Jennifer R. Mertens

Short-term alcohol and drug treatment outcomes predict long-term outcome.

INTRODUCTION Although addiction is recognized as a chronic, relapsing condition, few treatment studies, and none in a commercially insured managed care population, have measured long-term outcomes. We examined the relationship of 6-month treatment outcomes to abstinence 5 years post-treatment, and whether the predictors of abstinence at 5 years were different for those who were, and were not, abstinent at 6 months. METHODS The sample (N=784) is from an outpatient (day hospital and traditional outpatient) managed care chemical dependency program. Subjects were interviewed at baseline, 6 months, and 5 years. Logistic regression analysis was used to assess which individual, treatment and extra-treatment characteristics predicted alcohol and drug abstinence at 5 years. RESULTS Abstinence at 6 months was an important predictor of abstinence at 5 years. Among those abstinent at 6 months, predictors of abstinence at 5 years were older age, being female, 12-step meeting attendance, and recovery-oriented social networks. Among those not abstinent at 6 months, being alcohol dependent rather than drug dependent, 12-step meeting attendance, treatment readmission, and recovery-oriented social networks predicted abstinence at 5 years. CONCLUSION Our findings demonstrate a clear association between short-term and long-term treatment success. In addition, these results strongly support the importance of recovery-oriented social networks for those with good short-term outcomes, and the beneficial impact of readmission for those not initially successful in treatment.

Trends in prescribed opioid therapy for non-cancer pain for individuals with prior substance use disorders

ABSTRACT Long‐term opioid therapy for non‐cancer pain has increased. Caution is advised in prescribing for persons with substance use disorders, but little is known about actual health plan practices. This paper reports trends and characteristics of long‐term opioid use in persons with non‐cancer pain and a substance abuse history. Using health plan data (1997–2005), the study compared age–sex‐standardized rates of incident, incident long‐term and prevalent long‐term prescription opioid use, and medication use profiles in those with and without substance use disorder histories. The CONsortium to Study Opioid Risks and Trends study included adult enrollees of two health plans, Kaiser Permanente of Northern California (KPNC) and Group Health Cooperative (GH) of Seattle, Washington. At KPNC (1999–2005), prevalence of long‐term use increased from 11.6% to 17.0% for those with substance use disorder histories and from 2.6% to 3.9% for those without substance use disorder histories. Respective GH rates (1997–2005), increased from 7.6% to 18.6% and from 2.7% to 4.2%. Among persons with an opioid disorder, KPNC rates increased from 44.1% to 51.1%, and GH rates increased from 15.7% to 52.4%. Long‐term opioid users with a prior substance abuse diagnosis received higher dosage levels, were more likely to use Schedule II and long‐acting opioids, and were more often frequent users of sedative‐hypnotic medications in addition to their opioid use. Since these patients are viewed as higher risk, the increased use of long‐term opioid therapy suggests the importance of improved understanding of the benefits and risks of opioid therapy among persons with a history of substance abuse, and the need for more careful screening for substance abuse history than is the usual practice.

Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes

This study examined the association between stopping smoking at 1 year after substance use treatment intake and long-term substance use outcomes. Nine years of prospective data from 1185 adults (39% female) in substance use treatment at a private health care setting were analyzed by multivariate logistic generalized estimating equation models. At 1 year, 14.1% of 716 participants who smoked cigarettes at intake reported stopping smoking, and 10.7% of the 469 non-smokers at intake reported smoking. After adjusting for sociodemographics, substance use severity and diagnosis at intake, length of stay in treatment, and substance use status at 1 year, those who stopped smoking at 1 year were more likely to be past-year abstinent from drugs, or in past-year remission of drugs and alcohol combined, at follow-ups than those who continued to smoke (OR=2.4, 95% CI: 1.2-4.7 and OR=1.6, 95% CI: 1.1-2.4, respectively). Stopping smoking at 1 year also predicted past-year alcohol abstinence through 9 years after intake among those with drug-only dependence (OR=2.4, 95% CI: 1.2-4.5). We found no association between past-year alcohol abstinence and change in smoking status at 1 year for those with alcohol dependence or other substance use diagnoses when controlling for alcohol use status at 1 year. Stopping smoking during the first year after substance use treatment intake predicted better long-term substance use outcomes through 9 years after intake. Findings support promoting smoking cessation among smoking clients in substance use treatment.

Utilization and cost impact of integrating substance abuse treatment and primary Care

Objective. To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. Research Design. Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO’s primary care clinics independently from substance abuse treatment. Subjects. Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. Measures. Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. Results. For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from

The Excess Medical Cost And Health Problems of Family Members of Persons Diagnosed With Alcohol or Drug Problems

431.12 to

Family members of people with alcohol or drug dependence: health problems and medical cost compared to family members of people with diabetes and asthma

200.03 (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. Conclusions. (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.

The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients.

Background:Having a family member with substance use problems affects family functioning, which may lead to increased medical problems and increased health care utilization and costs in the other family members. Aim:We sought to estimate the excess medical costs and prevalence of diagnosed health conditions of family members of persons with an alcohol or drug diagnosis (AOD) compared with the family members of similar persons without an AOD. Methods:Using a large health plans administrative databases, we identified persons who received an AOD between 2001 and 2004 and a similar group of persons with no AOD during that time. Using a hierarchical linear mixed model, we compared the cost and utilization of the family members of the AOD and non-AOD patients in the 2 years prior to the AOD patients first AOD. Using logistic regression, we determined whether the family members of patients with AODs were more likely than comparison family members to be diagnosed with medical conditions. Results:Family members of patients with AODs had greater health care costs than comparison family members in the second year before the index date (

Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care–Based Model

490) and in the year before the index date (

Posttreatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders.

433). This was the case for both adult and child family members. They also were more likely to be diagnosed with many medical conditions, especially substance abuse and depression. Conclusions:Family members of patients with AODs have greater health care costs and are more likely to be diagnosed with a number of medical conditions than family members of similar persons without an AOD.

Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care: A Cluster Randomized Trial

AIMS To compare the medical costs and prevalence of health conditions of family members of people with an alcohol or drug dependence (AODD) diagnosis to family members of people with diabetes and asthma. SETTING Kaiser Permanente of Northern California (KPNC). PARTICIPANTS Family members of people diagnosed with AODD between 2002 and 2005, and matched samples of family members of people diagnosed with diabetes and asthma. MEASUREMENTS Logistic regression was used to determine whether the family members of people with AODD were more likely to be diagnosed with medical conditions than family members of people with diabetes or asthma. Multivariate models were used to compare health services cost and utilization of AODD family members and diabetes and asthma family members. Analyses were for the year before, and 2 years following, initial diagnosis of the index person. FINDINGS In the year before initial diagnosis of the index person, AODD family members were more likely to be diagnosed with substance use disorders, depression and trauma than diabetes or asthma family members. AODD family members had higher total health-care costs than diabetes family members in the year following, and the second year following, the index date (