Substance abuse and the need for money management assistance among psychiatric inpatients.

Patients who mismanage their funds may benefit from financial advice, case management or the involuntary assignment of a payee who restricts direct access to funds. Data from a survey of psychiatric inpatients at four VA hospitals (N = 236) was used to evaluate the relationship between substance abuse and clinician-rated need for money management assistance. Multivariate analytic techniques were used to control for sociodemographic factors and psychopathology. Alcohol and drug use severity both were modestly associated with need for assistance. The effect of substance use severity was greater in patients who were also diagnosed with a major mental illness. Clinicians indicated that 27 patients (11% of the sample) required an involuntary payee and 21 of the 27 (78%) had a Substance Abuse diagnosis. Only drug use severity was significantly associated with need for a payee. These data describe a substantial unmet need for money management assistance in psychiatric inpatients, particularly among those with substance abuse disorders. There is a need to examine the process by which the Social Security and Veterans Benefits Administrations assign payees to determine whether patients with co-morbid substance abuse are not being assigned a payee in spite of their discernible need for one.

Feasibility of a skills training approach to reduce substance dependence among individuals with schizophrenia.

A novel treatment for persons who have both schizophrenia and substance abuse was evaluated by incorporating cognitive-behavioral drug relapse prevention strategies into a skills training method originally developed to teach social and independent living skills to patients with schizophrenia. Thirty-four of 56 patients completed treatment and a three-month follow-up assessment. Participants learned substance abuse management skills and reported that they found the treatment relevant, useful, and satisfying, and their drug use decreased. Improvements were noted in medication adherence, psychiatric symptoms, and quality of life. This manual-driven therapy may play an important role in the treatment of substance abuse among patients with schizophrenia.

Veterans who may need a payee to prevent misuse of funds for drugs.

OBJECTIVE: This study sought to determine the possible need for a payee among Department of Veterans Affairs (VA) inpatients with substance use disorders who receive public support payments. METHODS: A total of 290 veterans hospitalized in VA psychiatric units completed a survey designed to identify patients who may be in need of a payee because of excessive expenditures for substances of abuse. Level 1 screening identified patients with a general likelihood of needing a payee because they received public support payments, did not have a payee, and had a substance abuse diagnosis. Level 2 screening identified level 1 patients for whom there was further evidence of need for a payee because, in addition to spending substantial amounts of money on substances of abuse, they reported either difficulty meeting basic material needs or substantial harm from substance use. RESULTS: Of 290 patients surveyed, 78 (27 percent) met level 1 criteria. Altogether, 35 patients (45 percent of level 1 patients and 13 percent of all surveyed patients) met the more specific level 2 criteria, indicating that they were likely to be in need of a payee. As expected, veterans who met the level 2 criteria were more likely than those meeting only the level 1 criteria to have both self-rated and clinician-rated difficulties managing money. However, clinicians did not rate these veterans as more likely to benefit from a payee. CONCLUSIONS: A substantial proportion of veterans who have not been assigned a payee may need one. More effective approaches to money management in this population are needed.

Payee relationships: institutional payees versus personal acquaintances.

Most patients' payees are friends or family members, but quantitative evaluations of patients' experience of payeeship published thus far have involved patients whose payees were mental health staff. We compared ratings of different aspects of payeeship among veterans whose payees were family or friends (n = 27) and among those with institutional payees (lawyers, accountants, or clinic-affiliates, n = 22). After adjusting for differences in sociodemographic characteristics, the two groups had small and statistically non-significant differences on measures of their interaction with their payees. Overall satisfaction with payees and trust in them was high.

Learning and Processes of Associative Mediation.

In the attempt to evaluate product and process views of associative mediation, 80 male and female university students learned paired-associate lists under one of several instructional sets. Those with mediation instructions wrote down associative mediators on cards-with (Intentional) or without (Incidental) instructions to learn the pairs--as pairs were projected onto a daylight screen. Others learned with Standard or Repetition instructions. Incidental mediation instructions were at least equal to Intentional mediation instructions in percent recall and were superior in number of associative mediators produced for normatively linked pairs (p < .05). Production of a mediator was significantly predictive of later recall (p < .001), but mediational instructions may have improved recall even when a rote strategy or no effective strategy was reported. Thus neither the product nor the process view could be rejected; it appeared possible that both types of factor were operating.

Do patients who mismanage their funds use more health services?

One rationale for establishing programs that help patients manage their funds is that such patients make extensive use of expensive inpatient services. We surveyed the money management habits of 406 inpatients and determined their use of Veterans Administration (VA) services and related costs over the subsequent year. In multivariate analyses, there was no statistically significant relationship between need for money management and service use or cost. The misspending of funds for drugs may precipitate hospitalization for some outpatients. However, in a sample of hospitalized patients, mismanagement of funds was not associated with longer length of stay or increased service use following discharge.