(PS6-B49) Substance Use Disorders in a Public Health Emergency: Efficiency Counts

Introduction: The United States is currently in a public health emergency. The Coronavirus Disease (COVID-19) is negatively impacting those with mental health and substance use disorders (SUD) (Dubey et al., 2020). Pandemic related stressors could result in 75,000 fatalities from SUD and mental health symptoms while access to care diminishes (Chiappini et al., 2020; Masters et al., 2021). Targeting processes existing across disorders may prove a novel way of increasing treatment efficiency needed during COVID-19 (Kroska et al., 2020). Psychological inflexibility, a transdiagnostic process shown to be related to SUD, exhibits additional increases in the magnitude of the relationship when presentations are co-occurring (Levin et al., 2014). Further investigation into transdiagnostic processes and co-occurring disorders is warranted (Dindo et al., 2017).  

Methods: This study aimed to determine the extent to which variances in psychological inflexibility and valued-action are explained by co-occurring mental health symptoms in SUD populations. It was proposed that anxiety, depression, chronic pain, pain with anxiety and depression (PAD), and no symptoms (NS) would significantly predict psychological inflexibility and valued-action. The present study was part of a larger investigation into acceptance and commitment therapy (ACT) for SUD. One-hundred thirteen participants (N = 113) were assessed at pre-treatment using multiple linear regression analyses.

Results: Results indicated that mental health symptoms explained 18.4% of the variance in psychological inflexibility, R² = .184, F(5, 107) = 4.84, p < .001, and 11.2% of the variance in valued-action, R² = .112, F(5, 107) = 2.71, p = .024. NS was the strongest unique predictor for psychological inflexibility, t(107) = –2.54, p = .013, followed by chronic pain, t(107) = –2.77, p = .007, and PAD, t(107) = 2.10, p = .038. Individually, anxiety and depression were not significant contributors. NS was the only unique predictor for valued-action t(107) = 2.86, p = .005.    

Conclusions: Combined mental health symptoms predicted psychological inflexibility and valued-action, stressing the impact of mental health in SUD populations. NS predicted reduced psychological inflexibility, while PAD predicted increased psychological inflexibility. Pain without anxiety and depression also predicted lower psychological inflexibility. While initially surprising, this finding indicates that experiencing pain in the absence of anxiety and depression is a sign of psychologically flexible coping. NS predicted valued-action, suggesting that absence of co-occurring mental health symptoms may increase valued-behavior. These findings have important implications for COVID-19 and future public health emergencies. Because of the current pandemic, the need for therapeutic efficiency is greater than ever. These findings demonstrate how assessing for mental health symptoms and targeting transdiagnostic processes, particularly when chronic pain, depression, and anxiety are present, can increase treatment efficiency in SUD settings.