40. Holder HD, Blose JO. The reduction of health care costs associated with alcoholism treatment: a 14-year longitudinal study. J Stud Alcohol. 1992;53:293–302
  41. Okin RL, Boccellari A, Azocar F, et al.  The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med. 2000;18:603–608
  42. Witbeck G, Hornfeld SH, Dalack GW. Emergency room outreach to chronically addicted individuals: a pilot study. J Subst Abuse Treat. 2000;19:39–43
  43. Drake RE, Mueser KT. Psychosocial approaches to dual diagnosis. Schizophr Bull. 2000;26:105–118
  44. Johnson J. Cost-effectiveness of mental health services for persons with a dual diagnosis. J Subst Abuse Treat. 2000;18:119–127
  45. Carey KB. Treatment of co-occurring substance abuse and major mental illness. New Dir Ment Health Serv. 1996;70:19–31
  46. Ho AP, Tsuang JW, Liberman RP, et al.  Achieving effective treatment of patients with chronic psychotic illness and comorbid substance dependence. Am J Psychiatry. 1999;156:1765–1770
  47. Jerrell JM, Ridgely MS. Comparative effectiveness of three approaches to serving people with severe mental illness and substance abuse disorders. J Nerv Ment Dis. 1995;183:566–576
  48. Rosenthal RN, Hellerstein DJ, Miner CR. Integrated services for treatment of schizophrenic substance abusers: demographics, symptoms, and substance abuse patterns. Psychiatr Q. 1992;63:3–26
  49. Drake RE, Yovetich NA, Bebout RR, et al.  Integrated treatment for dually diagnosed homeless adults. J Nerv Ment Dis. 1997;185:298–305
  50. Barreira P, Espey B, Fishbein R, et al.  Linking substance abuse and serious mental illness service delivery systems: initiating a statewide collaborative. J Behav Health Serv Res. 2000;27:107–113

 Supported by the South Central Mental Illness Research, Education, and Clinical Center.

☆☆ Address for reprints: Geoffrey M. Curran, PhD, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 58, North Little Rock, AR 72114; 501-257-1808, fax 501-257-1707; E-mail currangeoffreym@uams.edu

PII: S0196-0644(03)00170-7

doi: 10.1067/mem.2003.154

Annals of Emergency Medicine
Volume 41, Issue 5 , Pages 659-667 , May 2003