Tami L. Mark

The economic costs of heroin addiction in the United States

This study documents the costs of heroin addiction in the United States, both to the addict and society at large. Using a cost-of-illness approach, costs were estimated in four broad areas: medical care, lost productivity, crime, and social welfare. We estimate that the cost of heroin addiction in the United States was US

Understanding US addiction physicians' low rate of naltrexone prescription.

21.9 billion in 1996. Of these costs, productivity losses accounted for approximately US

Changes In US Spending On Mental Health And Substance Abuse Treatment, 1986–2005, And Implications For Policy

11.5 billion (53%), criminal activities US

For What Diagnoses Are Psychotropic Medications Being Prescribed? A Nationally Representative Survey of Physicians

5.2 billion (24%), medical care US

Evaluation of a tablet PC technology to screen and educate oncology patients.

5.0 billion (23%), and social welfare US

Advancing performance measures for use of medications in substance abuse treatment

0.1 billion (0.5%). The large economic burden resulting from heroin addiction highlights the importance of investment in prevention and treatment.

Productivity losses among treated depressed patients relative to healthy controls.

Naltrexone was approved by the US Food and Drug Administration (FDA) in December 1994. Although it is one of only two medications for alcohol rehabilitation approved in the US, naltrexone is not frequently prescribed. This paper examines the factors limiting physicians use of naltrexone. Data were collected through a survey of US physician members of two addiction medicine professional associations. Logistic regression analysis was conducted with the dependent variable being any prescription of naltrexone. Independent variables consisted of physician practice characteristics, physician ratings of naltrexones attributes (e.g. efficacy), physicians patient characteristics, and physicians exposure to information about naltrexone. On average, addiction medicine physicians prescribed naltrexone to 13% of their alcoholism patients. The two main self-reported reasons why physicians did not prescribe the medication to more patients were that patients refused to take the medication or comply with prescribing regimes (23%), and that patients could not afford the medication (21%). Multivariate results indicated that physician perceptions of naltrexones effectiveness and safety were significantly associated with prescribing. Physicians who had more exposure to information about the product (e.g. by reading more journal articles about naltrexone) were more likely to prescribe it. In summary, multiple factors are contributing to the relatively low naltexone prescription rate.

The Benefits and Challenges of Using Computer-Assisted Symptom Assessments in Oncology Clinics: Results of a Qualitative Assessment

The United States invests a sizable amount of money on treatments for mental health and substance abuse:

Spending trends on substance abuse treatment under private employer-sponsored insurance, 2001-2009.

135 billion in 2005, or 1.07 percent of the gross domestic product. We provide treatment spending estimates from the period 1986-2005 to build understanding of past trends and consider future possibilities. We find that the growth rate in spending on mental health medications-a major driver of mental health expenditures in prior years-declined dramatically. As a result, mental health and substance abuse spending grew at a slightly slower rate than gross domestic product in 2004 and 2005, and it continued to shrink as a share of all health spending. Of note, we also find that Medicaids share of total spending on mental health grew from 17 percent in 1986 to 27 percent in 2002 to 28 percent in 2005. The recent recession, the full implementation of federal parity law, and such health reform-related actions as the planned expansion of Medicaid all have the potential to improve access to mental health and substance abuse treatment and to alter spending patterns further. Our spending estimates provide an important context for evaluating the effect of those policies.

Smoking Cessation: the Value of a Comprehensive Carved-In Benefit

AbstractBackground: Psychoactive medications, such as antidepressants, are one of the most widely prescribed categories of drugs in the US; yet few studies have comprehensively examined the conditions for which psychoactive medications are prescribed. To our knowledge, no prior study has examined the extent to which psychoactive medications are prescribed for non-psychiatric somatic illnesses or the main types of psychiatric disorders for which psychoactive medications are being used.n Objective: To examine the diagnoses for which psychiatric medications are being prescribed in the US by analysing data from a nationally representative survey of physicians.n Methods: The data were obtained from the 2005 National Disease and Therapeutic Index (NDTI), a continuing survey of a US office-based panel of physicians. The 2005 physician panel consisted of approximately 4000 physicians reporting quarterly, which was projected to a universe of 500 722 physicians. The study focused on the diagnoses that were given as the primary reason for prescribing the following types of psychotropic medications: anti-depressants, antipsychotics and anti-anxiety medications.n Results: Of the total number of antidepressant drug mentions, 92.7% were prescribed for psychiatric conditions. The most common (65.3%) were mood disorders (e.g. depression), followed by anxiety disorders (16.4%), which together comprised 81.7% of all antidepressant drug mentions. Of the total number of anti-anxiety drug mentions, 67.7% were prescribed for psychiatric conditions. The most common diagnosis was anxiety disorders (comprising 39.6% of all drug mentions), followed by mood disorders (comprising 18.9% of all drug mentions). Almost one-third of anxiety medication drug mentions were for non-psychiatric conditions or conditions of unspecified type. Of the total number of antipsychotic drug mentions, 98.9% were prescribed for psychiatric conditions. The most common diagnoses, comprising 39.0% of all drug mentions, were mood disorders such as depression and bipolar disorder. The second most common psychiatric diagnosis was schizophrenia or other psychotic disorders, comprising 34.5% of drug mentions. Approximately 7.4% of drug mentions were for delirium, dementia, amnestic or other cognitive disorders. Attention-deficit/conduct/disruptive behaviour disorders were the diagnoses indicated on 5.7% of all antipsychotic drug mentions. Anxiety disorders were indicated on 5.5% of antipsychotic drug mentions. Disorders usually diagnosed in infancy/childhood/adolescence (e.g. autism) comprised 2.3% of antipsychotic drug mentions.n Conclusions: This research provides a broad view of the nature of psycho-active medication prescribing, which may serve as a guide to future research, policy and education about these medications, their perceived benefits and risks, and their uses.