Social determinants of substance use disorder treatment outcomes in a vulnerable population

项目摘要/摘要 物质使用障碍(SUD)对多个脆弱人群的影响不成比例， 包括有精神健康问题的个人。尽管长期以来人们一直认为苏德 最近的出版物显示，患有自闭症谱系障碍的个体的风险并未增加。 包括JAMA中的那些，相反地，强调了对SUD的不成比例的脆弱性 在患有自闭症谱系障碍(ASD)的青少年和成年人中， 几项国际研究。例如，在一项对台湾SUD患者的研究中， ASD的存在被证明是死亡率的三倍，增加了SUD症状的严重性和 使他们的病情升级。在美国，人们对SUD的易感性知之甚少 在患有自闭症的年轻人和成年人中，潜在地创造了一个“隐藏的”弱势群体 目前的药物使用治疗系统提供的服务不足。 这项拟议研究的总体目标是分析世界上最大的医疗数据集 美国国家医疗补助数据，以(1)比较各种肥皂水在 11岁及以上患有和不患有自闭症的个体；以及(2)分析自闭症的差异 患有和不患有自闭症的药物使用者的治疗使用情况和SUD严重程度。 为了确定上述关系的可延展性主持人，我们将首次合并 医疗补助患者，提供有关患者健康的社会决定因素的数据(例如，社会隔离和 经济不稳定)来自TransUnion，一个个人层面的社会经济国家储存库 数据(仅成人可用)。我们还将测试国家政策在以下方面的缓和效果 对特定的SUD和ASD干预措施的报销。 更具体地说，拟议的研究将检查SUD的流行率、严重性、模式 ASD状态会加重SU相关的不良事件。它还将审查 健康的社会决定因素、人口因素和国家一级的治疗政策 缓冲或放大ASD对物质使用相关结果的影响。

Project Summary/Abstract Substance use disorders (SUD) disproportionately affect multiple vulnerable populations, including individuals with mental health problems. Although it had been long assumed that SUD risks are not elevated among individuals with autism spectrum disorders, recent publications, including those in JAMA, highlighted, on the contrary, a disproportionate vulnerability to SUD among youth and adults with autism spectrum disorder (ASD), as independently reported in several international studies. For example, in a study of individuals with SUD in Taiwan, the presence of ASD was shown to triple mortality rates, increase severity of SUD symptoms and escalate their progression. In the US, very little is known about the elevated vulnerability to SUD among youth and adults with ASD, potentially creating a “hidden” vulnerable population underserved by the current substance use treatment systems. The overall goal of the proposed study is to analyze the world’s largest healthcare data set, the US national Medicaid data, to (1) compare the likelihood of having various SUDs among individuals with and without ASD, aged 11 and older; and (2) analyze differences in SUD treatment usage and SUD severity among substance-using individuals with and without ASD. To identify malleable moderators of the above relationships, we will for the first time merge Medicaid patient with data on patients’ social determinants of health (e.g. social isolation and economic instability) from TransUnion, a national repository of individual-level socio-economic data (available only for adults). We will also test moderating effects of state policies regarding reimbursement of specific SUD and ASD interventions. More specifically, the proposed study will examine whether SUD prevalence, severity, patterns and SU- related adverse events are exacerbated by ASD status. It will also examine the role of social determinants of health, demographic factors, and state-level treatment policies in buffering or amplifying the effects of ASD on substance use related outcomes.