Major
Psychology
Advisor
Paiva, Andrea
Advisor Department
Psychology
Date
4-2019
Keywords
peer recovery; substance use; peer; treatment; literature review
Abstract
Background: In the United States, the need for mental health and substance misuse treatment has been on the rise leading to an increase in healthcare costs and a reduction in barriers to care. Recently, there has been a growing interest in implementing peer support services (PSS) to increase access to care, improve treatment outcomes, and reduce healthcare related costs, such as emergency room visits, psychiatric hospitalization, and crisis stabilization.
Aims: This Honors project reports on a systematic review of the literature on treatment outcomes associated with PSS in mental health and/or substance misuse populations. It reviews the evidence that PSS may reduce healthcare related costs associated with these two populations. The second aim of this study is to identify potential gaps in the literature and make recommendations for future research.
Methods: Relevant publications were identified via a comprehensive keyword search on the PubMed database. Treatment outcomes on mental health and substance misuse populations, as well as healthcare costs were outcomes of interest. This study followed Khan et al. (2003)’s framework for conducting systematic literature reviews, including the use of quality assurance measure. Four types of studies were included: randomized controlled trials, quantitative studies, longitudinal studies, and population-based studies.
Results: A total of 609 articles were identified and 19 articles met inclusion criteria and were selected for review. There were 15 articles on mental health treatment outcomes, one on substance misuse treatment outcomes, and five on impacts to healthcare cost. There were two articles that covered both mental health treatment outcomes and another outcome. Eleven articles on mental health reported significant improvements in mental health outcomes and/or reductions in symptoms. The one article on substance misuse found a significant increase in outpatient service engagement in the short term and a greater sustained reduction in alcohol use long term. Three articles on healthcare cost found no significant reduction in healthcare related cost, with one study finding significant increases in outcomes associated with healthcare cost.
Conclusions: PSS have the potential to increase mental health and substance use treatment outcomes. This study did not find evidence that PSS reduce healthcare related costs. Gaps are identified in the literature on substance misuse treatment outcomes and healthcare related costs.
Comments
Substance abuse has become one of the largest healthcare crises in the country and have been placing a significant burden on the healthcare system. Substance abuse alone has an estimated cost of $740 billion annually when combining crime, lost productivity and healthcare costs (NIDA, 2017). The goals of peer recovery services are to reduce the healthcare burden, costs and assist in the treatment of difficult to manage conditions, such as in the case of mental health. Peer mentors are often engaged in the following range of activities: advocating for people in recovery, share resources, build skills and community relationships, lead recovery groups, mentor and set goals. Peer mentors are often involved in the supportive treatment of chronic health conditions, substance abuse recovery and/or trauma recovery (SAMSHA, 2018).
This project aims to conduct a systematic literature review around healthcare cost and treatment outcomes of peer recovery services. In the context of this project, systematic literature is defined as a process, “to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question,” (Cochrane Library, 2017). This project systematically evaluates the literature evidence on the hypothesis that peer recovery services reduce healthcare cost and increase substance abuse and mental health treatment outcomes.
The flowchart, as represented in Figure 1, showcases the review process. Initially, 638 articles were identified using the PubMed database and 630 were selected after duplicates were removed. Next, 76 articles were screened on titles and 524 were screened based on abstracts. The most common reason for screen out was the article not containing a structured, in-person peer recovery program. The remaining 30 articles were read in full and 11 were screened based on screening criteria, leaving the 19 articles that were selected for review.
The breakdown of the included articles by outcomes are: 15 articles on mental health treatment outcomes, one on substance use treatment outcomes and five on impacts to healthcare cost. There were two articles that covered both mental health treatment outcomes and another outcome. 11 articles on mental health reported significant improvements in mental health outcomes and/or reductions in symptoms. The one article on substance use found a significant increase in outpatient service engagement in the short term and a greater sustained reduction in alcohol use long term. Three articles on healthcare cost found no significant reduction in healthcare related cost, with one study finding significant increases in outcomes associated with healthcare cost.
This study demonstrates that peer recovery services have the potential to increase mental health and substance use treatment outcomes. This study did not find evidence that PRS reduce healthcare related costs. Gaps are identified in the literature on substance use treatment outcomes and healthcare related costs.