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1.  Posttreatment Low-Risk Drinking as a Predictor of Future Drinking and Problem Outcomes Among Individuals with Alcohol Use Disorders 
Treatment for alcohol disorders has traditionally been abstinence-oriented, but evaluating the merits of a low-risk drinking outcome as part of a primary treatment endpoint is a timely issue given new pertinent regulatory guidelines. This study explores a posttreatment low-risk drinking outcome as a predictor of future drinking and problem severity outcomes among individuals with alcohol use disorders in a large private, not for profit, integrated care health plan.
Study participants include adults with alcohol use disorders at 6 months (N = 995) from 2 large randomized studies. Logistic regression models were used to explore the relationship between past 30-day drinker status at 6 months posttreatment (abstinent [66%], low-risk drinking [14%] defined as nonabstinence and no days of 5+ drinking, and heavy drinking [20%] defined as 1 or more days of 5 + drinking) and 12-month outcomes, including drinking status and Addiction Severity Index measures of medical, psychiatric, family/social, and employment severity, controlling for baseline covariates.
Compared to heavy drinkers, abstinent individuals and low-risk drinkers at 6 months were more likely to be abstinent or low-risk drinkers at 12 months (adj. ORs = 16.7 and 3.4, respectively; p < 0.0001); though, the benefit of abstinence was much greater than that of low-risk drinking. Compared to heavy drinkers, abstinent and low-risk drinkers were similarly associated with lower 12-month psychiatric severity (adj. ORs = 1.8 and 2.2, respectively, p < 0.01) and family/social problem severity (adj. OR = 2.2; p < 0.01). While abstinent individuals had lower 12-month employment severity than heavy drinkers (adj. OR = 1.9; p < 0.01), low-risk drinkers did not differ from heavy drinkers. The drinking groups did not differ on 12-month medical problem severity.
Compared to heavy drinkers, low-risk drinkers did as well as abstinent individuals for many of the outcomes important to health and addiction policy. Thus, an endpoint that allows low-risk drinking may be tenable for individuals undergoing alcohol specialty treatment.
PMCID: PMC4114217  PMID: 22827502
Low-Risk Drinking; Drinking Outcomes; Social Functioning; Alcohol
2.  Costs of care for persons with opioid dependence in commercial integrated health systems 
When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems.
The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007–2008 were included. Propensity scores were used to help adjust for group differences.
Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002).
Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.
PMCID: PMC4142137  PMID: 25123823
Substance abuse; Cost analysis; Health care utilization; Commercial health insurance; Parity
3.  Ten-year stability of remission in private alcohol and drug outpatient treatment: Non-problem users versus abstainers 
Drug and alcohol dependence  2012;125(0):67-74.
This study examined stability of remission in patients who were abstainers and non-problem users at 1-year after entering private, outpatient alcohol and drug treatment. We examined: (a) How does risk of relapse change over time? (b) What was the risk of relapse for non-problem users versus abstainers? (c) What individual, treatment, and extra-treatment characteristics predicted time to relapse, and did these differ by non-problem use versus abstinence?
The sample consisted of 684 adults in remission (i.e., abstainers or non-problem users) 1 year following treatment intake. Participants were interviewed at intake, and 1, 5, 7, 9, and 11 years after intake. We used discrete-time survival analysis to examine when relapse is most likely to occur and predictors of relapse.
Relapse was most likely at 5-year, and least likely at 11-year follow-up. Non-problem users had twice the odds of relapse compared to abstainers. Younger individuals and those with fewer 12-step meetings and shorter index treatment had higher odds of relapse than others. We found no significant interactions between non-problem use and the other covariates suggesting that significant predictors of outcome did not differ for non-problem users.
Non-problem use is not an optimal 1-year outcome for those in an abstinence-oriented, heterogeneous substance use treatment program. Future research should examine whether these results are found in harm reduction treatment and self-help models, or in those with less severe problems. Results suggest treatment retention and 12-step participation are prognostic markers of long-term positive outcomes for those achieving remission at 1 year.
PMCID: PMC3644563  PMID: 22542217
Remission; Abstinence; Longitudinal; Treatment
4.  Do 12-step meeting attendance trajectories over 9 years predict abstinence? 
This study grouped treatment-seeking individuals (n=1825) by common patterns of 12-step attendance using 5 waves of data (75% interviewed year-9) to isolate unique characteristics and use-related outcomes distinguishing each class profile. The high class reported the highest attendance and abstention. The descending class reported high baseline alcohol severity, long treatment episodes, and high initial attendance and abstinence; but by year-5 their attendance and abstinence dropped. The early-drop class, which started with high attendance and abstinence but with low problem severity, reported no attendance after year 1. The rising class, with fairly high alcohol and psychiatric severity throughout, reported initially low attendance, followed by increasing attendance paralleling their abstention. Last, the low and no classes, which reported low problem-severity and very low/no attendance, had the lowest abstention. Female gender and high alcohol severity predicted attendance all years. Consistent with a sustained benefit for 12-step exposure, abstinence patterns aligned much like attendance profiles.
PMCID: PMC3320672  PMID: 22206631
Alcoholics Anonymous; 12-step groups; latent class growth analysis; trajectories analysis; alcohol and drug outcomes
5.  The role of continuing care on 9-year cost trajectories of patients with intakes into an outpatient alcohol and drug treatment program 
Medical Care  2012;50(6):540-546.
The importance of a continuing care approach for substance use disorders (SUDs) is increasingly recognized. Our prior research found that a Continuing Care model for SUDs that incorporates three components (regular primary care, and specialty SUD and psychiatric treatment as needed) is beneficial to long-term remission. The study builds on this work to examine the cost implications of this model.
To examine associations between receiving Continuing Care and subsequent healthcare costs over 9 years among adults entering outpatient SUD treatment in a private non-profit, integrated managed care health plan. We also compare the results to a similar analysis of a demographically matched control group without SUD’s.
Study Design
Longitudinal observational study.
Measures collected over 9 years include demographic characteristics, self-reported alcohol and drug use and Addiction Severity Index, and health care utilization and cost data from health plan databases.
Within the treatment sample, SUD patients receiving all components of Continuing Care had lower costs than those receiving fewer components. Compared to the demographically matched non-SUD controls, those not receiving Continuing Care had significantly higher inpatient costs (excess cost=$65.79/member-month; p < .01) over 9 years, while no difference was found between those receiving Continuing Care and controls.
Although a causal link cannot be established between receiving Continuing Care and reduced long-term costs in this observational study, findings reinforce the importance of access to health care and development of interventions that optimize patients receiving those services and that may reduce costs to health systems.
PMCID: PMC3354333  PMID: 22584889
continuing care; cost; primary care; longitudinal study
7.  Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care–Based Model 
How best to provide ongoing services to patients with substance use disorders to sustain long-term recovery is a significant clinical and policy question that has not been adequately addressed. Analyzing nine years of prospective data for 991 adults who entered substance abuse treatment in a private, nonprofit managed care health plan, this study aimed to examine the components of a continuing care model (primary care, specialty substance abuse treatment, and psychiatric services) and their combined effect on outcomes over nine years after treatment entry.
In a longitudinal observational study, follow-up measures included self-reported alcohol and drug use, Addiction Severity Index scores, and service utilization data extracted from the health plan databases. Remission, defined as abstinence or non-problematic use, was the outcome measure.
A mixed-effects logistic random intercept model controlling for time and other covariates found that yearly primary care, and specialty care based on need as measured at the prior time point, were positively associated with remission over time. Persons receiving continuing care (defined as having yearly primary care and specialty substance abuse treatment and psychiatric services when needed) had twice the odds of achieving remission at follow-ups (p<.001) as those without.
Continuing care that included both primary care and specialty care management to support ongoing monitoring, self-care, and treatment as needed was important for long-term recovery of patients with substance use disorders.
PMCID: PMC3242696  PMID: 21969646
8.  Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes 
Drug and alcohol dependence  2010;114(2-3):110-118.
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 1,185 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.
PMCID: PMC3062692  PMID: 21050681
longitudinal data; tobacco; alcohol; substance use; treatment
9.  Addiction treatment ultimatums and U.S. health reform: A case study 
Increased access to health care, including addiction treatment, has long been a goal of health reform in the U.S. An unanswered question is whether reform will change the way people get to addiction treatment; when treatment is easily accessible, do individuals self-refer, or do they still enter treatment via ultimatums, and if so, from which sources? To begin examining this, we used a single case study of a U.S. health plan that provides access similar to that called for in health reform.
Using a case study method of data from studies conducted in a large, private non-profit, integrated managed care health plan which includes addiction services, we examined the prevalence and source of ultimatums to enter treatment, and the characteristics of those receiving them. The plan is highly representative of changes to U.S. health care and other countries due to health reform.
Many individuals entering addiction treatment had received an ultimatum stemming from employment, legal, medical, and family sources. Having more employment problems, an occupation with public safety concerns, being older, male, and ethnicity predicted an employment ultimatum. Higher legal problem severity predicted a legal ultimatum. More men (and younger people) had family ultimatums, and more women (and older people) had medical ultimatums. Being younger, male, married, having higher employment and family problem severity, and being drug or combined drug/alcohol dependent rather than dependent on alcohol-only predicted an ultimatum from one’s family. On the whole, an ultimatum from one source was not related to having one from another source. Those most likely to receive ultimatums from multiple sources were women, those separated/divorced, and those having higher psychiatric and legal problem severity.
Even in an insured population with good access to addiction treatment, individuals often receive ultimatums to enter treatment rather than being self-referred. Understanding the treatment entry process, and how it is affected by health care systems, could benefit from international and other comparative research.
PMCID: PMC3225963  PMID: 22135620
alcohol and drug treatment systems; treatment entry; coercion
10.  The time is now: missed opportunities to address patient needs in community clinics in Cape Town, South Africa 
To investigate the prevalence and correlates of missed opportunities for addressing reproductive and mental health needs during patients’ visits to primary healthcare facilities.
We selected a random sample of participants from 14 of the 49 clinics in Cape Town’s public health sector using stratified, cluster random sampling (n = 2618). Participants were screened to identify those at risk for unsafe sexual behaviour and a mental disorder (specifically substance use, depression, anxiety, and suicide). Information pertaining to whether or not respondents were asked about these issues during clinic visits during the previous year was elicited. The rates and correlates of missed opportunities for providing reproductive and mental health interventions were calculated.
The criteria of a strict definition of a missed opportunity for reproductive or mental health care information were fulfilled by 25% of the sample, while 46% met criteria for a looser definition. After adjusting for the effects of other variables in the model, men and Coloured respondents were more likely to have satisfied the definition of a missed opportunity for an intervention, while having completed high school and having children increased the likelihood of receiving an intervention.
Consultations with primary healthcare providers in which these issues are not discussed may represent missed opportunities. Persons presenting for routine care can be counselled, screened and, if required, treated. Interventions are needed at the patient, provider, and community levels to increase the opportunities to provide reproductive and mental health care to patients during routine visits.
PMCID: PMC2954234  PMID: 20667052
missed opportunities; primary care; South Africa
11.  Individuals Receiving Addiction Treatment: Are Medical Costs of their Family Members Reduced? 
Addiction (Abingdon, England)  2010;105(7):1226-1234.
To examine whether alcohol and other drug (AOD) treatment of the individual with AOD disorders is related to reduced medical costs of family members.
Using Kaiser Permanente Northern California administrative databases we matched AOD treatment patients with health plan members without AOD disorders on age, gender, and utilization criteria; we identified family members of each group. We measured abstinence at 1-year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years post-intake. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and control family members. We used multilevel models to examine the 4-year trajectories of cost subsequent to measuring abstinence status, controlling for pre-intake cost, age, gender and family size.
AOD patients’ family members had significantly higher costs and more psychiatric and medical conditions than control family members in the pre-treatment year. At 2-5 years post-intake, each year family members of AOD patients who were abstinent at 1 year had similar average per member-month medical costs as control family members (e.g., difference at year 5=$2.63; p>.82), whereas average per member-month costs of family members of non-abstinent patients were higher (e.g., difference at year 5=$35.59; p=.06). Family members of AOD patients who were not abstinent at 1 year, had a trajectory of increasing medical cost (slope=$10.32; p=.03) relative to control family members.
Successful AOD treatment is related to medical cost reductions for family members; these reductions may be considered a proxy for improved health.
PMCID: PMC2907442  PMID: 20491730
family health; cost analysis; alcoholism and addictive behavior; substance abuse
12.  Integrating Primary Medical Care With Addiction Treatment 
The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment.
To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse–related medical conditions (SAMCs).
Randomized controlled trial conducted between April 1997 and December 1998.
Setting and Patients
Adult men and women (n=592) who were admitted to a large health maintenance organization chemical dependency program in Sacramento, Calif.
Patients were randomly assigned to receive treatment through an integrated model, in which primary health care was included within the addiction treatment program (n=285), or an independent treatment-as-usual model, in which primary care and substance abuse treatment were provided separately (n=307). Both programs were group based and lasted 8 weeks, with 10 months of aftercare available.
Main Outcome Measures
Abstinence outcomes, treatment utilization, and costs 6 months after randomization.
Both groups showed improvement on all drug and alcohol measures. Overall, there were no differences in total abstinence rates between the integrated care and independent care groups (68% vs 63%, P=.18). For patients without SAMCs, there were also no differences in abstinence rates (integrated care, 66% vs independent care, 73%; P=.23) and there was a slight but nonsignificant trend of higher costs for the integrated care group ($367.96 vs $324.09, P=.19). However, patients with SAMCs (n=341) were more likely to be abstinent in the integrated care group than the independent care group (69% vs 55%, P=.006; odds ratio [OR], 1.90; 95% confidence interval [CI], 1.22-2.97). This was true for both those with medical (OR, 3.38; 95% CI, 1.68-6.80) and psychiatric (OR, 2.10; 95% CI, 1.04-4.25) SAMCs. Patients with SAMCs had a slight but nonsignificant trend of higher costs in the integrated care group ($470.81 vs $427.95, P=.14). The incremental cost-effectiveness ratio per additional abstinent patient with an SAMC in the integrated care group was $1581.
Individuals with SAMCs benefit from integrated medical and substance abuse treatment, and such an approach can be cost-effective. These findings are relevant given the high prevalence and cost of medical conditions among substance abuse patients, new developments in medications for addiction, and recent legislation on parity of substance abuse with other medical benefits.
PMCID: PMC3056510  PMID: 11594896
13.  Medical Conditions of Hazardous Drinkers and Drug Users in Primary Care Clinics in Cape Town, South Africa 
Journal of drug issues  2009;39(4):75796776.
Research has identified a wide range of health conditions related to alcohol and drug use in studies conducted primarily in developed countries and in populations with severe alcohol and drug problems. Little is known about medical conditions in those with less severe alcohol and drug use in developing countries. We used WHO AUDIT and ASSIST screeners to identify hazardous drinking or drug use in public health clinics in Cape Town, South Africa, and included questions about doctor-diagnosed medical conditions. Using logistic regression we examined the relationship of medical conditions to hazardous alcohol, drug and tobacco use. Those with hazardous substance use had higher prevalence of many health conditions including tuberculosis. Hepatitis B, migraine, chronic bronchitis, and liver cirrhosis. Optimal treatment for some medical conditions may include treatment of underlying hazardous substance use, particularly use of drugs other than alcohol. In these populations, access to substance use treatment is limited and even brief interventions or advice may be useful.
PMCID: PMC3011276  PMID: 21197147
14.  Trends in prescribed opioid therapy for non-cancer pain for individuals with prior substance use disorders 
Pain  2009;145(3):287-293.
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.
PMCID: PMC2929845  PMID: 19581051
Prescription opioid episodes; Substance use disorders; Chronic pain management in managed care
15.  Prevalence and Correlates of Substance Use Among South African Primary Care Clinic Patients 
Substance use & misuse  2008;43(10):1395-1410.
We aimed to assess prevalence and correlates of hazardous use of tobacco, alcohol and other drugs in a primary care population in Cape Town, South Africa. Stratified random sampling was used to select 14 of the 49 clinics in the public health sector in Cape Town, and every “nth” patient, with those ages 18–25 oversampled (N = 2,618). Data were collected from December 2003 through 2004, using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test. Hazardous use of tobacco was most common, followed by alcohol and then other drugs. Hazardous tobacco use was associated with the 18–25 years age group, no religious involvement, high school completion, and higher stress. Hazardous alcohol use was associated with male gender, younger men, no religious involvement, employment, some high school education, and higher stress. Hazardous use of other drugs was associated with Colored (mixed) race (particularly among men), no religious involvement, employment, and stress. For all substances, women, particularly Black women, had the lowest rates of hazardous use. Although the study is cross-sectional, it does identify groups that may be at high risk of substance misuse and for whom intervention is urgent. Because prevalence of substance use is high in this population, routine screening should be introduced in primary care clinics.
PMCID: PMC2924913  PMID: 18696375
Alcohol; tobacco; drugs; hazardous use; prevalence; primary care; South Africa
16.  Family Members of Persons with Alcohol or Drug Dependence: Health Problems and Medical Cost Compared to Family Members of Persons with Diabetes and Asthma: Family Members of Persons with AODD 
Addiction (Abingdon, England)  2009;104(2):203-214.
To compare the medical costs and prevalence of health conditions of family members of persons with an alcohol or drug dependence (AODD) diagnosis to family members of persons with diabetes and asthma.
Kaiser Permanente of Northern California (KPNC)
Family members of persons diagnosed with AODD between 2002 and 2005, and matched samples of family members of persons diagnosed with diabetes and asthma.
Logistic regression was used to determine whether the family members of persons with AODD were more likely to be diagnosed with medical conditions than family members of persons 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 two years after, initial diagnosis of the index person.
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 after, and the second year after, the index date ($217 and $293, respectively). AODD family members had higher total health care costs than asthma family members in the year before, and second year after, the index date ($104 and $269, respectively).
AODD family members have unique patterns of health conditions compared to the diabetes and asthma family members, and have similar, or higher, health care cost and utilization.
PMCID: PMC2896239  PMID: 19149814
alcohol; drug; dependence; costs; family; diabetes; asthma
17.  Stress, Substance Use and Sexual Risk Behaviors among Primary Care Patients in Cape Town, South Africa 
AIDS and behavior  2009;14(2):359-370.
We assessed the relationship between stress, substance use and sexual risk behaviors in a primary care population in Cape Town, South Africa. A random sample of participants (and over-sampled 18–24 year olds) from 14 of the 49 clinics in Cape Town's public health sector using stratified random sampling (N=2,618), was selected. We evaluated current hazardous drug and alcohol use and three domains of stressors (Personal Threats, Lacking Basic Needs, and Interpersonal Problems). Several personal threat stressors and an interpersonal problem stressor were related to sexual risk behaviors. With stressors included in the model, hazardous alcohol use, but not hazardous drug use, was related to higher rates of sexual risk behaviors. Our findings suggest a positive screening for hazardous alcohol use should alert providers about possible sexual risk behaviors and vice versa. Additionally, it is important to address a broad scope of social problems and incorporate stress and substance use in HIV prevention campaigns.
PMCID: PMC2835823  PMID: 19205865
substance use; alcohol use; drug use; ASSIST; sexual risk behaviors; stressors
18.  The role of medical conditions and primary care services in five-year substance use outcomes among chemical dependency treatment patients 
Drug and alcohol dependence  2008;98(1-2):45-53.
Health problems are prevalent in chemical dependency (CD) treatment populations, and often precede reductions in substance use among untreated populations. Few studies have examined whether medical problems predict better long-term outcomes in treated individuals, or how primary care utilization and CD/primary care service integration affects long-term outcomes among those with health problems
In a sample of 598 CD patients in a private health plan, logistic regression models examined whether Substance Abuse-related Medical Conditions (SAMCs), integrated medical and CD care, and on-going primary care predicted remission of CD problems at 5 years.
Those with SAMCs were no more likely than others to be remitted at 5 years except among young adults and those with medical, but not psychiatric SAMCs. Higher levels of medical problem severity at intake and receiving integrated CD and primary care in the index treatment episode predicted remission in the full sample and among those with SAMCs. Among those with SAMCs, individuals with ongoing medical care—two to ten primary care visits—in the 5 years following intake were more likely to be remitted at 5 years than those with fewer visits.
This study highlights the potentially important role of medical services in the long-term treatment of CD disorders. CD treatment may benefit from a disease management approach similar to that recommended for other chronic medical problems: specialty care when the condition is severe followed by services in primary care when the condition is stabilized.
PMCID: PMC2741640  PMID: 18571875
Primary Care; Medical Comorbidities; Alcohol Dependence; Substance-Related Disorders; Treatment
19.  Medical conditions of adolescents in alcohol and drug treatment: Comparison with matched controls 
Alcohol and drug problems are associated with medical problems among adults. Research on the relationship of adolescent alcohol and drug use disorders to specific medical problems is less developed and focused on acute consequences. This study addresses gaps in the literature regarding medical comorbidities in adolescents with alcohol and drug use disorders.
This study compares the prevalence of medical conditions among 417 adolescent alcohol and drug treatment patients with 2,082 demographically-matched controls from the same managed care health plan and examines whether comparisons vary among substance-type subgroups.
Approximately one-fourth of the comorbid conditions examined were more common among adolescent alcohol and drug patients than among matched controls, and several were among the most costly conditions (e.g. asthma, injury). We also found that pain-related diagnoses, including headache, and abdominal pain, were more prevalent among alcohol and drug patients.
Our findings point to the importance of examining comorbid medical and chemical dependency in both adolescent primary care and specialty care. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of a substance use problem.
PMCID: PMC1876784  PMID: 17259058

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