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

• Published in: Substance use & misuse 2023, Vol.ahead-of-print (ahead-of-print), p.1-13
• Main Authors: Moran, Landhing M., Panlilio, Leigh V., Hertzel, Sara K., Bertz, Jeremiah W., Tyburski, Matthew, Etter, John R., Epstein, David H., Preston, Kenzie L., Phillips, Karran A.
• Format: Article
• Language: English
• Subjects: Baltimore; Clinicaltrialsgov Identifier NCT01571752; Drug abuse; Drug use; Drugs; DSM-5 symptoms; Health status; Humans; Medical treatment; Mental health; Moderation; neighborhood; Neighborhoods; Opioids; Residence Characteristics; Social disorganization; Sociodemographics; Stability; Stress; Substance abuse; Substance use disorder; Substance-Related Disorders - diagnosis; Symptoms; trajectory; Treatment methods; Treatment outcomes; Visits
• ISSN: 1082-6084; 1532-2491; 1532-2491
• DOI: 10.1080/10826084.2023.2223258

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. 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. 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. 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.