Traumatically injured young people are at elevated risk for opioid and other substance use following discharge from the hospital. There are few scalable procedures in place for monitoring patients’ behavioral health recovery and connecting them to needed services. This study piloted an adapted version of an existing technology-facilitated program to monitor substance use and connect patients to care (Trauma Resilience and Recovery Program).
Methods
Participants aged 12–30 years (n = 90) were enrolled from Level 1 trauma centers and invited to engage with the adapted Trauma Resilience and Recovery Program. The program involved app-based educational content, daily text message symptom monitoring, periodic online screenings, and referral to behavioral health services. Descriptive analyses were performed to characterize the sample and engagement in the program.
Results
Although interaction with app-based educational content was low (15% of participants), engagement in text-based monitoring (participants responded to 65% of prompts) and mental health screens (65% of participants completed all screens) was high. Rates of substance use varied across time points. Elevated depression, anxiety, and post-traumatic stress disorder symptoms were also observed. Most (85%) participants whose screener responses indicated likely presence of behavioral health concerns participated in clinician referral conversations.
Conclusion
The enhanced Trauma Resilience and Recovery Program content and procedures were effective in identifying young people experiencing substance use and mental health concerns following traumatic injury and illness. Future work is needed to improve the engagement with educational content and test the effectiveness of the enhanced Trauma Resilience and Recovery Program model in improving substance-related clinical outcomes for trauma-affected young people.
Centers for Disease Control and Prevention. National Center for Health Statistics. Multiple Cause of Death 1999-2021 on CDC WONDER Online Database, 2022.
2.
FriedmanJGodvinMShoverCL, et al.Trends in drug overdose deaths among US adolescents, January 2010 to June 2021. Jama2022; 327: 1398–1400.
3.
TanzLJDinwiddieATMattsonCL, et al.Drug overdose deaths among persons aged 10–19 years - United States, July 2019-December 2021. MMWR Morb Mortal Wkly Rep2022; 71: 1576–1582.
4.
GomesTTadrousMMamdaniMM, et al.The burden of opioid-related mortality in the United States. JAMA Netw Open2018; 1: e180217.
5.
PalamarJJCiccaroneDRutherfordC, et al.Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug Alcohol Depend2022; 234: 109398.
6.
MiechRAJohnstonLDO'MalleyPM, et al.Monitoring the Future national survey results on drug use, 1975–2021: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, 2022.
7.
SchepisTSKlareDLFordJA, et al.Prescription drug misuse: taking a lifespan perspective. Subst Abuse2020; 14: 1178221820909352.
8.
AdamsZWMorelandACohenJR, et al.Polyvictimization: Latent profiles and mental health outcomes in a clinical sample of adolescents. Psychol Violence2016; 6: 145–155.
9.
FortunaRJRobbinsBWCaiolaE, et al.Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics2010; 126: 1108–1116.
10.
McCabeSEWestBTTeterCJ, et al.Medical and nonmedical use of prescription opioids among high school seniors in the United States. Arch Pediatr Adolesc Med2012; 166: 797–802.
11.
BucknerJDScherzerCRRogersAH, et al.Opioid and cannabis co-use: the role of opioid use to cope with negative affect. J Subst Use Addict Treat2023; 145: 208942.
12.
DrazdowskiTK. A systematic review of the motivations for the non-medical use of prescription drugs in young adults. Drug Alcohol Depend2016; 162: 3–25.
13.
DrazdowskiTKKellyLMKliewerWL. Motivations for the nonmedical use of prescription drugs in a longitudinal national sample of young adults. J Subst Abuse Treat2020; 114: 108013.
14.
Doremus-FitzwaterTLVarlinskayaEISpearLP. Motivational systems in adolescence: possible implications for age differences in substance abuse and other risk-taking behaviors. Brain Cogn2010; 72: 114–123.
15.
HammondCJMayesLCPotenzaMN. Neurobiology of adolescent substance use and addictive behaviors: treatment implications. Adolesc Med State Art Rev2014; 25: 15–32.
16.
SchwebelDCGainesJ. Pediatric unintentional injury: behavioral risk factors and implications for prevention. J Dev Behav Pediatr2007; 28: 245–254.
BoydCJMcCabeSECranfordJA, et al.Adolescents’ motivations to abuse prescription medications. Pediatrics2006; 118: 2472–2480.
19.
KuntscheEKnibbeRGmelG, et al.Why do young people drink? A review of drinking motives. Clin Psychol Rev2005; 25: 841–861.
20.
BellTMRaymondJVetorA, et al.Long-term prescription opioid utilization, substance use disorders, and opioid overdoses after adolescent trauma. J Trauma Acute Care Surg2019; 87: 836–840.
21.
QuinnPDHurKChangZ, et al.Association of mental health conditions and treatments with long-term opioid analgesic receipt among adolescents. JAMA Pediatr2018; 172: 423–430.
22.
WhitesideLKRussoJWangJ, et al.Predictors of sustained prescription opioid use after admission for trauma in adolescents. J Adolesc Health2016; 58: 92–97.
23.
FakhrySMFergusonPLOlsenJL, et al.Continuing trauma: The unmet needs of trauma patients in the postacute care setting. Am Surg2017; 83: 1308–1314.
24.
Health Resources and Services Administration. Behavioral health workforce projections, 2016- 2030: Psychiatrists (adult), child and adolescent psychiatrists. Rockville, MD: HRSA Bureau of Health Workforce; 2018.
25.
RidingsLEAntonMTWinkelmannJ, et al.Trauma resilience and recovery program: addressing mental health in pediatric trauma centers. J Pediatr Psychol2019; 44: 1046–1056.
26.
RuggieroKJDavidsonTMAntonMT, et al.Patient engagement in a technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. J Am Coll Surg2020; 231: 223–230.
27.
RuggieroKDavidsonTBunnellB, et al.Trauma resilience and recovery program: A stepped care model to facilitate recovery after traumatic injury. Int J Emerg Ment Health2016; 18: 25.
28.
AdamsZWMarriottBRKarraS, et al.User-guided enhancements to a technology-facilitated resilience program to address opioid risks following traumatic injury in youth: qualitative interview study. JMIR Form Res2023; 7: e45128.
29.
KesslerRCAndrewsGColpeLJ, et al.Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med2002; 32: 959–976.
30.
BunnellBEDavidsonTMWinkelmannJR, et al.Implementation and utility of an automated text messaging system to facilitate symptom self-monitoring and identify risk for post-traumatic stress disorder and depression in trauma center patients. Telemed J E Health2019; 25: 1198–1206.
31.
KroenkeKSpitzerRLWilliamsJBW. The PHQ-9. J Gen Intern Med2001; 16: 606–613.
32.
SpitzerRLKroenkeKWilliamsJBW, et al.A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med2006; 166: 1092–1097.
BlevinsCAWeathersFWDavisMT, et al.The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Traumatic Stress2015; 28: 489–498.
35.
WeathersFLitzBKeaneT, et al.The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD. 2013.
36.
FoaEBAsnaaniAZangY, et al.Psychometrics of the child PTSD symptom scale for DSM-5 for trauma-exposed children and adolescents. J Clin Child Adolesc Psychol2018; 47: 38–46.
37.
BovinMJMarxBPWeathersFW, et al.Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders–fifth edition (PCL-5) in veterans. Psychol Assess2016; 28: 1379–1391.
38.
BasuDGhoshAHazariN, et al.Use of family CAGE-AID questionnaire to screen the family members for diagnosis of substance dependence. Indian J Med Res2016; 143: 722–730.
39.
CouwenberghCVan Der GaagRJKoeterM, et al.Screening for substance abuse among adolescents validity of the CAGE-AID in youth mental health care. Subst Use Misuse2009; 44: 823–834.
HamiltonCMStraderLCPrattJG, et al.The PhenX toolkit: Get the most from your measures. Am J Epidemiol2011; 174: 253–260.
42.
YardleyLSpringBJRiperH, et al.Understanding and promoting effective engagement with digital behavior change interventions. Am J Prev Med2016; 51: 833–842.
43.
GryczynskiJMitchellSGSchwartzRP, et al.Disclosure of adolescent substance use in primary care: comparison of routine clinical screening and anonymous research interviews. J Adolesc Health2019; 64: 541–543.
