UNMET NEED FOR HARM REDUCTION SERVICES AND MENTAL AND PHYSICAL HEALTH AMONGST A SAMPLE OF PEOPLE REPORTING PAST-YEAR ADDICTION PROBLEMS Jody Wolfe, Elaine Hyshka, and T. Cameron Wild Addiction and Mental Health Research Laboratory, School of Public Health, University of Alberta Public Health 2014 May 28, 2014

Population burden of addiction problems in Canada

Harm reduction as part of a tiered model of care for people living with addiction problems

Need for harm reduction services across the population

Research Questions What is the level of unmet need for harm reduction services amongst the general population of Albertans reporting past year [diagnosed or undiagnosed] addiction problems? Are those with unmet needs for harm reduction services experiencing more distress than those who have no unmet needs for harm reduction services?

GAP-MAP Data drawn from 2013 GAP-MAP study Gap analysis of public mental health and addictions programs (GAP- MAP) in Alberta Examined population need, program availability, and current level of investment in provincial addiction and mental health services.

Methods Single stage, stratified cluster sample design Random digit dialing Computer Assisted Telephone Interviews measured Demographics Health service utilization Physical and mental health N= 6,000 Alberta adults MANOVA used to assess differences between individuals reporting unmet needs and those with no unmet needs on six measures of psychiatric and physical health.

RESULTS

Perceived Need for Harm Reduction Services All Alberta adults 3,059,008 Perceived a need for harm reduction services 36, %

Perceived Need for Harm Reduction Services All Alberta adults 3,059,008 Unmet need for harm reduction services 7, % 6.5% Met criteria for a diagnosed or undiagnosed addiction 198,836

Patterns of Service Use

Measures of Well-Being ScaleDescriptionScoring Personal Well- being Index (PWI), 9 items Self-rated satisfaction with life domains (e.g., financial, health, community affiliation, etc.); ratings on a scale of 0- 10, Average of all items then multiplied by 10; higher scores reflect greater well-being Kessler-6 (K6), 6 items Frequency of experiencing 6 symptoms of mental ill-health, (e.g., hopelessness, nervousness, and feeling sad) in the past four weeks on a scale ranging from 0 (none of the time) to 4 (all of the time) Sum of all items with higher scores reflecting more distress General Health Questionnaire -12 (GHQ-12), 12 items Frequency respondents have experienced 12 symptoms (e.g., feeling under strain, losing sleep, lost confidence, feeling unhappy, etc.); rated on a scale ranging from 0 (more so than usual) to 3 (much less than usual) Sum of all items with higher scores reflecting poorer mental health

Measures of Well-Being ScaleDescriptionScoring Patient Health Questionnaire -9 (PHQ9), 9 items Frequency of experiencing symptoms of depression in the past month Summed, with higher scores reflecting greater depressive symptomology Alcohol Use Disorders Identification Test (AUDIT), 10 items Self-report measure used to identify hazardous and harmful drinking Higher scores reflect more problematic drinking habits Self-Rated Physical Health, 1 item “In general would you say your physical health is…,” rated on a 5- point scale Higher score reflects poorer perceived physical health Self-Rated Mental Health, 1 item “In general would you say your mental health is…,” rated on a 5-point scale Higher score reflects poorer perceived mental health

Unmet Need for Harm Reduction Services and Elements of Well-Being *Differences between those with and without unmet need for were statistically significant (p<.01) except PWI (p=.056) and GHQ-12 (p=.397)

Limitations Considerably underestimates need for harm reduction services in Alberta Does not enable substance-specific analysis

Conclusions Harm reduction needs exist across the population Unmet need associated with poorer health and reduced service use for individuals with addiction problems Additional research is needed to better understand this need Incorporating harm reduction services into mental health and addiction treatment systems and/or expanding access to harm reduction in Alberta could help connect more people with addictions to health and social services.

Thank you Questions? GAP Analysis of Public Addiction and Mental Health Programs: Final Report Wild, Wolfe, Wang, and Ohinmaa (2014)