Dean R. Gerstein

Do mechanisms that link addiction treatment patients to primary care influence subsequent utilization of emergency and hospital care

Background:Patients with drug use disorders are heavy users of emergency department (ED) and inpatient hospital care. This study examines whether formal mechanisms to link addiction treatment patients to primary medical care, either directly on site or by off-site referral—when compared with an absence of said mechanisms—might reduce these patients’ use of ED and hospital services after substance abuse treatment. Methods:We used longitudinal data from 6 methadone maintenance programs with 232 patients, 24 outpatient nonmethadone programs with 1202 patients, and 14 long-term residential programs with 679 patients in the National Treatment Improvement Evaluation Study. Multivariate logistic models controlling for health status and medical service utilization before treatment examined whether provision of medical services on- or off-site during treatment linkage led to reduced use of ED and hospital services in the year after treatment compared with no such provision. Results:On-site delivery of primary care reduced subsequent ED and hospital use among patients in methadone maintenance and long-term residential compared with the nonlinkage condition but not in outpatient nonmethadone programs. Off-site referral for medical care reduced subsequent ED visits but not hospitalizations in long-term residential programs. Conclusions:These findings suggest that for some treatment modalities, stronger primary care linkage mechanisms decrease subsequent utilization of expensive ED and hospital services. Future study should examine the cost implications of these strong linkage mechanisms and ways to strengthen linkages to off-site medical care.

Services Research Outcomes Study: Overview of Drug Treatment Population and Outcomes

The study examined a representative sample of the 1,060,000 individuals discharged from drug user treatment in the United States in the 12 months before September 1990, and compared self-reports of behavior 5 years before to 5 years after treatment. Self-reports about recent drug use were compared with urine samples, and the agreement between self-report and drug-test results was high. The key findings are that the number of alcohol and drug users declined markedly, ranging from one-seventh to more than one half; those who continued using drugs after treatment used them less frequently than before treatment; criminal behavior fell between one-quarter to one-half, and primary criminal support fell by one third; full-time employment did not change; homelessness, drug injection, and suicide attempts decreased by more than one-third.

Criminal Involvement Among Young Male Ecstasy Users

Ecstasy (MDMA) use increased rapidly in the U.S. between about 1995 and 2001. Most research on the drug focused on its psychopharmacological and public health contexts. Previous research on drugs-crime linkages suggests that there may have been a concommitant rise in ecstasy-related crimes. We explore this dimension here using data from 7794 arrested men, age 16 to 25, in the 2001 Arrestee Drug Abuse Monitoring (ADAM) sample and 9764 male respondents of similar age in the 2001 National Household Survey on Drug Abuse (NHSDA). Our results using a variety of bivariate and regression methods indicate that ecstasy use is less prevalent among young male arrestees than young men in general and that ecstasy use among arrestees is positively associated with various measures of drug market participation but negatively related to violent and property offenses. We recommend further investigation of ecstasy use in drug-oriented data sets and longitudinal studies to evaluate the link between ecstasy use and overall drug marketing.