Health-related material needs and substance use among emergency department patients

Abstract

Background: Emergency department (ED) visits related to substance use are common. ED patients also have high levels of health-related material needs (HRMNs), such as homelessness and food insecurity. However, little research has examined the intersection between ED patient HRMNs and substance use. Methods: We surveyed a random sample of public hospital ED patients. Surveys included validated single-item screeners for unhealthy alcohol and any drug use and questions on self-reported past-year material needs. We compared individual HRMNs and cumulative number of HRMNs by substance use screening status using bivariate and multivariable analyses. Results: A total of 2312 surveys were completed. Nearly one third of patients (32.3%, n = 747) screened positive for unhealthy alcohol use, and 21.8% (n = 503) screened positive for drug use. Prevalence of HRMNs for all patients—including food insecurity (50.8%), inability to meet essential expenses (40.8%), cost barriers to medical care (24.6%), employment issues (23.8%), and homelessness (21.4%)—was high and was significantly higher for patients with unhealthy alcohol use or drug use. In multivariable analyses, homelessness was independently associated with unhealthy alcohol use (adjusted odds ratio [aOR]: 1.61, 95% confidence interval [CI]: 1.24–2.09) and drug use (aOR: 2.30, 95% CI: 1.74–3.05). There was a significant stepwise increase in the odds of patient unhealthy alcohol or drug use as number of HRMNs increased. Conclusions: ED patients with unhealthy alcohol or drug use have higher prevalence of HRMNs than those without. Our findings suggest that HRMNs may act additively and that homelessness is particularly salient. Patients’ comorbid HRMNs may affect the success of ED-based substance use interventions.

Keywords:

• Alcohol
• drug use
• emergency care
• food insecurity
• homelessness
• social determinants
• substance use

Acknowledgments

The authors would like to thank all of the ED-CARES research assistants and the study Research Stakeholder and Expert Advisory Panel.

Author contributions

K.M.D., L.G., J.R., and E.G. conceived of the study. D.C. and K.M.D. led data collection for the study. K.M.D. conducted the analysis for the study, with assistance from T.M. E.G. assisted with the literature review. E.G. and K.M.D. drafted the manuscript. All authors provided critical feedback. All authors reviewed and approve of the final version.

Additional information

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health (K23DA039179, Principal Investigator [PI]: Doran), the United Hospital Fund (PI: Doran), and the Doris Duke Charitable Foundation—NYULMC (PI: Doran). The funders had no role in the conduct of the research or the writing of the manuscript. The content is solely the responsibility of the authors and does not represent the official views of any funder.