Time-to-Relapse in Substance Abuse Patients with Concomitant Affective Disorders from an Intensive Treatment Unit

From the 2018 HVPAA National Conference

Mike Wang (The Johns Hopkins University School of Medicine), Gabriel Pinilla (The Johns Hopkins University School of Medicine), Sarfraz Akmal (The Johns Hopkins University School of Medicine), Adam Kaplin (The Johns Hopkins University School of Medicine)


Relapsing must be considered when managing substance abuse patients. Psychiatric assessments in the intensive treatment unit offers insight into predictors that may shorten the time-to-relapse in this population. Understanding these predictors may lead to more effective preventative health initiatives and optimized healthcare for these patients, reducing rates of relapsing.


To examine the underlying risk factors decreasing time-to-relapse substance abuse patients with concomitant affective disorders from the Johns Hopkins Hospital Intensive Treatment Unit (JHH-ITU).


Prospective pilot cohort based on 76 patients admitted to the JHH-ITU with comorbid substance abuse and affective disorders. Potential predictors of relapse (substance-abuse related admission), were analyzed based on CRISP, emergency room, psychiatric in-patient and discharge notes. Cox’s hazards regression was used to determine time-to-relapse.

The sample included 63 (82.89%) men and 13 women (17.10%). Median age was 44.5 years (IQR 33-50.3) and 41 (53.94%) patients were African-American.


Patients abusing benzodiazepines, who were initially admitted to the Emergency Department, and/or have undergone multiple detoxification programs, would experience a shorter relapsing period.

Prolonged relapse appeared to be correlated with the history of intravenous drug abuse and a lower number of substances. Heavy intravenous drug users may opt to avoid treatment, which would be translated into more spaced-in-time medical admissions (information bias). Another feasible explanation is the more intensive treatment applied to these sub-groups at the JHH-ITU due to its highest severity.

Age, sex, education level, job or marital status, number of dependents and stressful events were not associated with time-to-relapse as has been previously suggested on the studies authored by Wahler (2014), Kassani (2015), Yang (2015) and Riley (2017).


Emergency department admission, participation in multiple detoxification programs, and benzodiazepine abuse proved to have a significant contribution to reduced time-to-relapse. Further prospective studies are required to determine time-to-relapse in intravenous and/or multiple substance users for clarifying the direction of the association.

Implications for the Patient

The understanding of the neuropsychiatric and social determinants of mental illness and drug abuse may lead to more effective preventative health initiatives, as well as optimized healthcare for these special patient populations, further reducing rates of relapsing and overdosing.

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