Gary A. Zarkin

Is moderate alcohol use related to wages? Evidence from four worksites

Moderate alcohol users (approximately two drinks per day on average) have recently been shown to have a lower risk of coronary heart disease relative to abstainers and heavy drinkers. Conversely, a few studies have found that alcoholism is associated with greater unemployment and lower earnings. But, little research has examined the differential effects of drinking levels on job compensation. We utilize a newly created database on employees at four worksites to test for a nonlinear relationship between alcohol use and wages. We also examine whether alcohol use affects wages indirectly through educational achievement, marital status, and poor health. Our findings suggest an inverse U-shaped relationship between alcohol consumption and wages with a peak at approximately 1.5 to 2.5 drinks per day on average. Thus, controlling for other variables and conditional on working, moderate alcohol users have higher wages than abstainers and heavy drinkers at these worksites. We also find evidence that alcohol use is related to wages through human capital variables.

Brief Intervention for Problem Drug Use in Safety-Net Primary Care Settings: A Randomized Clinical Trial

IMPORTANCE Although brief intervention is effective for reducing problem alcohol use, few data exist on its effectiveness for reducing problem drug use, a common issue in disadvantaged populations seeking care in safety-net medical settings (hospitals and community health clinics serving low-income patients with limited or no insurance). OBJECTIVE To determine whether brief intervention improves drug use outcomes compared with enhanced care as usual. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial with blinded assessments at baseline and at 3, 6, 9, and 12 months conducted in 7 safety-net primary care clinics in Washington State. Of 1621 eligible patients reporting any problem drug use in the past 90 days, 868 consented and were randomized between April 2009 and September 2012. Follow-up participation was more than 87% at all points. INTERVENTIONS Participants received a single brief intervention using motivational interviewing, a handout and list of substance abuse resources, and an attempted 10-minute telephone booster within 2 weeks (n = 435) or enhanced care as usual, which included a handout and list of substance abuse resources (n = 433). MAIN OUTCOMES AND MEASURES The primary outcomes were self-reported days of problem drug use in the past 30 days and Addiction Severity Index-Lite (ASI) Drug Use composite score. Secondary outcomes were admission to substance abuse treatment; ASI composite scores for medical, psychiatric, social, and legal domains; emergency department and inpatient hospital admissions, arrests, mortality, and human immunodeficiency virus risk behavior. RESULTS Mean days used of the most common problem drug at baseline were 14.40 (SD, 11.29) (brief intervention) and 13.25 (SD, 10.69) (enhanced care as usual); at 3 months postintervention, means were 11.87 (SD, 12.13) (brief intervention) and 9.84 (SD, 10.64) (enhanced care as usual) and not significantly different (difference in differences, β = 0.89 [95% CI, -0.49 to 2.26]). Mean ASI Drug Use composite score at baseline was 0.11 (SD, 0.10) (brief intervention) and 0.11 (SD, 0.10) (enhanced care as usual) and at 3 months was 0.10 (SD, 0.09) (brief intervention) and 0.09 (SD, 0.09) (enhanced care as usual) and not significantly different (difference in differences, β = 0.008 [95% CI, -0.006 to 0.021]). During the 12 months following intervention, no significant treatment differences were found for either variable. No significant differences were found for secondary outcomes. CONCLUSIONS AND RELEVANCE A one-time brief intervention with attempted telephone booster had no effect on drug use in patients seen in safety-net primary care settings. This finding suggests a need for caution in promoting widespread adoption of this intervention for drug use in primary care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00877331.

A structured instrument for estimating the economic cost of drug abuse treatment: The Drug Abuse Treatment Cost Analysis Program (DATCAP)

Drug abuse treatment programs need to know the cost of the services they provide. Indeed, continued public and private funding is now being linked to cost and performance measures, and programs can use financial data to improve organizational efficiency. However, one of the dangers of promoting cost studies at treatment programs is that most program staff are not technically prepared to perform a cost analysis and little user-friendly information is available to offer assistance. Furthermore, not all cost methods are consistent, which can lead to noncomparable estimates that are difficult to use for policy or planning purposes. Our paper tries to fill this gap in the research literature and provide treatment programs with a much-needed technical assistance tool. Specifically, we present a structured and scientifically-based instrument for estimating the economic cost of treatment services. The Drug Abuse Treatment Cost Analysis Program (DATCAP) is described in detail along with a companion instrument to analyze treatment financing; the Drug Abuse Treatment Financing Analysis Program (DATFin). The components of both instruments are outlined and findings from a variety of actual case studies are presented. Lastly, we discuss the DATCAP Users Manual, which will enable individual programs to begin collecting the necessary data and estimating economic costs at their own clinics.

Alcohol use and wages: New results from the national household survey on drug abuse

A recent study published in the Journal of Health Economics by French and Zarkin [French, M.T., Zarkin, G.A., 1995. Is moderate alcohol use related to wages? Evidence from four worksites, Journal of Health Economics 14, 319-344] found evidence of a positive, inverse-U-shaped relationship between wages and alcohol consumption for individuals at four worksites. In this paper, we attempted to replicate French and Zarkins findings using a combined sample of prime-age workers from the 1991 and 1992 National Household Surveys on Drug Abuse (NHSDA). Whereas French and Zarkin found that individuals who consume approximately 1.5 to 2.5 drinks per day have higher wages than non-drinkers and heavy drinkers, we found no evidence of a turning point at this consumption level for either men or women. Our results do suggest that men who use alcohol have approximately 7% higher wages than men who do not drink, and this apparent wage premium is approximately the same over a wide range of alcohol consumption. For women, the estimated alcohol use premium is approximately half as large as for men and is statistically insignificant.

Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States.

OBJECTIVES Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. METHODS A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. RESULTS Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was

The Effects of Time in Drug Abuse Treatment and Employment on Posttreatment Drug Use and Criminal Activity

21.83 and

Symptoms of Dependence, Multiple Substance Use, and Labor Market Outcomes

18.09, respectively. CONCLUSIONS EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress.

The effect of treatment completion and length of stay on employment and crime in outpatient drug-free treatment

The impact of length of stay in drug abuse treatment on follow-up drug use and criminal behavior has important clinical and policy implications. In this paper we use longitudinal data from the Treatment Outcome Prospective Study to estimate the simultaneous effects of time in treatment and employment outcomes--weeks worked and total earnings--on posttreatment drug use and criminal activity. The drug use/criminal activity variables include four indexes measuring the severity of use, drug-related problems, predatory illegal acts, and overall criminal behavior. The results show that time in treatment had a negative and statistically significant impact on these outcome variables for every modality with residential clients experiencing the largest relative impact. The time-in-treatment effect was robust even when employment outcomes were modeled jointly with drug use and criminal activity outcomes. These findings highlight the importance of length of stay in treatment in the recovery and rehabilitation of drug abusers.

The relationship between drug use and labor supply for young men

The prevalence and costs of alcohol and drug disorders pose a serious social concern for policymakers. In this paper, we use data from the National Household Surveys on Drug Abuse (NHSDA) to estimate simple descriptive statistics and analysis of variance (ANOVA) models of the relationship between symptoms of dependence and labor market outcomes for alcohol, cigarettes, marijuana, and other illicit drugs. For men, we find that substance use with symptoms of dependence is associated with both lower employment rates and fewer hours of work. For women, we find that substance use with symptoms of dependence is associated with lower employment rates, but we find no consistent evidence of a relationship between symptoms of dependence and the number of hours worked. Finally, all of our point estimates are smaller in magnitude when we control for multiple substance use, suggesting that comorbidities play a critical role in the relationship between substance use and labor market outcomes. Our results suggest that policymakers and researchers should consider the full spectrum of substance use and dependence rather than focusing on the simple use of a single substance.

Are QALYs an appropriate measure for valuing morbidity in acute diseases

Length of stay in treatment has been found to be a significant predictor of positive post-treatment outcomes, such as decreases in unemployment and crime. However, length of stay may be an incomplete predictor of successful treatment. Surprisingly, few studies have examined whether completing treatment in addition to length of stay is an important factor in explaining positive treatment outcomes. The objective of our study is to examine the effect that treatment completion and length of stay have on post-treatment employment and crime for patients in outpatient drug-free treatment, the largest treatment modality in the United States. We use conditional logit and multiple regression models with program-level indicator variables (fixed effects) to estimate the effect of treatment completion and length of stay on employment and crime controlling for drug use severity, previous treatment history, and other patient demographics. Data are from the National Treatment Improvement Evaluation Study and include 986 adults enrolled in outpatient drug-free programs across the United States. We find that treatment completion and length of stay are significantly related to post-treatment employment. Holding length of stay constant, the occurrence of employment at follow-up among patients who complete their planned treatment is almost 2 times that of patients who do not complete treatment. However, treatment completion did not have a statistically significant effect on the probability of post-treatment crime. Although our results are mixed, these findings suggest that greater attention should be placed on evaluating the importance of both length of stay and treatment completion in treatment outcome studies.