Health Outcomes by Neighborhood (HON): Effects of Neighborhood, Social Instability, and Health Factors on 12-Month Trajectories of Substance-Use Disorder Symptoms

Abstract

Background

Previous studies have shown that environment and health can influence drug use trajectories and the effects of substance use disorder (SUD) treatments. We hypothesized that trajectories of drug use-related problems, based on changes in DSM-5 symptoms, would vary by type(s) of drugs used, health factors, and neighborhood characteristics.

Methods

We assessed mental and physical health, stress, social instability, neighborhood characteristics (disorderliness and home value), and DSM-5 symptom counts at two study visits, 12 months apart, in a community sample (baseline N = 735) in Baltimore, MD. Three prominent categories of drug-use trajectory were identified with K-means cluster analysis of symptom counts: Persistent (4 or more symptoms at both visits or at Visit 2), Improved (decrease from 4 or more symptoms at Visit 1 to 3 or fewer symptoms at Visit 2), and Low-Stable (3 or fewer symptoms at both visits). Baseline health and neighborhood measures were tested as predictors of trajectory in mediation and moderation models.

Results

Among people with current opioid- and/or stimulant-use, odds of an Improved trajectory were (1) decreased with neighborhood disorder and social instability, or (2) increased with home value and social instability. Odds of a Low-Stable trajectory were decreased by social instability and stress but increased in those who were older or self-identified as white.

Conclusions

Trajectories of drug use-related problems are influenced by sociodemographic variables, neighborhood factors, and health. Assessing DSM-5 symptom counts as an outcome measure may be valuable in monitoring or predicting long-term trajectories and treatment effectiveness.

Keywords:

• substance use disorder
• DSM-5 symptoms
• trajectory
• neighborhood
• mental health
• stress
• Clinicaltrialsgov Identifier NCT01571752

Disclosure Statement

The authors report there are no competing interests to declare.

Data availability Statement

The data presented here are not publicly available because other components of the study protocol are still ongoing: https://clinicaltrials.gov/ct2/show/NCT01571752.

Authors’ contributions

KAP, DHE and KLP conceived and planned the study. LMM and SKH conducted the study and collected and managed the data. LVP performed statistical analyses, interpreted results, and created the figures. MT processed participant home address data to produce environmental measures data and edited the methods section. JRE collected data, performed statistical analyses, and interpreted results. LMM wrote the first draft of the manuscript. JWB contributed substantially to interpretation of the results and editing drafts of the manuscript. All authors contributed to additional drafts and read and approved the final manuscript.

Authors’ information

LMM and JWB are currently at the NIDA Center for Clinical Trials Network. SKH is a Staff Psychologist at The Center, LLC, King of Prussia, PA. KAP is currently at the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Service Administration (SAMHSA).

Additional information

Funding

This study was supported by the Intramural Research Program of NIH, NIDA. The views and opinions expressed in this manuscript are those of the authors only and do not necessarily represent the views, official policy or position of the U.S. Department of Health and Human Services or any of its affiliated institutions or agencies.