Screening for Addictive Disorders Within a Workers’ Compensation Clinic: An Exploratory Study

Abstract

We conducted a cross-sectional study investigating the extent of addictive disorders within a workers’ compensation (WC) clinic. We also examined the feasibility of substance abuse screening within the same clinic. In , 100 patients were asked to complete the World Health Organization's Alcohol, Smoking, Substance Involvement Screening Test (WHO-ASSIST) and the Current Opioid Misuse Measure (COMM). According to the WHO-ASSIST, we found that 46% of WC patients required intervention for at least one substance-related disorder (25% tobacco, 23% sedatives, 8% opioids), and according to the COMM, 46% screened positive for prescription opioid misuse. Importantly, the addition of this screening was brief, economical, and well accepted by patients. Further research should analyze the costs and benefits of detection and intervention of substance-related disorders in this setting.

RÉSUMÉ

Le problème de la dépendance dans une clinique pour les accidents des travailles

Nous avons étudié la dépendance dans une clinique pour les accidents des travailles. En , 100 patients ont passes un test du “World Health Organization's Alcohol, Smoking, Substance Involvement Screening Test (WHO-ASSIST)” et “Current Opioid Misuse Measure (COMM).” 46% des patients ont nécessité une intervention pour le problème de la dépendance (25% du tabac, 23% des sédatifs, des opiacés 8%). En outre, 46% avaient un problème avec les opioïdes sur ordonnance.Avec plus de recherches, cela devrait etudie les couts et les benefices de la detection de la dependance.

RESUMEN

Los trastornos adictivos en una mutua de accidentes laborales y enfermedades profesionales

Realizamos un estudio transversal sobre la magnitud de los trastornos adictivos en una mutua de accidentes laborales y enfermedades profesionales (WC). A su vez, examinamos si la detección de abuso de sustancias en dicha clínica era factible. En , pedimos a 100 pacientes que completaran el test de screening de la Organización Mundial de la Salud sobre el consumo de alcohol, tabaco y otras sustancias: “World Health Organization's Alcohol, Smoking, Substance Involvement Screening Test (WHO-ASSIST)” y sobre el uso indebido de opioides: “Current Opioid Misuse Measure (COMM).” Según la WHO-ASSIST, el 46% de los pacientes requirieron intervención por el equipo de la mutua de trabajadores (WC) en al menos un trastorno relacionado con sustancias (25% tabaco, 23% ansiolíticos, y 8% opiáceos) y; de acuerdo con el COMM, el 46% usaban de manera indebida los opiáceos prescritos. Es importante destacar que dicho screening fue breve, económico y bien aceptado por los pacientes. Es necesario, en futuras investigaciones, analizar, en este contexto, los costes y beneficios de la detección e intervención de los trastornos relacionadas con sustancias.

Keywords :

• workers’ compensation
• substance-related disorders
• opioid-related disorders
• aberrant drug behaviors
• gambling
• substance abuse detection
• current opioid misuse measurement
• World Health Organization's alcohol smoking substance involvement screening test

THE AUTHORS

Dr. Iman Parhami, MD, MPH, Since medical school, Dr. Parhami has been conducting research under the primary mentorship of Dr. Timothy Fong at the Department of Psychiatry and Biobehavioral Sciences at University of California, Los Angeles (UCLA). Currently, as a Postdoctoral Research Fellow, he focuses on substance-related disorders, including pathological gambling, and the public health-related repercussions associated with them. Dr. Parhami is interested in the translation of empirically supportive tools such as screening instruments and interventions to the clinical setting.

Dr. Mark Hyman, MD, is an Associate Professor on the clinical faculty at the UCLA. He pursued medical school, internship and residency at UCLA. Now an Associate Professor, his internal medicine research and interests have expanded to include headaches, smoking cessation, spinal disorders, police arrest techniques, Tuberous Sclerosis Complex, impairment, and workers’ compensation issues. He is currently publishing research on worker compensation patients for sleep disorders, addictions, and digital retinal examinations. He is a fellow of the American College of Physicians and the American Academy of Disability Evaluating Physicians and currently on the National Board of Directors.

Aaron Siani, BSc, is currently a medical student at the David Geffen School of Medicine at UCLA. He is pursuing 1 year of research at the Semel Institute for Neuroscience and Human Behavior at UCLA. The focus of his work has been in the characterization and management of addictive disorders. Previously, he was involved in research investigating the biophysical properties of potassium and calcium ion channels at UCLA's Division of Molecular Medicine in the Department of Anesthesiology. He is interested in the translation of his work on addictive disorders into clinical practice, and he has ambitions of a career robust with both clinical involvement and academic research.

Stephanie Lin, BA, is a third-year medical student at the David Geffen School of Medicine at UCLA.

Michael Collard, MA, is a second-year medical student at the University of Missouri-Kansas City. He completed his master's degree in Medical Sciences at Boston University School of Medicine with an emphasis in mental health and behavioral medicine. Following this, he worked at the Department of Psychiatry and Biobehavioral Sciences at UCLA for 2 years as a research coordinator performing data collection, analysis, and reporting. His current research interests include substance abuse and treatment options.

John Joseph Garcia, BSc, is a fourth-year medical student at the David Geffen School of Medicine at UCLA. His research interests are those of neurological and psychiatric disorders.

Dr. Laurie Casaus, MD, leads the inpatient dual diagnosis treatment team at The Resnick Neuropsychiatric Hospital at UCLA and she is an Assistant Clinical Professor at UCLA School of Medicine.

Dr. John Tsuang, MD, is the Director of Dual Diagnosis Treatment Program at Harbor/UCLA Medical Center and he is a Clinical Professor at UCLA School of Medicine. His research interests are focused on pharmacological and psychosocial intervention of co-occurring disorders. He is also doing some studies on methamphetamine safety trials and phase II clinical trials for treatment of methamphetamine addiction.

Dr. Timothy W. Fong, MD, is an Associate Professor of Psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA. He is the Co-Director of the UCLA Gambling Studies Program and the Director of the UCLA Addiction Medicine Clinic. He is also the Director of the UCLA Addiction Psychiatry Fellowship. Dr. Fong's research interests are focused on developing effective treatments for pathological gambling and understanding the causes and course of impulse control disorders.