{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T15:28:31Z","timestamp":1766503711705,"version":"build-2065373602"},"reference-count":48,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Poor adherence to treatment is a common clinical problem in individuals affected by mental illness and substance use\/dependence. In Italy, mental care is organized in a psychiatric service and addiction unit (SERD), characterized by dual independent assets of treatment. This difference, in the Emergency Room setting, leads to a risk of discontinuity of treatment in case of hospitalization. In this study we clinically characterized individuals who decided to attend hospital post-discharge appointments at SERD, in accordance with medical advice. Methods: This is a retrospective study, based on two years of discharged records of patients entering \u201cVersilia Hospital\u201d (Viareggio, Italy) emergency room, with urinalyses testing positive for substance use, and hospitalization after psychiatric consultation. The sample was divided according to the presence or absence of SERD consultation after discharge. Results: In the 2-year period of the present study, 1005 individuals were hospitalized. Considering the inclusion criterion of the study, the sample consisted of 264 individuals. Of these, 128 patients attended post-discharge appointments at SERD showing urinalyses positive to cocaine, opiates, and poly use; they were more frequently diagnosed as personality disorder and less frequently as bipolar disorder. The prediction was higher for patients that had already been treated at SERD, for patients who received SERD consultation during hospitalization, and for patients with positive urinalyses to cocaine and opiates at treatment entry. Conversely, patients who did not attend SERD consultation after discharge were affected by bipolar disorders. Limitations: Small sample size. Demographical data are limited to gender and age due to paucity of data in hospital information systems. SERD is located far from the hospital and is open only on weekdays; thus, it cannot ensure a consultation with all inpatients. Conclusions: Mental illness diagnosis, the set of substance use positivity at hospitalization, and having received SERD consultation during hospitalization appeared to have a critical role in promoting continuity of care. Moreover, to reduce the gap between the need and the provision of the treatment, a more effective personalized individual program of care should be implemented.<\/jats:p>","DOI":"10.3390\/ijerph19020760","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T14:05:07Z","timestamp":1641909907000},"page":"760","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Substance Use\/Dependence in Psychiatric Emergency Setting Leading to Hospitalization: Predictors of Continuity of Care"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7728-3705","authenticated-orcid":false,"given":"Angelo Giovanni Icro","family":"Maremmani","sequence":"first","affiliation":[{"name":"Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy"},{"name":"Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Lucca, Italy"},{"name":"PISA-School of Clinical and Experimental Psychiatry, 56100 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirella","family":"Aglietti","sequence":"additional","affiliation":[{"name":"SERD (Drug Addiction Service), Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, 55049 Viareggio, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Intaschi","sequence":"additional","affiliation":[{"name":"SERD (Drug Addiction Service), Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, 55049 Viareggio, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Bacciardi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy"},{"name":"PISA-School of Clinical and Experimental Psychiatry, 56100 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"ref_1","unstructured":"Health, M.O. (2020, October 02). National Guidelines for Mental Health, Available online: http:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_779_allegato.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1001\/jama.1990.03450190043026","article-title":"Comorbidity of mental disorders with alchool and other drug abuse","volume":"19","author":"Regier","year":"1990","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1001\/archpsyc.1997.01830160031005","article-title":"Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey","volume":"54","author":"Kessler","year":"1997","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1176\/ps.2007.58.7.942","article-title":"Treatment for co-occurring mental and substance use disorders in five state Medicaid programs","volume":"58","author":"Clark","year":"2007","journal-title":"Psychiatr Serv."},{"key":"ref_5","first-page":"497","article-title":"Follow-up services after an emergency department visit for substance abuse","volume":"13","author":"Breton","year":"2007","journal-title":"Am. J. Manag. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1080\/00952990.2017.1329315","article-title":"Importance of short-term continuing care plan adherence on long-term outcomes among patients discharged from residential substance use treatment","volume":"43","author":"Proctor","year":"2017","journal-title":"Am. J. Drug Alcohol Abuse"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/08897077.2019.1635964","article-title":"Opioid, cocaine, and amphetamine use disorders are associated with higher30-day inpatient readmission rates in the United States","volume":"41","author":"Salemi","year":"2020","journal-title":"Subst. Abuse"},{"key":"ref_8","first-page":"1599","article-title":"Motivation for treatment in patients with substance use disorder: Personal volunteering versus legal\/familial enforcement","volume":"10","author":"Bilici","year":"2014","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13011-017-0111-8","article-title":"Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: An observational study","volume":"12","author":"Morandi","year":"2017","journal-title":"Subst. Abuse Treat. Prev. Policy"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jsat.2017.10.011","article-title":"Variability in motivational interviewing adherence across sessions, providers, sites, and research contexts","volume":"84","author":"Hallgren","year":"2018","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.psychres.2015.06.005","article-title":"Adjunctive psychosocial intervention following Hospital discharge for Patients with bipolar disorder and comorbid substance use: A pilot randomized controlled trial","volume":"228","author":"Wenze","year":"2015","journal-title":"Psychiatry. Res."},{"key":"ref_12","first-page":"189","article-title":"The challenge of patient adherence","volume":"1","author":"Martin","year":"2005","journal-title":"Clin. Risk Manag."},{"key":"ref_13","unstructured":"(2020, October 02). Organization of Department of Mental Health and Addictions. Available online: https:\/\/www.uslnordovest.toscana.it\/trasparenzausl12\/attivita-zona-distretto\/dipartimento-salute-mentale."},{"key":"ref_14","unstructured":"WHO (2011). International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), World Health Organization."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s11414-010-9224-9","article-title":"Patterns of substance abuse treatment seeking following cocaine-related emergency department visits","volume":"38","author":"Fortney","year":"2011","journal-title":"J. Behav. Health Serv. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1001\/jamainternmed.2018.6749","article-title":"Initiating Opioid Agonist Treatment for Opioid Use Disorder in the Inpatient Setting: A Teachable Moment","volume":"179","author":"Raheemullah","year":"2019","journal-title":"JAMA Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.drugalcdep.2017.08.018","article-title":"Polysubstance use by psychiatry inpatients with co-occurring mental health and substance use disorders","volume":"180","author":"Timko","year":"2017","journal-title":"Drug Alcohol Depend."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/00005053-199802000-00004","article-title":"Personality disorders in substance abusers: Relation to substance use","volume":"186","author":"Rounsaville","year":"1998","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/j.1530-0277.1994.tb00040.x","article-title":"Drinking outcomes of alcohol abusers diagnosed as antisocial personality disorder","volume":"18","author":"Longabaugh","year":"1994","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/00005053-199307000-00006","article-title":"A comparison of alternate systems for diagnosing antisocial personality disorder in cocaine abusers","volume":"181","author":"Carroll","year":"1993","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/00005053-199503000-00007","article-title":"Treatment response of antisocial substance abusers","volume":"183","author":"Cacciola","year":"1995","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1037\/0021-843X.106.1.74","article-title":"The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence rates and relation to alcohol typology variables","volume":"106","author":"Morgenstern","year":"1997","journal-title":"J. Abnorm. Psychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1002\/(SICI)1099-1077(199706)12:2+<S79::AID-HUP905>3.0.CO;2-T","article-title":"Addiction, Personality and Motivation","volume":"12","author":"Eysenck","year":"1997","journal-title":"Hum. Psychopharmacol. Clin. Exp."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1034\/j.1399-5618.2000.020306.x","article-title":"Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry","volume":"2","author":"Chengappa","year":"2000","journal-title":"Bipolar Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/j.1399-5618.2006.00370.x","article-title":"Bipolar disorder and comorbid alcoholism: Prevalence rate and treatment considerations","volume":"8","author":"Frye","year":"2006","journal-title":"Bipolar Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1176\/appi.ajp.160.5.883","article-title":"Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder","volume":"160","author":"Frye","year":"2003","journal-title":"Am. J. Psychiatry"},{"key":"ref_27","first-page":"445","article-title":"The incremental effect of age-weighting on YLLs, YLDs, and DALYs: A response","volume":"74","author":"Murray","year":"1996","journal-title":"Bull. World Health Organ."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1016\/S0140-6736(13)61530-5","article-title":"Global burden of disease attributable to illicit drug use and dependence: Findings from the Global Burden of Disease Study 2010","volume":"382","author":"Degenhardt","year":"2013","journal-title":"Lancet"},{"key":"ref_29","first-page":"23","article-title":"Possible trajectories of addictions: The role of bipolar spectrum","volume":"18","author":"Maremmani","year":"2016","journal-title":"Heroin Addict. Relat. Clin. Probl."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1744-859X-11-23","article-title":"Clinical presentations of substance abuse in bipolar heroin addicts at time of treatment entry","volume":"11","author":"Maremmani","year":"2012","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"133","DOI":"10.3109\/10673229809000321","article-title":"The effect of comorbid substance use disorders on the course of bipolar disorder: A review","volume":"6","author":"Tohen","year":"1998","journal-title":"Harv. Rev. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/00131746-200103000-00004","article-title":"Bipolar disorder with comorbid substance abuse: Diagnosis, prognosis, and treatment","volume":"7","author":"Goldberg","year":"2001","journal-title":"J. Psychiatr. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"701","DOI":"10.3389\/fpsyt.2018.00701","article-title":"Substance Dependence Among Bipolar, Unipolar Depression and Psychotic Homeless: A Canadian National Study","volume":"9","author":"Maremmani","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/NMD.0000000000000462","article-title":"Substance Use Among Homeless Individuals With Schizophrenia and Bipolar Disorder","volume":"205","author":"Maremmani","year":"2017","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jad.2015.01.059","article-title":"The impact of mood symptomatology on pattern of substance use among homeless","volume":"176","author":"Maremmani","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e19282","DOI":"10.5812\/ircmj.19282","article-title":"Comorbidity and pattern of substance use in hospitalized psychiatric patients","volume":"16","author":"Sepehrmanesh","year":"2014","journal-title":"Iran. Red Crescent Med. J."},{"key":"ref_37","first-page":"29","article-title":"Drug (heroin) addiction, bipolar spectrum and impulse control disorders","volume":"15","author":"Bacciardi","year":"2013","journal-title":"Heroin Addict. Relat. Clin. Probl."},{"key":"ref_38","first-page":"33","article-title":"Addictive disorders, bipolar spectrum and the impulsive link: The psychopathology of a self-regenerating pathway","volume":"7","author":"Maremmani","year":"2005","journal-title":"Heroin Addict. Relat. Clin. Probl."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.drugalcdep.2011.03.029","article-title":"Predictors of clinical trial dropout in individuals with co-occurring bipolar disorder and alcohol dependence","volume":"118","author":"Prisciandaro","year":"2011","journal-title":"Drug Alcohol Depend."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/01.pra.0000393840.18099.d6","article-title":"Improving treatment adherence in patients with bipolar disorder and substance abuse: Rationale and initial development of a novel psychosocial approach","volume":"17","author":"Gaudiano","year":"2011","journal-title":"J. Psychiatr Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1080\/08039488.2018.1538387","article-title":"Self-reported treatment adherence among psychiatric in- and outpatients","volume":"72","author":"Karpov","year":"2018","journal-title":"Nord. J. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.jad.2013.08.026","article-title":"Treatment adherence in bipolar I and schizoaffective disorder, bipolar type","volume":"151","author":"Murru","year":"2013","journal-title":"J. Affect. Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s11126-019-09631-6","article-title":"Insight and Symptom Severity in an Inpatient Psychiatric Sample","volume":"90","author":"Rozalski","year":"2019","journal-title":"Psychiatr. Q."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3389\/fpsyt.2012.00061","article-title":"Correlations between awareness of illness (insight) and natural history of addiction in heroin addicted patients","volume":"3","author":"Maremmani","year":"2012","journal-title":"Front. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1093\/alcalc\/agv028","article-title":"Former Heroin-Dependent Alcohol Use Disorder Patients. Prevalence, Addiction History and Clinical Features","volume":"50","author":"Pacini","year":"2015","journal-title":"Alcohol Alcohol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s11020-005-7455-9","article-title":"Treatment for dual diagnosis patients in the psychiatric and substance abuse systems","volume":"7","author":"Timko","year":"2005","journal-title":"Ment. Health Serv. Res."},{"key":"ref_47","first-page":"3","article-title":"Manifesto Italiano per la Cura delle Tossicodipendenze: Il Modello di Cura Misto. Un manifesto per una nuova organizzazione dell\u2019assistenza sanitaria a soggetti tossicodipendenti da oppiacei","volume":"3","author":"Maremmani","year":"2013","journal-title":"Riv. Soc. Ital. Med. Gen."},{"key":"ref_48","first-page":"194","article-title":"\u201cContinuum Care\u201d in alcohol abuse disorders.. A manifesto to bridge the gap in personalisation of treatment pathways","volume":"21","author":"Maremmani","year":"2015","journal-title":"J. Psychopathol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/2\/760\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:14:50Z","timestamp":1760364890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/2\/760"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,11]]},"references-count":48,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["ijerph19020760"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19020760","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,1,11]]}}}