Sterling, Stacy
Young-Wolff, Kelly
Klatsky, Arthur L.
Assessing the Impact of Cannabis Legalization on Adolescent Cannabis Use and Cannabis-Related Health Conditions
Recreational cannabis legalization (RCL) has high potential to lead to increases in adolescent cannabis use and related health conditions, but few studies have examined this question and results are mixed. Using data from adolescents in KPNC''s large integrated health care…
Association of Pregnancy Intentions With Substance Use During Early Pregnancy
The goal of this study was to evaluate the association between pregnancy intentions and substance use in early pregnancy among pregnant women receiving prenatal care in a large, integrated healthcare system. The sample comprised 29,787 Kaiser Permanente Northern California pregnant…
Kaiser Permanente Northern California Alcohol Registry
The registry will increase understanding of the development of alcohol use disorders (AUD) and recovery from AUD, including factors that affect the likelihood of recovery success, such as quantity of alcohol consumed and the involvement of health and substance abuse…
Women’s Multi-Ethnic Health and Lifestyle Survey
We propose to survey White, Black, Latina, Filipina, Chinese, South Asian, Vietnamese, and Japanese women aged 35-79 to characterize and compare these racial/ethnic groups on behaviors and risks related to 7 lifestyle medicine domains (diet, physical activity, sleep, stress management,…
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes, Covid-19 Supplement
This study examines the increase in alcohol consumption during the Covid-19 pandemic and the major shift to virtual treatment modalities for alcohol problems, with a focus on potential disparities in treatment access, by race, ethnicity, age and gender. Understanding potential…
Buprenorphine Effect on Suicidal Behavior
Large observational study to evaluate the effects of initiating buprenorphine treatment on subsequent suicidal behavior among people with opioid use disorder.
Prevalence and Medication Treatment of Opioid Use Disorder Among Primary Care Patients with Hepatitis C and HIV
Hepatitis C and HIV are associated with opioid use disorders (OUD) and injection drug use. Medications for OUD can prevent the spread of HCV and HIV. To describe the prevalence of documented OUD, as well as receipt of office-based medication…
Association between marijuana use and electrocardiographic abnormalities by middle age The Coronary Artery Risk Development in Young Adults (CARDIA) Study
To evaluate the prevalence of electrocardiogram (ECG) abnormalities in marijuana users as an indirect measure of subclinical cardiovascular disease (CVD). Longitudinal and cross-sectional secondary data analysis from the CARDIA (Coronary Artery Risk Development in Young Adults) study. Four communities in…
Alcohol-Related Care and HCV Treatment among Patients with Problematic Alcohol Use and HCV
This study will examine substance use treatment among patients with hepatitis C who have unhealthy alcohol use and how well they engage in appropriate and timely hepatitis C care. The findings will be used to conduct an intervention study aimed…
The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system
Smoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination. Participants were people with HIV (PWH) in Kaiser Permanente Northern California. Predictors included smoking status and unhealthy alcohol use (exceeding…
PRimary Care Opioid Use Disorders treatment (PROUD) trial protocol: a pragmatic, cluster-randomized implementation trial in primary care for opioid use disorder treatment
Most people with opioid use disorder (OUD) never receive treatment. Medication treatment of OUD in primary care is recommended as an approach to increase access to care. The PRimary Care Opioid Use Disorders treatment (PROUD) trial tests whether implementation of…
Core outcomes set for research on the treatment of opioid use disorder (COS-OUD): the National Institute on Drug Abuse Clinical Trials Network protocol for an e-Delphi consensus study
A lack of consensus on the optimal outcome measures to assess the efficacy and effectiveness of interventions for the treatment of opioid use disorder (OUD) has hampered the pooling of research data for evidence synthesis and clinical guidelines. A core…
Association between self-reported caffeine intake during pregnancy and social responsiveness scores in childhood: The EARLI and HOME studies
Maternal nutrition during gestation has been investigated for its role in child neurodevelopment. However, little is known about the potential impact of gestational caffeine exposure on child autistic behaviors. Here, we assess the relation between maternal caffeine intake during pregnancy…
Three-Year Outcomes After Brief Treatment of Substance Use and Mood Symptoms
Screening, brief intervention, and referral to treatment (SBIRT) for adolescents exhibiting co-occurring substance use and mental health problems may improve outcomes and have long-lasting effects. This study examined the relationship between access to SBIRT and substance use, depression and medical…
HIV Stigma and Its Associations with Longitudinal Health Outcomes Among Persons Living with HIV with a History of Unhealthy Alcohol Use
This study examined the demographic and clinical correlates of HIV stigma and evaluated how HIV stigma was associated with physical and mental health outcomes one year later in a primary-care based cohort of persons living with HIV (PLHIV; N = 584). HIV…
Health System-Based Unhealthy Alcohol Use Screening and Treatment Comparing Demographically-Matched Participants With and Without HIV
Unhealthy alcohol use among persons living with HIV (PLWH) is linked to significant morbidity, and use of alcohol services may differ by HIV status. Our objective was to compare unhealthy alcohol use screening and treatment by HIV status in primary…
Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system
Practitioners expected the Affordable Care Act (ACA) to increase availability of health services and access to treatment for Americans with substance use disorders (SUDs). Yet research has not examined the associations among ACA enrollment mechanisms, deductibles, and the use of…
Addiction Telemedicine Consultation in Primary Care: Increasing Access to Pharmacotherapy and Specialty Treatment for Alcohol Problems
A cluster-randomized trial of Addiction Medicine consultation (AMC) for primary care physicians (PCPs) and patients examining the effectiveness of a telehealth AMC intervention on initiation of alcohol use treatment, anti-craving medication and/or specialty addiction treatment initiation, and on patient alcohol…
Trends and correlates of self-reported alcohol and nicotine use among women before and during pregnancy, 2009-2017
To examine trends and correlates of frequency of self-reported alcohol and nicotine use among pregnant women. Cross-sectional study of 363,240 pregnancies from 2009 to 2017 screened for self-reported substance use at their first prenatal visit in Kaiser Permanente Northern California.…
Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study (COVID-19 Revision)
As of March 26, 2020, there have been more than 80,000 cases and 1,000 deaths in the US due to COVID-19. Because it attacks the lungs, COVID-19 could be an especially serious threat to those who smoke or vape tobacco…
Impact of In Utero Marijuana Exposure on Neurodevelopment, Behavior and Mental Health: A Longitudinal Birth Cohort Study
This study will investigate whether maternal prenatal marijuana use increases the risk of impairments in a child's executive functioning and mental health, after accounting for other factors such as tobacco, alcohol, and other drug use; socioeconomic status, and maternal mental…
The Kaiser Permanente Northern California Adult Alcohol Registry, an Electronic Health Records-Based Registry of Patients With Alcohol Problems: Development and Implementation
Electronic health record (EHR)-based disease registries have aided health care professionals and researchers in increasing their understanding of chronic illnesses, including identifying patients with (or at risk of developing) conditions and tracking treatment progress and recovery. Despite excessive alcohol use…
Remission From Unhealthy Drinking Among Patients With an Alcohol Use Disorder: A Longitudinal Study Using Systematic, Primary Care-Based Alcohol Screening Data
Using electronic health record (EHR) data from a systematic, primary care-based alcohol screening, brief intervention, and referral to treatment (SBIRT) initiative within a health system, we examined correlates of remission from unhealthy drinking among patients with an alcohol use disorder…
Changes in Days of Unhealthy Alcohol Use and Antiretroviral Therapy Adherence, HIV RNA Levels, and Condomless Sex: A Secondary Analysis of Clinical Trial Data
In a sample of people with HIV (PWH) enrolled in an alcohol intervention trial and followed for 12 months, we examined the association of changes in days (i.e., decrease, increase, no change [reference]) of unhealthy drinking (consuming ≥ 4/≥ 5 drinks for women/men) with…
Neurodevelopmental outcomes in infants receiving opioid-replacement
Infants with Neonatal Opioid Withdrawal Syndrome (NOWS) are often treated with prolonged opioid-replacement pharmacotherapy. Whether opioid exposure in-utero or significant opioid exposure used to treat withdrawal symptoms impacts neurodevelopmental outcomes is unknown. Our aim is to evaluate neurodevelopmental outcomes at…
Alcohol and drug use, partner PrEP use and STI prevalence among people with HIV
People with HIV (PWH) have a high burden of bacterial sexually transmitted infections (STIs). We examined the relationship of alcohol and drug use and partner pre-exposure prophylaxis (PrEP) use to STI prevalence in a cohort of PWH with a history…
Online patient-provider cannabis consultations
Cannabis has been legalized, decriminalized, or medicalized in over half the U.S. states. With restrictions on cannabis research, accepted standards to guide clinical practice are lacking. Analyzing online communications through a digital health platform, we characterized patient questions about cannabis…
Prevalence and treatment of opioid use disorders among primary care patients in six health systems
The U.S. experienced nearly 48,000 opioid overdose deaths in 2017. Treatment of opioid use disorder (OUD) with buprenorphine is a recommended part of primary care, yet little is known about current U.S. practices in this setting. This observational study reports…
Management of Cannabis Use in Breastfeeding Women: The Untapped Potential of Certified Lactation Consultants
Recent increases in maternal cannabis use, in combination with rapidly changing cannabis policies in the United States, pose a unique threat to maternal and child health. To date, 33 states and the District of Columbia (D.C.) have legalized medicinal cannabis,…
Meta-analysis of 16 studies of the association of alcohol with colorectal cancer
Alcohol consumption is an established risk factor for colorectal cancer (CRC). However, while studies have consistently reported elevated risk of CRC among heavy drinkers, associations at moderate levels of alcohol consumption are less clear. We conducted a combined analysis of…
Functional validity, role, and implications of heavy alcohol consumption genetic loci
High alcohol consumption is a risk factor for morbidity and mortality, yet few genetic loci have been robustly associated with alcohol intake. Here, we use U.K. Biobank (n = 125,249) and GERA (n = 47,967) datasets to determine genetic factors…
Routes of cannabis administration among females in the year before and during pregnancy: Results from a pilot project
Use of cannabis during pregnancy is on the rise, yet little is known about how women administer cannabis during the perinatal period. This study examined self-reported modes of cannabis administration among women in the year before and during pregnancy, and…
LIFE EXPECTANCY DISPARITIES AMONG ADULTS WITH HIV IN THE UNITED STATES AND CANADA: THE IMPACT OF A REDUCTION IN DRUG- AND ALCOHOL-RELATED DEATHS USING THE LIVES SAVED SIMULATION (LISSO) MODEL
Improvements in life expectancy among people living with human immunodeficiency virus (PLWH) receiving antiretroviral treatment in the United States and Canada might differ among key populations. Given the difference in substance use among key populations and the current opioid epidemic,…
Long-term opioid therapy definitions and predictors: A systematic review
This review sought to (a) describe definitions of long-term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short-term opioid use to LTOT for opioid-naïve individuals. We conducted a systematic review of the peer-reviewed…
Benzodiazepine and unhealthy alcohol use among adult outpatients
Concomitant excessive alcohol consumption and benzodiazepine use is associated with adverse health outcomes. We examined associations of unhealthy alcohol use and other patient characteristics with benzodiazepine use. A cross-sectional analysis of 2,089,525 Kaiser Permanente of Northern California outpatients screened for…
Neurocognitive Impairment and Dementia in People With and Without HIV
People with HIV infection are at increased risk for dementia, possibly due to the combined effects of HIV-associated inflammation and traditional dementia risk factors such as chronic drug use and cerebrovascular disease. With the widespread use of antiretroviral therapy for…
Validity of Self-reported Cannabis Use Among Pregnant Females in Northern California
Most clinical and epidemiologic estimates of prenatal cannabis use are based on self-report, and the validity of self-reported cannabis use has not been examined in a large, representative population of pregnant women. We determined the validity of self-reported prenatal cannabis…
Cannabis Use and Markers of Systemic Inflammation The Coronary Artery Risk Development in Young Adults Study
It is unclear whether cannabis use in humans plays a role in the regulation of inflammatory responses. This study aimed to examine cannabis-attributable immunomodulation as manifested in levels of fibrinogen, C-reactive protein (CRP), and interleukin-6 (IL-6). The Coronary Artery Risk…
Interventions to Reduce Unhealthy Alcohol Use among Primary Care Patients with HIV: the Health and Motivation Randomized Clinical Trial
Unhealthy alcohol use has adverse effects on HIV treatment. Screening, brief intervention, and referral to treatment (SBIRT) has some evidence of efficacy but may not be sufficient for those with low motivation or comorbid substance use. To examine the effectiveness…
Optimizing Medical Decision-Making for Older Patients with Type 2 Diabetes
Medicare-age patients with type 2 diabetes are projected to double in the next 25 years and have high rates of complications and adverse drug events. However, older patients are largely excluded from the major clinical trials of diabetes care. This…
Enhanced Recovery After Surgery to Change Process Measures and Reduce Opioid Use After Cesarean Delivery: A Quality Improvement Initiative
To evaluate implementation of an enhanced recovery after surgery (ERAS) program for patients undergoing elective cesarean delivery by comparing opioid exposure, multimodal analgesia use, and other process and outcome measures before and after implementation. An ERAS program was implemented among…
Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial
Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. The Promoting Access to Care Engagement (PACE) trial currently in…
Prenatal Opioid Exposure: Neurodevelopmental Consequences and Future Research Priorities
Neonatal opioid withdrawal syndrome (NOWS) has risen in prevalence from 1.2 per 1000 births in 2000 to 5.8 per 1000 births in 2012. Symptoms in neonates may include high-pitched cry, tremors, feeding difficulty, hypertonia, watery stools, and breathing problems. However,…
Characteristics of New Opioid Use Among Medicare Beneficiaries: Identifying High-Risk Patterns
Opioid prescription patterns, including long-term use, multiple prescribers, and high opioid doses, increase the risk for adverse outcomes; however, previous research in older adult populations has primarily described opioid dose patterns using average daily dose measures or using very high…
Expanding the Scope and Reach of Adolescent Substance Use Early Intervention Research
This study explores the enduring impact of screening, brief intervention, and referral to treatment (SBIRT) delivered in pediatric primary care, on young adults. We will examine substance use, mental health and medical outcomes, and health services utilization and cost over…
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity, and Patient Outcomes
Using a theory-driven conceptual framework, this multimethod study examines factors that facilitate or impede the successful implementation and long-term sustainability of screening, brief intervention, and referral to treatment (SBIRT) for risky alcohol use in real-world health care settings. This study…
Self-reported Daily, Weekly, and Monthly Cannabis Use Among Women Before and During Pregnancy
As the overall prevalence of prenatal cannabis use rises, it is vital to also monitor trends in the frequency of cannabis use in the period leading up to and during pregnancy because more frequent use may confer greater health risks…
Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study
The goal of this application is to examine the association between maternal marijuana use during pregnancy and adverse obstetrical and neonatal outcomes. We aim to: 1) Examine trends in prenatal marijuana use following the legalization of marijuana for recreational purposes…
Multi-Ancestry Genome-Wide Association Study of Lipid Levels Incorporating Gene-Alcohol Interactions
A person's lipid profile is influenced by genetic variants and alcohol consumption, but the contribution of interactions between these exposures has not been studied. We therefore incorporated gene-alcohol interactions into a multiancestry genome-wide association study of levels of high-density lipoprotein…
Serum Sex Hormones and the Risk of Fracture across the Menopausal Transition: Study of Women’s Health Across the Nation
Sex steroid hormones have been linked to fractures in older women. To test the hypothesis that hormones measured over the menopausal transition predict fractures. Seven US clinical centers. Two thousand nine hundred sixty women (average age, 46.4 ± 2.7 years)…
Health Care Use Over 3 Years After Adolescent SBIRT
Most studies on adolescent screening, brief intervention, and referral to treatment (SBIRT) have examined substance use outcomes. However, it may also impact service use and comorbidity-an understudied topic. We address this gap by examining effects of SBIRT on health care…
Trends in marijuana use among pregnant women with and without nausea and vomiting in pregnancy, 2009-2016
Cross-sectional studies indicate an elevated prevalence of prenatal marijuana use in women with nausea and vomiting in pregnancy (NVP). However, it is unknown whether differences in marijuana use by NVP status have persisted over time as marijuana becomes more acceptable…
A Quality Framework for Emergency Department Treatment of Opioid Use Disorder
Emergency clinicians are on the front lines of responding to the opioid epidemic and are leading innovations to reduce opioid overdose deaths through safer prescribing, harm reduction, and improved linkage to outpatient treatment. Currently, there are no nationally recognized quality…
Mentoring Alcohol-Use Intervention Research in Health Care Settings
This research will examine the relationship of alcohol use and depression over time using data based in the electronic health record (EHR), in the context of health care. We will conduct secondary analysis of depression and hazardous drinking patterns in…
Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use
Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders1. They are heritable2,3 and etiologically related4,5 behaviors that have been resistant to gene discovery efforts6-11. In sample sizes up to 1.2 million individuals,…
Evaluating the Impact of Changes in Opioid Prescribing Across Health Systems Implementing Zero Suicide
Henry Ford Health System, Kaiser Permanente Colorado, Kaiser Permanente Northern California, Kaiser Permanente Northwest, and Kaiser Permanente Southern California are implementing the National Zero Suicide Model (NZSM), and have received funding from the National Institute of Mental Health to evaluate…
A Pragmatic Trial of Parent-Focused Prevention in Pediatric Primary Care: Implementation and Adolescent Health Outcomes in Three Health Systems
This study involves a partnership between Kaiser Permanente Northern California, Kaiser Permanente Colorado, Henry Ford Health System, and the University of Washington Social Development Research Group. The collaborators will conduct a pragmatic trial testing the feasibility and health impact of…
Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015
In the United States whites are more likely to misuse opioid pain relievers (OPRs) than blacks, and blacks are less likely to be prescribed OPRs than whites. Our objective is to determine whether racial discrimination in medical settings is protective…
Healthcare Effectiveness Data and Information Set (HEDIS) measures of alcohol and drug treatment initiation and engagement among people living with the human immunodeficiency virus (HIV) and patients without an HIV diagnosis
Background: Problematic use of alcohol and other drugs (AOD) is highly prevalent among people living with the human immunodeficiency virus (PLWH), and untreated AOD use disorders have particularly detrimental effects on human immunodeficiency virus (HIV) outcomes. The Healthcare Effectiveness Data…
Patient characteristics associated with treatment initiation and engagement among individuals diagnosed with alcohol and other drug use disorders in emergency department and primary care settings
Background: Treatment initiation and engagement rates for alcohol and other drug (AOD) use disorders differ depending on where the AOD use disorder was identified. Emergency department (ED) and primary care (PC) are 2 common settings where patients are identified; however,…
The association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of treatment initiation and engagement for alcohol and other drug use disorders
Background: Medical comorbidity may influence treatment initiation and engagement for alcohol and other drug (AOD) use disorders. We examined the association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement measures.Methods: We used electronic…
Factors associated with Healthcare Effectiveness Data and Information Set (HEDIS) alcohol and other drug measure performance in 2014-2015
Background: Only 10% of patients with alcohol and other drug (AOD) disorders receive treatment. The AOD Initiation and Engagement in Treatment (AOD-IET) measure was added to the national Healthcare Effectiveness Data and Information Set (HEDIS) to improve access to care.…
The prevalence of Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment among patients with cannabis use disorders in 7 US health systems
Background: Cannabis use disorders (CUDs) have increased with more individuals using cannabis, yet few receive treatment. Health systems have adopted the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of initiation and engagement in alcohol and other drug (AOD)…
Psychiatric comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of alcohol and other drug treatment initiation and engagement across 7 health care systems
Background: Psychiatric comorbidity is common among patients with alcohol and other drug (AOD) use disorders. To better understand how psychiatric comorbidity influences AOD treatment access in health care systems, the present study examined treatment initiation and engagement among a large,…
Predictors of Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement among patients with opioid use disorder across 7 health systems
Background: The prevalence of opioid use disorder (OUD) has increased rapidly in the United States and improving treatment access is critical. Among patients with OUD, we examined factors associated with the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures…
How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies.
BACKGROUND AND AIMS: Providing take-home naloxone (THN) to people who use opioids is an increasingly common strategy for reversing opioid overdose. However, implementation is hindered by doubts regarding the ability of people who use opioids to administer naloxone and respond…
Characteristics of patients with substance use disorder before and after the Affordable Care Act
The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of…
Medical and non-medical marijuana use in depression: Longitudinal associations with suicidal ideation, everyday functioning, and psychiatry service utilization
Marijuana use is clinically problematic in depression, and non-medical and medical use may both contribute to barriers to care in this population. Among outpatients with depression, we examined the differential impact of medical or non-medical marijuana use, relative to no-use,…
Developing a Prescription Opioid Registry in Diverse Health Systems
Building on past research, this project will establish the infrastructure to expand a prescription opioid registry across diverse health systems in the Addiction Research Network. Harmonized electronic health record data elements will be used to examine how changes in opioid…
The PPARγ Agonist Pioglitazone Fails to Alter the Abuse Potential of Heroin, But Does Reduce Heroin Craving and Anxiety.
Possibly through its effects on glia, the peroxisome proliferator-activated gamma receptor (PPARγ) agonist pioglitazone (PIO) has been shown to alter the effects of heroin in preclinical models. Until now, these results have not been assessed in humans. Heroin-dependent participants were…
Depression Screening Rates and Symptom Severity by Alcohol Use Among Primary Care Adult Patients
Hazardous alcohol use with depression may exacerbate health conditions and complicate medical care. We examined the rate of depression screening by alcohol use severity among primary care patients screened for hazardous alcohol use and, among those screened, examined patterns of…
Factors associated with hazardous alcohol use and motivation to reduce drinking among HIV primary care patients: Baseline findings from the Health & Motivation study
Limited primary care-based research has examined hazardous drinking risk factors and motivation to reduce use in persons with HIV (PWH). We computed prevalence ratios (PR) for factors associated with recent (5) included: moderate/severe depression (PR: 1.43; 1.03, 2.00) and other…
Association of Nausea and Vomiting in Pregnancy With Prenatal Marijuana Use
Use of marijuana, an antiemetic, is increasing among pregnant women,1,2 and data from 2 small surveys3,4 indicate that women self-report using marijuana to alleviate nausea and vomiting in pregnancy (NVP). To date, only 1 epidemiologic study5 has examined whether women…
Patient and System Characteristics Associated with Performance on the HEDIS Measures of Alcohol and Other Drug Treatment Initiation and Engagement
Understand patient and system characteristics associated with performance on the Healthcare Effectiveness Data and Information Set (HEDIS) Alcohol and Other Drug (AOD) Initiation and Engagement of Treatment (IET) measures. This mixed-methods study linked patient and health system data from four…
Use of a prescription opioid registry to examine opioid misuse and overdose in an integrated health system
Strategies are needed to identify at-risk patients for adverse events associated with prescription opioids. This study identified prescription opioid misuse in an integrated health system using electronic health record (EHR) data, and examined predictors of misuse and overdose. The sample…
Lifetime Marijuana Use and Subclinical Atherosclerosis: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Unlike tobacco, the effect of marijuana smoke on subclinical atherosclerosis, a surrogate measure for cardiovascular disease, is not known. This study aimed to determine the association between lifetime exposure to marijuana and measures of subclinical atherosclerosis in mid-life. We used…
Pediatrician and Behavioral Clinician-Delivered Screening, Brief Intervention and Referral to Treatment: Substance Use and Depression Outcomes
Early intervention for adolescent substance use and mental health problems may mitigate potential harm. We examined patient outcomes from a pragmatic trial of two modalities of delivering screening, brief intervention, and referral to treatment (SBIRT) and usual care (UC) in…
Association between paternal alcohol consumption before conception and anogenital distance of offspring
There are limited studies on the effects of paternal alcohol consumption, before conception, on the reproductive development of offspring. Anogenital distance (AGD), the distance from the center of the anus to the genitals, is a sensitive biomarker of reproductive hormone…
Self-Reported Marijuana Use Over 25 Years and Abdominal Adiposity: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
We investigated the association between cumulative lifetime and current marijuana use with total abdominal adipose tissue (AT), visceral AT, subcutaneous AT, intermuscular AT, and mean liver attenuation (LA) at mid-life. Longitudinal and cross-sectional secondary data analysis of participants in the…
Alcohol, Marijuana, and Opioid Use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters
Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a…
Novel genetic associations for blood pressure identified via gene-alcohol interaction in up to 570K individuals across multiple ancestries
Heavy alcohol consumption is an established risk factor for hypertension; the mechanism by which alcohol consumption impact blood pressure (BP) regulation remains unknown. We hypothesized that a genome-wide association study accounting for gene-alcohol consumption interaction for BP might identify additional…
Alcohol and Drug Use, Pain and Psychiatric Symptoms among Adults Seeking Outpatient Psychiatric Treatment: Latent Class Patterns and Relationship to Health Status
Substance use, psychiatric problems, and pain frequently co-occur, yet clinical profiles of treatment-seeking patients are poorly understood. To inform service and treatment planning, substance use and symptom patterns were examined in an outpatient psychiatry clinic, along with the relationship of…
Adverse impact of marijuana use on clinical outcomes among psychiatry patients with depression and alcohol use disorder
This study examined whether marijuana use was associated with clinically problematic outcomes for patients with depression and alcohol use disorder (AUD). The sample consisted of 307 psychiatry outpatients with mild to severe depression and past 30-day hazardous drinking/drug use, who…
Characteristics of drug use among pregnant women in the United States: Opioid and non-opioid illegal drug use.
BACKGROUND: The opioid epidemic in the US is affecting pregnant women and their offspring, with rising numbers of maternal and neonatal treatment episodes. The aim of this study was to characterize pregnant drug users in order to inform intervention strategies…
Extension of the Consortium to improve OutcoMes in HIV/Aids, Alcohol, Aging & multi-Substance (COMpAAAS)
With support from the National Institute on Alcohol Abuse and Alcoholism, the Consortium to improve OutcoMes in HIV/Aids, Alcohol, Aging & multi-Substance (COMpAAAS) has analyzed data from patients in the Veterans Administration Cohort Study. This project seeks to extend this…
Population-Based Screening and Brief Intervention in Primary Care: Health and Drinking Outcomes, Cost and Utilization
In June 2013, Kaiser Permanente Northern California incorporated alcohol screening, brief intervention, and referral to treatment (SBIRT) into the clinical workflow of its Adult Medicine program, alongside other preventive health measures (e.g., smoking screening, exercise, cancer screening, etc.). SBIRT has…
Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults
Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent…
Specialty addiction and psychiatry treatment initiation and engagement: Results from an SBIRT randomized trial in pediatrics
Many adolescents needing specialty addiction or psychiatry treatment never access care. We examined initiation and engagement with addiction and/or psychiatry treatment among adolescents referred to treatment from a trial comparing two different modalities of delivering Screening, Brief Intervention and Referral…
Prenatal Alcohol Exposure in Relation to Autism Spectrum Disorder: Findings from the Study to Explore Early Development (SEED)
Prenatal alcohol exposure can affect neurodevelopment, but few studies have examined associations with autism spectrum disorder (ASD). We assessed the association between maternal alcohol use and ASD in the Study to Explore Early Development, a multi-site case-control study of children…
Genetic contributors to variation in alcohol consumption vary by race/ethnicity in a large multi-ethnic genome-wide association study
Alcohol consumption is a complex trait determined by both genetic and environmental factors, and is correlated with the risk of alcohol use disorders. Although a small number of genetic loci have been reported to be associated with variation in alcohol…
The role of marijuana use disorder in predicting emergency department and inpatient encounters: A retrospective cohort study
Marijuana use disorder (MUD) is the most common illegal drug use disorder and its prevalence is increasing. It is associated with psychiatric and medical problems, but little is known about its impact on emergency department (ED) and inpatient utilization rates.…
Trajectories of remission and mortality over 13 years after intake to substance use treatment
Little is known about the relationships between long-term patterns of substance use and mortality risk among substance use disorder (SUD) patients. To determine distinct patterns of remission and relapse of SUD over time and examine their relationship with mortality. The…
Marijuana Use and Estimated Glomerular Filtration Rate in Young Adults
Marijuana use has become more widely accepted in the United States and has been legalized in many areas. Although it is biologically plausible that marijuana could affect kidney function, epidemiologic data are lacking. We conducted a cohort study among young…
Alcohol and Drug Use and Aberrant Drug-Related Behavior Among Patients on Chronic Opioid Therapy
To better identify individuals on chronic opioid therapy (COT) at high risk for aberrant-drug related behavior (ADRB). We examine whether patients with low level alcohol and drug use have similar characteristics to those with alcohol and drug disorders. We then…
Alcohol brief intervention in primary care: Blood pressure outcomes in hypertensive patients
In clinical trials alcohol brief intervention (BI) in adult primary care has been efficacious in reducing alcohol consumption, but we know little about its impact on health outcomes. Hypertension is a prevalent and costly chronic condition in the U.S. and…
Prescription opioid registry protocol in an integrated health system
To establish a prescription opioid registry protocol in a large health system and to describe algorithms to characterize individuals using prescription opioids, opioid use episodes, and concurrent use of sedative/hypnotics. Protocol development and retrospective cohort study. Using Kaiser Permanente Northern…
Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes
Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term…
Identifying Risk Factors for Prenatal Substance and Polysubstance Use
The overarching goal of this K01 study is to identify recent trends in prenatal substance use and develop data-driven, evidence-based, generalizable predictive models to identify women at greatest risk for continued substance use in pregnancy. Specifically, we aim to: 1)…
A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol
Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating…
Supplement for Integrating Addiction Research in Health Systems: the Addiction Research Network
This study examines factors influencing performance measures of treatment initiation and engagement for alcohol and drugs across seven health care systems.
Integrating Addiction Research in Health Systems: the Addiction Research Network – DUPLICATED DO NOT ACTIVATE
The overall goal of the Addictions Research Network (ARN) node of the Clinical Trials Network is to conduct research to improve outcomes in all patients with substance use disorders (SUDs) who are seen in medical settings. The ARN includes 15…
Buprenorphine and Substance Abuse Services for Prescription Opioid Dependence – DUPLICATED DO NOT ACTIVATE
This study is a randomized trial of adjunctive substance abuse services in combination with buprenorphine treatment for opioid abuse/dependence.
The Impact of Health Care Reform on Addiction and HIV Series
This study examines the impact of the Affordable Care Act (ACA) on substance use disorder (SUD) treatment, including SUD patients with HIV, in the context of a large health care delivery system
Primary Care-Based Interventions to Reduce Alcohol Use among HIV Patients
This randomized clinical trial uses a health plan’s electronic medical record (EMR) alcohol screen and examines innovative behavioral interventions and their cost effectiveness for hazardous drinking within a large HIV primary care clinic.
Smoke-Free Laws and Hazardous Drinking: A Cross-Sectional Study among U.S. Adults
Tobacco and alcohol use are strongly associated. This cross-sectional study examined the relationship of smoke-free law coverage and smoke-free bar law coverage with hazardous drinking behaviors among a representative sample of U.S. adult drinkers (n= 17,057). We merged 2009 National…
Effects of Ibudilast on the Subjective, Reinforcing, and Analgesic Effects of Oxycodone in Recently Detoxified Adults with Opioid Dependence.
Ibudilast, a nonselective phosphodiesterase inhibitor, is used clinically in Asia for the treatment of asthma and poststroke dizziness. Recent preclinical studies have suggested that it also inhibits glial cell activation in rodents, and may alter opioid-mediated effects, including analgesia and…
Motivation deficits and use of alcohol and illicit drugs among individuals with schizophrenia
This study examined the impact of substance use on intrinsic motivation and evaluated the association between intrinsic motivation and substance use recovery among individuals with schizophrenia. Alcohol and illicit drug use and intrinsic motivation were evaluated at baseline and 6-months…
Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System
The Affordable Care Act (ACA) was expected to benefit patients with substance use disorders, including opioid use disorders (OUDs). This study examined buprenorphine use and health services utilization by patients with OUDs pre- and post-ACA in a large health care…
Cumulative Lifetime Marijuana Use and Incident Cardiovascular Disease in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
To investigate the effects of marijuana in the development of incident cardiovascular and cerebrovascular outcomes. Participants were 5113 adults aged 18 to 30 years at baseline (1985-1986) from the Coronary Artery Risk Development in Young Adults study, who were followed…
No evidence of compensatory drug use risk behavior among heroin users after receiving take-home naloxone.
INTRODUCTION: Some fear that distribution of naloxone to persons at risk of experiencing an opioid overdose may reduce the perceived negative consequences of drug use, leading to riskier patterns of use. This study assessed whether participation in naloxone/overdose training altered…
Post-treatment Low-risk Drinking as a Predictor of Future Drinking and Problem Outcomes among Individuals with Alcohol Use Disorders: A 9-year Follow-up
Treatment for alcohol use disorders (AUDs) has traditionally been abstinence oriented, but new research and regulatory guidelines suggest that low-risk drinking may also be an acceptable treatment outcome. However, little is known about long-term outcomes for patients who become low-risk…
Video Consultation to Increase Integration of Primary Care and Addiction Medicine and Improve Alcohol-Related Health Outcomes
KPNC has been a leader in implementing alcohol SBIRT as part of routine primary care with its Alcohol as a Vital Sign initiative, which involves medical assistants (MAs) screening all patients in Adult Medicine and Family Practice for alcohol problems,…
Development of Predictive Models for the Development of Adolescent Substance Use Problems
The objective of this study is to develop models to predict the development of substance use disorders (SUDs) among adolescents in four health systems: KPNC, KPHI, Henry Ford and Geisinger. We will focus on EHR data available during study period…
Integrating Addiction Research in Health Systems: The Addiction Research Network
This cooperative agreement supports addiction research in 15 health systems from across the U.S. by establishing the Health Systems Network (HSN) node of the NIDA Clinical Trials Network. HSN research includes a range of study designs and settings, but emphasizes…
Evaluation of SBIRT for Adolescents in School and Pediatric Health Settings
This study examines the effectiveness of a group intervention (“Teen MPower”) for adolescents with behavioral health problems at improving patient outcomes and increasing specialty behavioral health treatment access, and examining barriers to and facilitators of implementation. Behavioral health problems –…
Prescription Opioid Management in Chronic Pain Patients: A Patient-Centered Activation Intervention – DUPLICATED DO NOT ACTIVATE
This randomized trial is based in primary care and focuses on management of prescription opioids among chronic pain patients. The intervention uses a patient activation approach to self-management for these patients and to link them to existing health plan resources.
Examination of New Treatment Endpoints Based on World Health Organization Consumption Levels
Five risk categories have been determined based on WHO criteria for risk of consumption on a single drinking day in relation to acute problems (very high risk: 4.4+ drinkers per drinking day in the prior month; high risk: 2.9-4.3 drinks…
Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement
Risk factors associated with developing opioid use disorders (OUD) are documented, but less is known about different pathways to initiation of opioids or opioid dependence, or how such pathways affect treatment engagement. We recruited 283 adults with electronic medical record…
Buprenorphine and Substance Abuse Services for Prescription Opioid Dependence
This study is a randomized trial of adjunctive substance abuse services in combination with buprenorphine treatment for opioid abuse/dependence. We will examine treatment as usual vs. case management/telephonic support, and outcomes of medication compliance, substance use and psychiatric severity.
The Impact of Health Care Reform on Addiction and HIV Services
To examine the impact of the ACA on treatment for individuals with drug use disorders and who are HIV+. We will examine how this population changes after 2014 enrollment, and subsequent substance abuse treatment and HIV treatment utilization. We will…
Screening for Youth Alcohol and Drug Use: A Study of Primary Care Providers
This is a renewal of a study in which we examioned barriers and facilitators to intervening with alcohol and drug (AOD) problems for adolescents in primary care (PC). The behavioral health fields have failed to persuade primary care providers (PCPs)…
Primary Care-Based Interventions to Reduce Alcohol Use among HIV Patients – DUPLICATED DO NOT ACTIVATE
This is a comparative effectiveness study of innovative intervention delivery models to reduce hazardous alcohol use among 400 HIV-infected patients recruited from a large KPNC clinic that has integrated hazardous drinking screening within the electronic medical record. We will compare…
Buprenorphine and Substance Abuse Services for Prescription Opioid Dependence – DUPLICATED DO NOT ACTIVATE
This study is a randomized trial of adjunctive substance abuse services in combination with buprenorphine treatment for opioid abuse/dependence. We will examine treatment as usual vs. case management/telephonic support, and outcomes of medication compliance, substance use and psychiatric severity.
The Impact of Health Care Reform on Addiction and HIV Services – DUPLICATED DO NOT ACTIVATE
The aim of this study is to examine the impact of the ACA on treatment for individuals with drug use disorders and who are HIV-positive. We will examine how this population changes after 2014 enrollment, and subsequent substance abuse treatment…
Racial Differences in HIV and HCV Risk Behaviors, Transmission, and Prevention Knowledge among Non-Treatment-Seeking Individuals with Opioid Use Disorder.
In light of New York's recently reinforced strategy to end the AIDS epidemic by expanding testing, treatment, and access to pre-exposure prophylaxis (PrEP), we assessed drug use and sexual risk behaviors, along with HIV/Hepatitis C virus (HCV) transmission and prevention…
The role of hazardous drinking reductions in predicting depression and anxiety symptom improvement among psychiatry patients: A longitudinal study
Co-occurrence of depression, anxiety, and hazardous drinking is high in clinical samples. Hazardous drinking can worsen depression and anxiety symptoms (and vice versa), yet less is known about whether reductions in hazardous drinking improve symptom outcomes. Three hundred and seven…
Marijuana use and service utilization among adolescents 7 years post substance use treatment
In an environment of increasingly liberal attitudes towards marijuana use and legalization, little is known about long-term trajectories of marijuana use among clinical samples of adolescents, and how these trajectories relate to health services utilization over time. Latent growth curve…
High-Deductible Health Plans: Implications for Substance Use Treatment
To examine whether high-deductible health plans are related to patient complexity, health services use, and medical care costs among substance use treatment patients. Electronic health record data from Kaiser Permanente Northern California; 2007-2011. Retrospective analysis of electronic health record data…
Alcohol, Cannabis, and Opioid Use Disorders, and Disease Burden in an Integrated Health Care System
We examined prevalence of major medical conditions and extent of disease burden among patients with and without substance use disorders (SUDs) in an integrated health care system serving 3.8 million members. Medical conditions and SUDs were extracted from electronic health…
Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial
Research has shown that higher activation and engagement with health care is associated with better self-management. To our knowledge, the linkage intervention (LINKAGE) is the first to engage patients receiving addiction treatment with health care using the electronic health record…
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…
Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis
Patients and clinicians have begun to recognize the advantages and disadvantages of buprenorphine relative to methadone, but factors that influence choices between these two medications remain unclear. For example, we know little about how patients' preferences and previous experiences influence…
Association Between Lifetime Marijuana Use and Cognitive Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Marijuana use is increasingly common in the United States. It is unclear whether it has long-term effects on memory and other domains of cognitive function. To study the association between cumulative lifetime exposure to marijuana use and cognitive performance in…
Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine
Studies suggest that dexmedetomidine-an intravenous central-acting ?2-adrenergic agonist that effectively reduces anxiety among critically ill patients-is being used in patients with severe alcohol withdrawal. However, evidence supporting its use is limited, and it is not approved for this indication. To…
Implementation of adolescent family-based substance use prevention programs in health care settings: Comparisons across conditions and programs
BACKGROUND: The majority of knowledge related to implementation of family-based substance use prevention programs is based on programs delivered in school and community settings. The aim of this study is to examine procedures related to implementation effectiveness and quality of…
Measures of outcome for stimulant trials: ACTTION recommendations and research agenda
The development and approval of an efficacious pharmacotherapy for stimulant use disorders has been limited by the lack of a meaningful indicator of treatment success, other than sustained abstinence. In March, 2015, a meeting sponsored by Analgesic, Anesthetic, and Addiction…
Marijuana use and risk of prediabetes and diabetes by middle adulthood: the Coronary Artery Risk Development in Young Adults (CARDIA) study
The impact of marijuana use on metabolic health is largely unknown. This study sought to clarify the cross-sectional and longitudinal associations between self-reported marijuana use, and prediabetes (defined as fasting glucose 5.6-6.9 mmol/l, 2 h glucose post OGTT 7.8-11.0 mmol/l…
Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care: A Cluster Randomized Trial
Early intervention for substance use is critical to improving adolescent outcomes. Studies have found promising results for Screening, Brief Intervention, and Referral to Treatment (SBIRT), but little research has examined implementation. To compare SBIRT implementation in pediatric primary care among…
The effects of pioglitazone, a PPARγ receptor agonist, on the abuse liability of oxycodone among nondependent opioid users.
AIMS: Activation of PPARγ by pioglitazone (PIO) has shown some efficacy in attenuating addictive-like responses in laboratory animals. The ability of PIO to alter the effects of opioids in humans has not been characterized in a controlled laboratory setting. The…
Alcohol and cardiovascular diseases: where do we stand today?
For centuries, multiple medical risks of heavy alcohol drinking have been evident with simultaneous awareness of a less harmful or sensible drinking limit. The increased risks of heavy drinking, defined as three or more standard-sized drinks per day, are both…
Sex and Age Differences in Global Pain Status Among Patients Using Opioids Long Term for Chronic Noncancer Pain
The use of chronic opioid therapy (COT) has risen dramatically in recent years, especially among women. However, little is known about factors influencing overall pain and function (global pain status) among COT users. Characterizing the typical experiences of COT patients…
Population-representative Incidence of Drug-induced Acute Liver Failure Based on an Analysis of an Integrated Healthcare System
Medications are a major cause of acute liver failure (ALF) in the United States, but no population-based studies have evaluated the incidence of ALF from drug-induced liver injury. We aimed to determine the incidence and outcomes of drug-induced ALF in…
Need and utility of a polyethylene glycol marker to ensure against urine falsification among heroin users.
BACKGROUND: Deceptive methods of falsifying urine samples are of concern for anyone who relies on accurate urine toxicology results. A novel method to combat these efforts utilizes polyethylene glycol (PEG) markers administered orally prior to providing a urine sample. By…
Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours?
To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours. Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed…
Drinking experience uncovers genetic influences on alcohol expectancies across adolescence
To test whether drinking onset moderates genetic and environmental contributions to individual differences in the etiology of alcohol expectancies across adolescence. Longitudinal twin design. Community sample from Los Angeles, CA, USA. A total of 1292 male and female twins, aged…
Tobacco and Alcohol in Relation to Male Breast Cancer: An Analysis of the Male Breast Cancer Pooling Project Consortium
The etiology of male breast cancer is poorly understood, partly due to its relative rarity. Although tobacco and alcohol exposures are known carcinogens, their association with male breast cancer risk remains ill-defined. The Male Breast Cancer Pooling Project consortium provided…
Does adopting a prenatal substance use protocol reduce racial disparities in CPS reporting related to maternal drug use? A California case study
This study examined whether adopting a standardized prenatal substance use protocol (protocol) in a hospital labor and delivery unit reduced racial disparities in reporting to child protective services (CPS) related to maternal drug use during pregnancy. This study used an…
Alcohol Intake, Beverage Choice, and Cancer: A Cohort Study in a Large Kaiser Permanente Population
The authors studied incident cancer risk from 1978 to 1985 and through follow-up in 2012 relative to light-to-moderate and heavy drinking and to the choice of alcoholic beverage in a cohort of 124,193 persons. With lifelong abstainers as referent, heavy…
Physician versus non-physician delivery of alcohol screening, brief intervention and referral to treatment in adult primary care: the ADVISe cluster randomized controlled implementation trial
Unhealthy alcohol use is a major contributor to the global burden of disease and injury. The US Preventive Services Task Force has recommended alcohol screening and intervention in general medical settings since 2004. Yet less than one in six US…
Advising depression patients to reduce alcohol and drug use: Factors associated with provider intervention in outpatient psychiatry
Mental health clinicians have an important opportunity to help depression patients reduce co-occurring alcohol and drug use. This study examined demographic and clinical patient characteristics and service factors associated with receiving a recommendation to reduce alcohol and drug use from…
Alcohol and the Risk of Barrett’s Esophagus: A Pooled Analysis from the International BEACON Consortium
Results from studies examining the association between alcohol consumption and the risk of Barrett's esophagus have been inconsistent. We assessed the risk of Barrett's esophagus associated with total and beverage-specific alcohol consumption by pooling individual participant data from five case-control…
Predictors of Abstinence from Heavy Drinking During Treatment in COMBINE and External Validation in PREDICT
The goal of the current study was to use tree-based methods (Zhang and Singer, 2010, Recursive Partitioning and Applications, 2nd ed. Springer, New York) to identify predictors of abstinence from heavy drinking in COMBINE (Anton et al. JAMA 2006; 295:2003), the…
Volume and Type of Alcohol During Early Pregnancy and the Risk of Miscarriage
Research on alcohol consumption during pregnancy and miscarriage spans over three decades, yet the relationship is still not well-understood. To assess the relationship between volume and type of alcohol consumed during pregnancy in relation to miscarriage. We utilized data from…
Abuse potential of intranasal buprenorphine versus buprenorphine/naloxone in buprenorphine-maintained heroin users.
In spite of the clinical utility of buprenorphine, parenteral abuse of this medication has been reported in several laboratory investigations and in the real world. Studies have demonstrated lower abuse liability of the buprenorphine/naloxone combination relative to buprenorphine alone. However,…
Should pregnant women with substance use disorders be managed differently?
Pregnant women with substance use disorders have multiple special needs, which might be best managed within a multiprofessional treatment setting involving medical, psychological and social care. Adequate treatment provision remains a challenge for healthcare professionals, who should undergo special training…
Comparison of a drug versus money and drug versus drug self-administration choice procedure with oxycodone and morphine in opioid addicts.
This double-blind, placebo-controlled study investigated the effects of oral morphine (0, 45, 135 mg/70 kg) and oral oxycodone (0, 15, 45 mg/70 kg) on buprenorphine-maintained opioid addicts. As a 3: 1 morphine : oxycodone oral dose ratio yielded equivalent subjective…
Substance abuse/dependence treatment: a European perspective.
During the past decade, substantial progress has been made in the field of addiction medicine in Europe, particularly regarding the development of new treatment interventions, resulting in a wide range of therapeutic options for patients with substance use disorders. However,…
Association between alcohol and cardiovascular disease; Mendelian randomisation analysis based on individual participant data
To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. Mendelian randomisation meta-analysis of 56 epidemiological studies. 261 991 individuals of European descent, including 20…
Effectiveness of nurse-practitioner-delivered brief motivational intervention for young adult alcohol and drug use in primary care in South Africa: a randomized clinical trial
To assess the effectiveness of brief motivational intervention for alcohol and drug use in young adult primary care patients in a low-income population and country. A randomized controlled trial in a public-sector clinic in Delft, a township in the Western…
Moderate alcohol intake and cancer: the role of underreporting
There is compelling evidence that heavy alcohol drinking is related to increased risk of several cancer types, but the relationship of light-moderate drinking is less clear. We explored the role of inferred underreporting among light-moderate drinkers on the association between…
Comparison of health care needs of child family members of adults with alcohol or drug dependence versus adults with asthma or diabetes
To compare the health problems, preventive care utilization, and medical costs of child family members (CFMs) of adults diagnosed with alcohol or drug dependence (AODD) to CFMs of adults diagnosed with diabetes or asthma. Child family members of adults diagnosed…
Alcohol and drug treatment involvement, 12-step attendance and abstinence: 9-year cross-lagged analysis of adults in an integrated health plan
This study explored causal relationships between post-treatment 12-step attendance and abstinence at multiple data waves and examined indirect paths leading from treatment initiation to abstinence 9-years later. Adults (N = 1945) seeking help for alcohol or drug use disorders from…
Does age at first treatment episode make a difference in outcomes over 11 years?
This study examines the associations between age at first substance use treatment entry and trajectory of outcomes over 11 years. We found significant differences in individual and treatment characteristics between adult intakes first treated during young adulthood (25 years or…
‘The chief of the service is very enthusiastic about it’: A qualitative study of the adoption of buprenorphine for opioid addiction treatment
Qualified physicians may prescribe buprenorphine to treat opioid dependence, but medication use remains controversial. We examined adoption of buprenorphine in two not-for-profit integrated health plans, over time, completing 101 semi-structured interviews with clinicians and clinician-administrators from primary and specialty care.…
Do Patient-perceived Pros and Cons of Opioids Predict Sustained Higher-Dose Use?
Chronic opioid therapy (COT) is associated with various adverse outcomes, especially at higher doses, yet little is known about predictors of sustained higher-dose COT. This study aimed to ascertain, among higher-dose COT patients, the association of patient-perceived pros and cons…
Five-Year Healthcare Utilization and Costs Among Lower-Risk Drinkers Following Alcohol Treatment
Lower-risk drinking is increasingly being examined as a treatment outcome for some patients following addiction treatment. However, few studies have examined the relationship between drinking status (lower-risk drinking in particular) and healthcare utilization and cost, which has important policy implications.…
Increased cigarette tax is associated with reductions in alcohol consumption in a longitudinal U.S. sample
BACKGROUND: Cigarette taxation has been recognized as one of the most significant policy instruments to reduce smoking. Smoking and drinking are highly comorbid behaviors, and the public health benefits of cigarette taxation may extend beyond smoking-related outcomes to impact alcohol…
Under-reporting of drug use among individuals with schizophrenia: prevalence and predictors
BACKGROUND:Illicit drug use is common in individuals with schizophrenia, and it has been suspected that many individuals under-report their use of substances, leading to significant barriers to treatment. This study sought to examine the degree to which individuals with schizophrenia…
Feasibility and acceptability of a novel, computerized screening and brief intervention (SBI) for alcohol and sweetened beverage use in pregnancy
Recommended screening and brief intervention (SBI) for alcohol use during pregnancy is impeded by high patient loads and limited resources in public health settings. We evaluated the feasibility, acceptability and validity of a new self-administered, single-session, bilingual, computerized Screening and…
Cost of Care for HIV-Infected Patients with Co-Occurring Substance Use Disorder or Psychiatric Disease: Report from a Large, Integrated Health Plan
Background. The costs of providing care to HIV-infected (HIV+) patients with co-occurring diagnoses of substance use (SU) disorder or psychiatric disease (PD) are not well documented. It is our objective to evaluate costs in these HIV+ patients receiving care in…
Examination of rare missense variants in the CHRNA5-A3-B4 gene cluster to level of response to alcohol in the San Diego Sibling Pair study
BACKGROUND:Common variants in the CHRNA5-A3-B4 gene cluster have been shown to be associated with nicotine dependence and alcohol use disorders (AUDs) and related traits, including the level of response (LR) to alcohol. Recently, rare variants (MAF < 0.05) in CHRNB4…
Posttraumatic stress disorder symptom clusters, alcohol misuse, and women’s use of intimate partner violence
Exploring how PTSD and alcohol misuse relate to women's use of intimate partner violence (IPV) is vital to develop our understanding of why some women may engage in IPV, which can serve to maximize intervention efforts for women. This study…
Factors Associated With Treatment Initiation for Psychiatric and Substance Use Disorders Among Persons With HIV
Prior studies of individuals with HIV infection have found that accessing psychiatric and substance abuse treatment when needed can improve health and prolong life, yet little is known about factors associated with treatment initiation. In a retrospective cohort design including…
Characterizing the longitudinal patterns of substance use among individuals diagnosed with serious mental illness after psychiatric hospitalization
AIM:To characterize longitudinal patterns of substance use across a large sample of psychiatric patients discharged from inpatient admission, followed for 1-year post-hospitalization.DESIGN:Prospective cohort study.SETTING:Kansas City, MO, USA; Pittsburgh, PA, USA; Worcester, MA, USA.PARTICIPANTS:Eight hundred and one schizophrenia-spectrum (n = 204),…
Longitudinal associations between smoking cessation medications and alcohol consumption among smokers in the International Tobacco Control Four Country survey
BACKGROUND: Available evidence suggests that quitting smoking does not alter alcohol consumption. However, smoking cessation medications may have a direct impact on alcohol consumption independent of any effects on smoking cessation. Using an international longitudinal epidemiological sample of smokers, we…
Genetic analysis of a population heavy drinking phenotype identifies risk variants in whites
Genetic association studies thus far have used detailed diagnoses of alcoholism to identify loci associated with risk. This proof-of-concept analysis examined whether population data of lifetime heaviest alcohol consumption may be used to identify genetic loci that modulate risk. We…
Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample
BACKGROUND: Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health…
Motivational interviewing to reduce hazardous drinking and drug use among depression patients
This randomized study examined the efficacy of motivational interviewing (MI) to reduce substance use among adults with depression in outpatient psychiatry. The sample consisted of 104 participants ages 18 and over who reported hazardous drinking (three drinks or more per…
Posttreatment Low-Risk Drinking as a Predictor of Future Drinking and Problem Outcomes Among Individuals with Alcohol Use Disorders
BACKGROUND: 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…
Post-diagnosis Alcohol Consumption and Breast Cancer Prognosis in the After Breast Cancer Pooling Project
BACKGROUND: Alcohol consumption is an established risk factor for incident breast cancer. However, its role in breast cancer prognosis remains unclear. METHODS: We conducted an investigation of postdiagnosis alcohol consumption with recurrence and mortality among 9,329 breast cancer patients in…
12-step participation and outcomes over 7 years among adolescent substance use patients with and without psychiatric comorbidity
This study examines the associations between 12-step participation and outcomes over 7 years among 419 adolescent substance use patients with and without psychiatric comorbidities. Although level of participation decreased over time for both groups, comorbid adolescents participated in 12-step groups…
Alcohol, tobacco and drug use as reasons for abortion
AIMS: Concern about the effects of alcohol and drug use during pregnancy is intertwined with debates about abortion. There is concern that alcohol abstinence recommendations lead women using low levels of alcohol to terminate otherwise wanted pregnancies. This study examines…
Prescribed opioid difficulties, depression and opioid dose among chronic opioid therapy patients
BACKGROUND: Chronic opioid therapy has increased dramatically, as have complications related to prescription opioids. Little is known about the problems and concerns attributed to opioids by patients receiving different opioid doses. METHODS: We surveyed 1883 patients who were receiving chronic…
12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment
BACKGROUND: Adolescents who attend 12-step groups following alcohol and other drug (AOD) treatment are more likely to remain abstinent and to avoid relapse post-treatment. We examined whether 12-step attendance is also associated with a corresponding reduction in health care use…
Shared genetic contributions to early-onset drinking and drinking to cope motives
INTRODUCTION: Recent evidence from empirical studies indicates that individuals who begin drinking at an early age may be more likely to use alcohol to cope with negative mood states and stress; however, the mechanisms underlying this association are unclear. One…
Integrating Substance Use Treatment Into Adolescent Health Care
Substance use (SU) problems are common among adolescents, a serious health risk for them and a major public health problem, but are inadequately addressed in most pediatric health care settings. Primary care offers an excellent context for SU assessment and…
Performance measures for substance use disorders — what research is needed?
In 2010, the Washington Circle convened a meeting, supported by the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), for a multidisciplinary group of experts to focus on the research gaps in…
Ten-year stability of remission in private alcohol and drug outpatient treatment: Non-problem users versus abstainers
BACKGROUND: 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…
Depression and Ambivalence Toward Chronic Opioid Therapy for Chronic Noncancer Pain
OBJECTIVES:: Chronic opioid therapy (COT) for chronic noncancer pain (CNCP) is characterized by both high rates of patient-initiated discontinuation and by perceived helpfulness among those who sustain opioid use. This study examines predictors of the desire to cut down or…
Interactive effects of childhood maltreatment and recent stressful life events on alcohol consumption in adulthood
OBJECTIVE: Childhood maltreatment is associated with early alcohol use initiation, alcohol-related problem behaviors, and alcohol use disorders in adulthood. Heavy drinking risk among individuals exposed to childhood maltreatment could be partly attributable to stress sensitization, whereby early adversity leads to…
Remission from alcohol and other drug problem use in public and private treatment samples over seven years
BACKGROUND: The treatment of alcohol and other drugs is now more commonly framed in terms of a chronic condition which requires ongoing monitoring. A model which includes continuing access to health care may optimize outcomes. Most studies of chronic care…
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…
Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse
PURPOSE Opioid misuse in the context of chronic opioid therapy (COT) is a growing concern. Depression may be a risk factor for opioid misuse, but it has been difficult to tease out the contribution of co-occurring substance abuse. This study…
The importance of exposure rate on odds ratios by cigarette smoking and alcohol consumption for esophageal adenocarcinoma and squamous cell carcinoma in the Barrett’s Esophagus and Esophageal Adenocarcinoma Consortium
BACKGROUND: Cigarette smoking is associated with esophageal adenocarcinoma (EAC), esophagogastric junctional adenocarcinoma (EGJA) and esophageal squamous cell carcinoma (ESCC), and alcohol consumption with ESCC. However, no analyses have examined how delivery rate modifies the strength of odds ratio (OR) trends…
The Role of Continuing Care in 9-year Cost Trajectories of Patients With Intakes Into an Outpatient Alcohol and Drug Treatment Program
BACKGROUND: The importance of a continuing care approach for substance use disorders (SUDs) is increasingly being recognized. Our prior research found that a Continuing Care model for SUDs that incorporates 3 components (regular primary care, and specialty SUD and psychiatric…
Twelve-step attendance trajectories over seven years among adolescents entering substance use treatment in an integrated health plan
AIMS: This study examines 12-Step attendance trajectories over 7 years, factors associated with the trajectories, and relationships between the trajectories and long-term substance use outcomes among adolescents entering out-patient substance use treatment in a private, non-profit integrated managed-care health plan.…
Effects of age and life transitions on alcohol and drug treatment outcome over nine years
OBJECTIVE: The purpose of this study was to examine the effects of age, common life transitions, treatment, and social support on outcomes 5-9 years after alcohol and other drug (AOD) treatment intake. METHOD: Participants were patients from a large outpatient…
The effects of age at drinking onset and stressful life events on alcohol use in adulthood: a replication and extension using a population-based twin sample
BACKGROUND: A study by Dawson and colleagues (Alcohol Clin Exp Res 2007; 31:69) using data from National Epidemiologic Survey on Alcohol and Related Condition found earlier drinking onset age, and higher levels of past-year stressful life events (SLE) were associated…
The Relationship Between Neighborhood Characteristics and Recruitment into Adolescent Family-Based Substance Use Prevention Programs
Youth in disadvantaged neighborhoods are at risk for poor health outcomes. Characteristics of these neighborhoods may translate into intensified risk due to barriers utilizing preventive care such as substance use prevention programs. While family-level risks affect recruitment into prevention programs;…
Concurrent Use of Alcohol and Sedatives Among Persons Prescribed Chronic Opioid Therapy: Prevalence and Risk Factors
Taking opioids with other central nervous system (CNS) depressants can increase risk of oversedation and respiratory depression. We used telephone survey and electronic health care data to assess the prevalence of, and risk factors for, concurrent use of alcohol and/or…
Peer Influences on Adolescent Alcohol and Other Drug Use Outcomes
PURPOSE: To examine the role of family environment and peer networks in abstinence outcomes for adolescents 1 year after intake to alcohol and other drug (AOD) treatment. DESIGN: Survey of 419 adolescents 13 to 18 years of age at consecutive…
Influence of site differences between urban and rural American and Central European opioid-dependent pregnant women and neonatal outcome characteristics.
BACKGROUND: Multi-center trials enable the recruitment of larger study samples, although results might be influenced by site-specific factors.METHODS: Site differences of a multi-center prospective double-blind, double-dummy randomized controlled trial (7 centers: Central Europe (Vienna)/USA (3 urban/3 rural centers)) comparing safety…
Opioid dependent and pregnant: what are the best options for mothers and neonates?
Pregnancy in opioid-dependent women is a major public health issue. Women who are afflicted by opioid addiction are a highly vulnerable group of patients frequently becoming pregnant unplanned and at risk of adverse pregnancy outcomes and peri-natal complications. Opioid agonist…
Formal and informal substance use treatment utilization and alcohol abstinence over seven years: Is the relationship different for blacks and whites?
BACKGROUND: This study examines whether the effects of formal substance use treatment utilization and Alcoholics Anonymous (AA) on 30-day abstinence vary for black versus white Americans. METHODS: The current analysis utilizes data from a longitudinal sample of 1013 black and…
Parent and child characteristics related to chosen adolescent alcohol and drug prevention program
Mothers were allowed to choose between two different family-based adolescent alcohol-drug prevention strategies and the choice was examined in relation to parent and teen characteristics. Under real world conditions, parents are making choices regarding health promotion strategies for their adolescents…
Association between marijuana exposure and pulmonary function over 20 years
CONTEXT: Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear. OBJECTIVE: To analyze associations between marijuana (both current and lifetime exposure) and pulmonary function. DESIGN, SETTING,…
Effect of Sexually Transmitted Infections, Lifetime Sexual Partner Count, and Recreational Drug Use on Lower Urinary Tract Symptoms in Men Who Have Sex With Men
OBJECTIVE: To investigate the relationship of lower urinary tract symptoms (LUTS) to urinary tract infection, prostatitis, sexually transmitted infection, lifetime sexual partner count, and recreational drug use in a population of men who have sex with men. LUTS in men…
Using Standardized Patients to Evaluate Screening, Brief Intervention, and Referral to Treatment (SBIRT) Knowledge and Skill Acquisition for Internal Medicine Residents
Comprehensive clinical competency curricula for hazardous drinking and substance use disorders (SUDs) exists for medical students, residents, and practicing health care providers. Evaluations of these curricula typically focus on learner attitudes and knowledge, although changes in clinical skills are of…
Prescription Long-term Opioid Use in HIV-infected Patients
OBJECTIVES: To examine changes the in use of prescription opioids for the management of chronic noncancer pain in human immunodeficiency virus (HIV)-infected patients and to identify patient characteristics associated with long-term use. METHODS: Long-term prescription opioid use (ie, 120+ days…
Early start: a cost-beneficial perinatal substance abuse program
OBJECTIVE: To conduct a cost-benefit analysis of Early Start, an integrated prenatal intervention program for stopping substance use in pregnancy. METHODS: A retrospective cohort study was conducted of 49,261 women who had completed prenatal substance abuse screening questionnaires at obstetric…
Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy
This paper used data from a study of pediatric primary care provider (PCP) screening practices to examine barriers to and facilitators of adolescent alcohol and other drug (AOD) screening in pediatric primary care. A web-based survey (N?=?437) was used to…
Using Needs Assessment to Develop Curricula for Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Academic and Community Health Settings
This article describes the use of a brief needs assessment survey in the development of alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) curricula in 2 health care settings in the San Francisco Bay Area. The samples…
Does Lack of Multinutrient Supplementation During Early Pregnancy Increase Vulnerability to Alcohol-Related Preterm or Small-for-Gestational-Age Births?
The objective of this study was to assess whether women who do not take multinutrient supplements during early pregnancy are more susceptible to the effects of low-to-moderate alcohol consumption on preterm birth and small-for-gestational-age birth (SGA) compared to women who…
Continuing care and long-term substance use outcomes in managed care: early evidence for a primary care-based model
OBJECTIVES: 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…
First-trimester fetal heart rate in mothers with opioid addiction.
AIM: To investigate the difference in fetal heart rate of opioid-dependent mothers compared to non-dependent mothers in the first trimester of pregnancy.DESIGN: The data of 74 consecutive singleton pregnancies of mothers enrolled in a maintenance programme for opioid-dependent women was…
Impact of treatment approach on maternal and neonatal outcome in pregnant opioid-maintained women.
OBJECTIVE: The objective of this study is to compare maternal and neonatal outcome of opioid-dependent women maintained on buprenorphine or methadone throughout pregnancy in a randomized double-blind double-dummy clinical trial (CT) with a comparison group undergoing a structured standard protocol…
Patterns of alcohol and drug use among depressed older adults seeking outpatient psychiatric services
OBJECTIVE: Alcohol and drug use and related problems may compromise depression treatment, and older adults may be especially at risk for poor outcomes. However, alcohol and drug use among older adults have not been studied in settings in which depression…
Alcohol intake and risk of oesophageal adenocarcinoma: a pooled analysis from the BEACON Consortium
BACKGROUND AND AIMS: Alcohol intake is a strong and well established risk factor for oesophageal squamous cell carcinoma (OSCC), but the association with oesophageal adenocarcinoma (OA) or adjacent tumours of the oesophagogastric junction (OGJA), remains unclear. Therefore, the association of…
The influence of gene-environment interactions on alcohol consumption and alcohol use disorders: a comprehensive review
Since 2005, a rapidly expanding literature has evaluated whether environmental factors such as socio-cultural context and adversity interact with genetic influences on drinking behaviors. This article critically reviews empirical research on alcohol-related genotype-environment interactions (GxE) and provides a contextual framework…
Alcohol screening and changes in problem drinking behaviors in medical care settings: a longitudinal perspective
OBJECTIVE: Although the effect of alcohol assessment in medical settings has received attention, the longitudinal study of such efforts has been restricted to studying a single assessment/intervention dose. Such interventions can be recurrent and have effects on subsequent problem drinking.…
Subdiagnostic alcohol use by depressed men and women seeking outpatient psychiatric services: consumption patterns and motivation to reduce drinking
BACKGROUND: This study examined alcohol use patterns among men and women with depression seeking outpatient psychiatric treatment, including factors associated with recent heavy episodic drinking and motivation to reduce alcohol consumption. METHODS: The sample consisted of 1,183 patients aged 18…
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…
A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics.
Hispanics are disproportionately affected by substance abuse, HIV infection, intimate partner violence, and mental health conditions. To address health disparities among Hispanics and other vulnerable groups, it is necessary to understand the complex interactions between health conditions clustering together (e.g.,…
Time-scheduled vs. pain-contingent opioid dosing in chronic opioid therapy
Some expert guidelines recommend time-scheduled opioid dosing over pain-contingent dosing for patients receiving chronic opioid therapy (COT). The premise is that time-scheduled dosing results in more stable opioid blood levels and better pain relief, fewer adverse effects, less reinforcement of…
Excess mortality among HIV-infected patients diagnosed with substance use dependence or abuse receiving care in a fully integrated medical care program
BACKGROUND: We examined the association between substance use (SU) disorder and mortality among HIV-infected patients in a large, private medical care program. METHODS: In a retrospective cohort design, HIV-infected patients (>/=14 years old) from a large health plan (Northern California)…
Accounting for the association between childhood maltreatment and alcohol-use disorders in males: a twin study
BACKGROUND: An association between childhood maltreatment and subsequent alcohol abuse and/or dependence (AAD) has been found in multiple studies of females. Less is known about the association between childhood maltreatment and AAD among males, and the mechanisms that underlie this…
Mortality after diagnosis of psychiatric disorders and co-occurring substance use disorders among HIV-infected patients
We examined the associations between psychiatric diagnoses, substance use disorders, health services, and mortality among 9751 HIV-infected patients (>/=14 years old) in a large, private medical care program, in a retrospective cohort design over a 12-year period. All study data…
Alcohol consumption and breast cancer recurrence and survival among women with early-stage breast cancer: the life after cancer epidemiology study
PURPOSE: To examine the association of alcohol consumption after breast cancer diagnosis with recurrence and mortality among early-stage breast cancer survivors. PATIENTS AND METHODS: Patients included 1,897 LACE study participants diagnosed with early-stage breast cancer between 1997 and 2000 and…
Age and gender trends in long-term opioid analgesic use for noncancer pain
OBJECTIVES: We describe age and gender trends in long-term use of prescribed opioids for chronic noncancer pain in 2 large health plans. METHODS: Age- and gender-standardized incident (beginning in each year) and prevalent (ongoing) opioid use episodes were estimated with…
Alcohol consumption and rectal tumor mutations and epigenetic changes
PURPOSE: An association between alcohol and rectal cancer has been reported in the epidemiological literature. In this study we further explore the association by examining specific tumor markers with alcohol consumption as well as types of alcoholic beverages consumed. METHODS:…
Breast cancer DNA methylation profiles are associated with tumor size and alcohol and folate intake
Although tumor size and lymph node involvement are the current cornerstones of breast cancer prognosis, they have not been extensively explored in relation to tumor methylation attributes in conjunction with other tumor and patient dietary and hormonal characteristics. Using primary…
Access to treatment for adolescents with substance use and co-occurring disorders: challenges and opportunities
OBJECTIVE: To review the research on economic and systemic barriers faced by adolescents needing treatment for alcohol and drug problems, particularly those with co-occurring conditions. METHOD: We reviewed the literature on adolescent access to alcohol and drug services, including early…
Predictors of longitudinal substance use and mental health outcomes for patients in two integrated service delivery systems
AIM: Individuals who have both substance use disorders and mental health problems have poorer treatment outcomes. This study examines the relationship of service utilization and 12-step participation to outcomes at 1 and 5 years for patients treated in one of…
Individuals receiving addiction treatment: are medical costs of their family members reduced?
AIMS: To examine whether alcohol and other drug (AOD) treatment is related to reduced medical costs of family members. DESIGN: Using the administrative databases of a private, integrated health plan, we matched AOD treatment patients with health plan members without…
Drinking Patterns, Gender and Health II: Predictors of Preventive Service Use
Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers. Researchers hypothesize that…
Achalasia, alcohol-stasis, and acute necrotizing esophagitis: connecting the dots.
Acute necrotizing esophagitis (ANE) or “black esophagus” is defined as a circumferential dark pigmentation of the esophagus on endoscopy and mucosal necrosis on histology. Due to its rarity, the etiopathogenesis of this alarming finding is poorly understood. We report a…
Stress, substance use and sexual risk behaviors among primary care patients in Cape Town, South Africa
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…
Drinking Patterns, Gender and Health I: Attitudes and Health Practices
Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking. We examined gender/alcohol consumption differences in health-related attitudes…
Empirically defined subtypes of alcohol dependence in an Irish family sample
Alcohol dependence (AD) is clinically and etiologically heterogeneous. The goal of this study was to explore AD subtypes among a sample of 1221 participants in the Irish Affected Sib Pair Study of Alcohol Dependence, all of whom met DSM-IV criteria…
Low to moderate alcohol intake is not associated with increased mortality after breast cancer
BACKGROUND: Both alcohol consumption and obesity have been linked with breast cancer morbidity and mortality. An inverse association between alcohol intake and obesity suggests possible confounding between these variables (and perhaps other factors) with breast cancer outcomes. METHODS: Alcohol intake…
Transitioning into and out of problem drinking across seven years
OBJECTIVE: The extent to which problem drinkers transition into and out of problem drinking was examined using Markov modeling. METHOD: Study participants (N = 1,350) were randomly sampled from one county's general population and from consecutive admissions to public and…
Opioid prescriptions for chronic pain and overdose: a cohort study
BACKGROUND: Long-term opioid therapy for chronic noncancer pain is becoming increasingly common in community practice. Concomitant with this change in practice, rates of fatal opioid overdose have increased. The extent to which overdose risks are elevated among patients receiving medically…
Ethnic disparities in accessing treatment for depression and substance use disorders in an integrated health plan
OBJECTIVE: This study examined ethnic differences in accessing treatment for depression and substance use disorders (SUDs) among men and women in a large integrated health plan, and explored factors potentially contributing to health care disparities. METHODS: Participants were 22,543 members…
Addiction treatment ultimatums and U.S. health reform: A case study
AIMS: 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,…
Alcohol and lung airways function
BACKGROUND: Limited data suggest that moderate alcohol drinkers may have better lung airways function than abstainers. Because few studies have fully accounted for confounders (including smoking and coronary disease), and some might have been biased by the inclusion with nondrinkers…
Drinking patterns, gender and health III: Avoiding versus seeking health care
Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care. Alcohol consumption has generated interest because heavy, chronic…
Red wine consumption and risk of prostate cancer: the California men’s health study
Red wine contains polyphenol antioxidants that inhibit prostate cancer development in animal studies. We investigated the effect of red wine intake on the risk of prostate cancer using data prospectively collected in the California Men's Health Study (CMHS). CMHS is…
Do multivitamin supplements modify the relationship between prenatal alcohol intake and miscarriage?
OBJECTIVE: To determine whether multivitamin supplements modify the relationship between alcohol consumption during pregnancy and the risk of miscarriage. STUDY DESIGN: We used data from a population-based cohort study of pregnant women (n=1061; response rate=39%). Participants were asked about their…
Trends in long-term opioid therapy for noncancer pain among persons with a history of depression
OBJECTIVE: We report trends in long-term opioid use among patients with a history of depression from two large health plans. METHODS: Using claims data, age- and gender-adjusted rates for long-term (>90 days) opioid use episodes were calculated for 1997-2005, comparing…
Trends in prescribed opioid therapy for non-cancer pain for individuals with prior substance use disorders
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…
Medical Conditions of Hazardous Drinkers and Drug Users in Primary Care Clinics in Cape Town, South Africa
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…
Mood-related drinking motives mediate the familial association between major depression and alcohol dependence
BACKGROUND: Major depression and alcohol dependence co-occur within individuals and families to a higher than expected degree. This study investigated whether mood-related drinking motives mediate the association between major depression and alcohol dependence, and what the genetic and environmental bases…
Three-year chemical dependency and mental health treatment outcomes among adolescents: the role of continuing care
BACKGROUND: Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long-term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This…
Organizational determinants of outpatient substance abuse treatment duration in women
Longer treatment duration has consistently been related to improved substance use outcomes. This study examined how tailored women's programming and organizational characteristics were related to duration in outpatient substance abuse treatment in women. Data were from two waves of a…
Twelve-Step affiliation and 3-year substance use outcomes among adolescents: social support and religious service attendance as potential mediators
AIMS: Twelve-Step affiliation among adolescents is little understood. We examined 12-Step affiliation and its association with substance use outcomes 3 years post-treatment intake among adolescents seeking chemical dependency (CD) treatment in a private, managed-care health plan. We also examined the…
Association between prenatal tobacco exposure and outcome of neonates born to opioid-maintained mothers. Implications for treatment.
BACKGROUND: Prenatal nicotine exposure is associated with increased neonatal mortality, low birth weight, and smaller head circumference. Opioid-dependent pregnant women show a particularly high prevalence of tobacco smoking and are at greater risk for additional adverse events. However, little is…
Substance use, symptom, and employment outcomes of persons with a workplace mandate for chemical dependency treatment
OBJECTIVE: This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. METHODS: The sample included 448 employed members of a private, nonprofit…
Alcohol types and sociodemographic characteristics as risk factors for Barrett’s esophagus
BACKGROUND & AIMS: Little is known about the effects of alcohol use and sociodemographics on the risk of Barrett's esophagus, a precursor to esophageal adenocarcinoma. We evaluated the association between alcohol use, alcohol type, sociodemographic profiles, other lifestyle factors, and…
Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization
PURPOSE: Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation could compromise other SU abstinence. This study…
Family members of people with alcohol or drug dependence: health problems and medical cost compared to family members of people with diabetes and asthma
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).…
Using drink size to talk about drinking during pregnancy: a randomized clinical trial of Early Start Plus
This clinical trial compared two brief alcohol use interventions in prenatal clinics: Early Start (ES), a substance-abuse screening and treatment program integrated with prenatal care focused on abstention (n=298), and Early Start Plus (ESP), adding a computerized drink-size assessment tool…
Health Services Research for Drug and Alcohol Treatment and Prevention
Health services research is a multidisciplinary field that examines ways to organize, manage, finance, and deliver high-quality care. This specialty within substance abuse research developed from policy analyses and needs assessments that shaped federal policy and promoted system development in…
The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients
INTRODUCTION: 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…
Alcoholic beverage intake and risk of lung cancer: the California Men’s Health Study
We investigated the effect of alcoholic beverage consumption on the risk of lung cancer using the California Men's Health Study. METHODS: The California Men's Health Study is a multiethnic cohort of 84,170 men ages 45 to 69 years who are…
Alcohol and hypertension: a review
In recent decades alcohol use has joined other correlates of hypertension (HTN), such as obesity and salt intake, as a major research focus about HTN risk factors. In cross-sectional and prospective epidemiologic studies, higher blood pressure (BP) has consistently been…
Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard
OBJECTIVE: To evaluate the impact of Early Start, an obstetric clinic-based prenatal substance abuse treatment program, on perinatal outcomes. STUDY DESIGN: Subjects were 49 985 women who completed Prenatal Substance Abuse Screening Questionnaires at obstetric clinics between 1 January 1999…
Computerized screening for alcohol and drug use among adults seeking outpatient psychiatric services
OBJECTIVE: This study examined routine computerized screening for alcohol and drug use of men and women seeking outpatient psychiatric services (excluding chemical dependency treatment) and prevalence based on electronic medical records of consecutive admissions. METHODS: The sample of 422 patients,…
Tailored treatment in the outpatient substance abuse treatment sector: 1995-2005
Interest in improving the quality of addiction treatment has led to the development of clinical paradigms that emphasize the principle of tailored care-matching treatments to the specific needs of each client or client subgroup. This work analyzes how trends in…
The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry
BACKGROUND: Alcohol consumption is a common behavior. Little is known about the relationship between alcohol consumption and glycemic control among people with diabetes. OBJECTIVE: To evaluate the association between alcohol consumption and glycemic control. DESIGN: Survey follow-up study, 1994-1997, among…
Nine-year psychiatric trajectories and substance use outcomes: an application of the group-based modeling approach
This study identifies longitudinal psychiatric trajectories of 934 adult individuals entering chemical dependency treatment in a private, managed care health plan and examines the relationship of these trajectories with substance use (SU) outcomes. The authors apply a group-based modeling approach…
Illicit drug use and HIV treatment outcomes in a US cohort
OBJECTIVE: To determine the prevalence of illicit drug use and the impact on HIV treatment. DESIGN: Multivariable regression of cross-sectional data from 1163 HIV-infected and 294 controls from the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM).…
Alcohol in emerging adulthood: 7-year study of problem and dependent drinkers
OBJECTIVE: This study examined the level, changes and predictors of alcohol consumption and binge drinking over a 7-year period among young adults (18-25 years) who met the criteria for problem drinking. METHOD: Interviews with 270 18 to 25 years old…
Prevalence and correlates of substance use among South African primary care clinic patients
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…
Gender differences in the relationship of community services and informal support to seven-year drinking trajectories of alcohol-dependent and problem drinkers
OBJECTIVE: The purpose of this study was to examine how community service contacts and informal support are related to the course of drinking for dependent and problem-drinking persons in a population-based sample of women versus men over 7 years. METHOD:…
Substance use, education, employment, and criminal activity outcomes of adolescents in outpatient chemical dependency programs
Although the primary outcome of interest in clinical evaluations of addiction treatment programs is usually abstinence, participation in these programs can have a wide range of consequences. This study evaluated the effects of treatment initiation on substance use, school attendance,…
Concurrent and simultaneous drug and alcohol use: results of the 2000 National Alcohol Survey
This study estimates the prevalence, assesses predictors and evaluates factors associated with concurrent and simultaneous use of drugs and alcohol in the United States population. Using data from the 2000 National Alcohol Survey (n=7612), respondents were asked if they used…
Tailoring of outpatient substance abuse treatment to women, 1995-2005
BACKGROUND: Tailoring substance abuse treatment to women often leads to better outcomes. Previous evidence, however, suggests limited availability of such options. OBJECTIVES: This investigation sought to depict recent changes in outpatient substance abuse treatment (OSAT) tailoring to women and to…
Do licensing and accreditation matter in outpatient substance abuse treatment programs?
Licensing and accreditation are widely used to improve and convey organizational quality. The objective of this study was to provide substance abuse treatment stakeholders with better evidence about how well licensing and accreditation actually correlate with staffing and treatment practices.…
Illicit drug use in young adults and subsequent decline in general health: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
BACKGROUND: The long-term health consequences of drug use among healthy young adults in the general population are not well described. We assessed whether drug use predicted decline in general self-rated health (GSRH) in a community-based cohort, healthy at baseline. METHODS:…
Gender differences in seven-year alcohol and drug treatment outcomes among older adults
This study examined participants at seven-year follow-up to assess long-term outcomes of older women (n = 25) and men (n = 59) ages 55 and over in an outpatient addiction program. It measured demographic characteristics, alcohol and drug use, psychiatric…
Alcohol consumption, medical conditions, and health behavior in older adults
OBJECTIVES: To examine associations between drinking patterns, medical conditions, and behavioral health risks among older adults. METHODS: Analyses compared survey participants (health plan members ages 65 to 90, N = 6662) who drank moderately to those who drank over recommended…
Medical conditions of adolescents in alcohol and drug treatment: comparison with matched controls
PURPOSE: 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 excess medical cost and health problems of family members of persons diagnosed with alcohol or drug problems
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…
Nonmedical use of prescription drugs among a longitudinal sample of dependent and problem drinkers
BACKGROUND: Increasing trends in the nonmedical use of prescription drugs (NMPD) have been documented, yet little is known about the demographic, severity, and social network influences related to NMPD among treated and untreated problem and dependent drinkers. METHODS: To determine…
Alcohol drinking and total mortality risk
To evaluate further the relation between alcohol consumption and total mortality, we have carried out new Cox proportional hazards model analyses of 21,535 deaths through 2002 in the Kaiser Permanente study. This follow-up includes 2,618,523 person-years of observation, with a…
Cigarette smoking and long-term alcohol and drug treatment outcomes: a telephone follow-up at five years
This prospective study examined the relationship between cigarette smoking and five-year substance abuse treatment outcomes. Of 749 individuals who began private outpatient treatment, 598 (80%) were re-interviewed by telephone at five years. At five-year follow-up, 53% reported smoking cigarettes in…
Using drink size to talk about drinking during pregnancy: Early start plus
Heavy drinking during pregnancy can cause birth defects and other alcohol-related effects. Because costs associated with fetal complications are high, health care organizations are invested in finding ways to intervene with pregnant drinkers. We describe a computerized intervention tested at…
Early start: an integrated model of substance abuse intervention for pregnant women
Untreated perinatal substance abuse is associated with serious adverse maternal and neonatal outcomes. Historically, many barriers have prevented pregnant women from seeking treatment. Early Start (ES) breaks new ground by sidestepping these barriers with a fully integrated service delivery model.ES…
Maternal illness and drug/medication use during the period surrounding pregnancy and risk of childhood leukemia among offspring
Maternal illness and drug/medication use (prescription, over-the-counter, and illicit) during pregnancy might be related to childhood leukemia risk. These issues were evaluated using data (1995-2002) from the Northern California Childhood Leukemia Study. The authors selected 365 children under age 15…
Incidence and antecedents of nonmedical prescription opioid use in four US communities. The Coronary Artery Risk Development in Young Adults (CARDIA) prospective cohort study
BACKGROUND: Nonmedical use of prescription opioids has emerged as a major public health problem during the last decade, but direct measures of incidence and predisposing factors are lacking. METHODS: We prospectively measured incidence and antecedents of nonmedical prescription opioid use…
Sequelae of systemic hypertension in alcohol abstainers, light drinkers, and heavy drinkers
A link exists between alcohol intake and increased blood pressure (BP), with many studies showing increased hypertension prevalence in heavy drinkers. The harmful and beneficial effects of alcohol can confound the study of the long-term risks of alcohol-related hypertension. We…
Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study)
Marijuana use has been associated with increased appetite, high caloric diet, acute increase in blood pressure, and decreases in high-density lipoprotein cholesterol and triglycerides. Marijuana is the most commonly used illicit drug in the United States, but its long-term effects…
Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours
AIMS: Our aim was to examine the associations of alcohol consumption with six diabetes self-care behaviours. METHODS: We determined levels of alcohol consumption and examined associations between alcohol consumption and six self-care behaviours in 65 996 adults with diabetes who…
Course of recovery from alcoholism
This article represents the proceedings of a symposium at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, organized and chaired by Kamilla L. Venner. This symposium integrated current empirical research on the course of recovery from alcoholism…
Chemical dependency patients with cooccurring psychiatric diagnoses: service patterns and 1-year outcomes
BACKGROUND: Improving services and treatment outcomes for individuals with cooccurring alcohol and drug use disorders and psychiatric conditions has been a critical challenge to clinicians and policy makers. This study examined 1-year outcomes for individuals entering chemical dependency (CD) treatment…
Higher prevalence of systemic hypertension among moderate alcohol drinkers: an exploration of the role of underreporting
OBJECTIVE: Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), but the relationship between moderate drinking and HTN remains unclear. We explored the possible role of underreporting among moderate drinkers. METHOD: In a cross-sectional analysis of 105,378…
Adolescents entering chemical dependency treatment in private managed care: ethnic differences in treatment initiation and retention
PURPOSE: There has been little research on adolescents of different ethnicities in chemical dependency (CD) treatment, despite a focus on ethnic disparities in health care in recent years. In particular, little is known about ethnic differences in utilization of adolescent…
Addiction treatment history, medical services utilization, and cost: a longitudinal analysis of problem drinkers
Few studies have examined the long-term patterns of health services utilization and cost for alcohol use disorders. This paper used data from baseline, 3-year, and 5-year follow-up interviews to compare utilization and cost of medical care services for problem drinkers…
Availability of services for women in outpatient substance abuse treatment: 1995-2000
Women entering substance abuse treatment have more severe substance abuse problems and more medical and psychiatric comorbidities than men. Research shows that specialized women's services are associated with better retention and outcomes but relatively little is known about their availability…
Adolescents with co-occurring substance use and mental conditions in a private managed care health plan: prevalence, patient characteristics, and treatment initiation and engagement
This study examined the prevalence, patient characteristics, and treatment initiation and engagement of adolescents with co-occurring substance use (SU) and serious mental health (MH) diagnoses in a private, managed care health plan. We identified 2,005 adolescents aged 12-17, who received…
Translating research findings into practice: example of treatment services for adolescents in managed care
An important question in the alcoholism treatment field is how research findings can be translated into real-world clinical practice. Researchers have developed a new research-practice integration (RPI) model that can both drive the formulation of studies and new research questions…
Gay/Lesbian sexual orientation increases risk for cigarette smoking and heavy drinking among members of a large Northern California health plan
BACKGROUND AND SIGNIFICANCE: Tobacco and alcohol use and related morbidity and mortality are critical public health problems. Results of several, but not all, studies suggest that lesbians and gay men are at elevated risk for smoking tobacco and alcohol misuse.…
Health care services use by adolescents with intakes into an outpatient alcohol and drug treatment program
We examined utilization and cost in the 1 year pre- and post-intake among a sample of adolescents (N=419) entering chemical dependency (CD) treatment. Multivariate analyses showed that these youth used significantly more medical services than a demographically matched sample of…
Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry
BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers' patterns of AA involvement over time and how these relate to abstinence. METHOD: This…
Cocaine and coronary calcification in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study
BACKGROUND: Cocaine use is associated with myocardial ischemia and infarction, but it is unclear whether this is only because of the acute effects of cocaine on heart rate, blood pressure, and vasomotor tone or whether accelerated atherosclerosis from long-term exposure…
Readmission among chemical dependency patients in private, outpatient treatment: patterns, correlates and role in long-term outcome
OBJECTIVE: Similar to other chronic conditions, chemical dependency is a chronic, relapsing condition. Yet predominant treatment models do not provide ongoing, long-term treatment services; readmission is the available long-term care for alcohol and drug patients. We examine readmission patterns and…
Five-year trajectories of health care utilization and cost in a drug and alcohol treatment sample
BACKGROUND: The study examined the effect of individual characteristics on longitudinal patterns of health care utilization and cost among individuals entering chemical dependency (CD) treatment. METHOD: Structured interviews and computerized administrative databases were linked to obtain severity, utilization and cost…
Reasons for drinking less and their relationship to sustained remission from problem drinking
AIMS: To compare representative general population and treated samples on their reasons for drinking less and whether particular reasons were related to sustained remission from problem drinking for either group. PARTICIPANTS AND DESIGN: A total of 659 problem drinking adults…
Community providers’ views of alcohol and drug problems
This study contrasts community health and social service providers' views on alcohol vs. other drug abuse. A probability sample of 457 social work and other providers from a county's public and private medical and mental health clinics, welfare and criminal…
Alcohol consumption, risk of injury, and high-cost medical care
This study examined the effect of alcohol use on the probabilities of injury, inpatient hospital stay, and emergency department visit. Data were obtained from a sample of adults (N = 1219) recruited from a Northern California county. Alcohol use measures…
Adolescents in private chemical dependency programs: who are most at risk for HIV?
Consecutive intakes (N = 419) between ages 13 and 18 years to chemical dependency (CD) programs in a large private health plan were interviewed. The prevalence of six HIV risk behaviors was measured and categorized into zero, one, and multiple…
Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs
BACKGROUND: There exists substantial evidence that individuals with alcohol and drug disorders have heightened comorbidities and health care costs. However, little is known about the larger population of 'hazardous' drinkers (those whose consumption increases their 'risk of physical and psychological…
Health services for women in outpatient substance abuse treatment
OBJECTIVE: To evaluate how a sample of outpatient substance abuse treatment units respond to organizational and environmental influences by adopting and implementing treatment services for women. DATA SOURCES: The National Drug Abuse Treatment System Survey from 1995 and 2000, a…
Chemical dependency and psychiatric services for adolescents in private managed care: implications for outcomes
BACKGROUND: Many adolescents with alcohol and drug problems have mental health comorbidities. The literature suggests that patients entering chemical dependency (CD) treatment with co-occurring problems have less successful outcomes, including treatment dropout and relapse. We examined the impact of psychiatric…
Alcohol consumption, binge drinking, and early coronary calcification: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study
It is unclear to what extent the apparently beneficial cardiovascular effects of moderate alcohol consumption are mediated by protection against atherosclerosis. Alcohol consumption, coronary heart disease risk factors, and coronary calcification (a marker of atherosclerosis) were measured during 15 years…
Relationship between use of psychiatric services and five-year alcohol and drug treatment outcomes
OBJECTIVE: The objective of this study was to examine the relationship between use of psychiatric services and alcohol and drug treatment outcomes five years after such treatment. It was anticipated that receipt of psychiatric services would predict long-term abstinence. METHODS:…
Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town
Objective: To document prevalence of, and association between, substance use and HIV risk behaviours among primary care patients. Method: Cross-sectional survey. Four primary care clinics in Cape Town. We selected clinics using stratified sampling, and systematically selected 131 patients from…
Pathways to chemical dependency treatment for adolescents in an HMO
This study examines pathways to chemical dependency (CD) treatment for adolescents in a prepaid health plan, including factors influencing treatment referral and access. Data were collected from 419 adolescent CD treatment intakes ages 13 to 18 in a large, private…
Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program
AIMS: This study compared 5-year treatment outcomes of older adults to those of middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term…
Dependent and problem drinking over 5 years: a latent class growth analysis
Understanding the long-term course of problematic drinking is a fundamental concern for health services research in the alcohol field. The stability of, or change in, the course of drinking--especially heavy drinking--has both theoretical and applied relevance to alcohol research. We…
Adolescents with substance diagnoses in an HMO: factors associated with medical provider referrals to substance abuse and mental health treatment
This study examines the factors related to referrals of adolescents with substance use disorders to substance abuse or mental health treatment by their medical providers. Administrative and chart review data from the membership of a large private health maintenance organization…
Does marital status predict long-term drinking? Five-year observations of dependent and problem drinkers
OBJECTIVE: Married individuals have lower rates of problem drinking, but little is known about this relationship in the context of other factors. This longitudinal analysis examines marital status with other individual predisposing, problem severity and social predisposing characteristics to understand…
A naturalistic comparison of outcomes at social and clinical model substance abuse treatment programs
Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with…
Using chart reviews to assess postpartum substance abuse. A pilot study
The use of chart reviews to assess substance use one-year postpartum was examined in this pilot study by comparing interviews with chart reviews for 23 women assessed positive for risk during pregnancy. There was no indication that providers asked about…
Sources of informal pressure on problematic drinkers to cut down or seek treatment
Objective: To examine how patterns of expressions of concern about drinking from family members and friends differ according to the demographic characteristics of the drinker. Method: A probability sample of adult treated (n=926) and untreated (n=672) problem?drinking individuals from a…
Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls
BACKGROUND: Substance abuse and health problems seem to be inextricably related. Yet, prior research on the health conditions related to substance abuse is largely focused on alcohol and is from patients treated in publicly funded programs, inpatients, and the general…
The role of community services and informal support on five-year drinking trajectories of alcohol dependent and problem drinkers
OBJECTIVE: The purpose of this study was to examine how informal support and community services impact the course of alcohol disorders by examining the trajectories of alcohol consumption over 5 years in dependent and problem drinkers. METHOD: Alcohol dependent adults…
Wine, liquor, beer, and mortality
A substantially increased risk for heavy drinkers and a slightly reduced risk for lighter drinkers results in the J-shaped alcohol-mortality curve. Limited data suggest a more favorable mortality experience for drinkers of wine than for drinkers of liquor or beer.…
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…
Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program
OBJECTIVE: This study examined how well older chemical dependency patients succeed in treatment relative to middle-aged and younger patients in a mixed-age private HMO outpatient program. To predict successful outcome, we tested a model incorporating age group differences in individual,…
How important is treatment? One-year outcomes of treated and untreated alcohol-dependent individuals
AIMS: To compare representative treatment and untreated samples of alcohol-dependent individuals in rates of abstinence and non-problematic use at 1-year follow-up. PARTICIPANTS AND DESIGN: A total of 482 alcohol-dependent adults in a northern California county identified through a probability survey…
The persistent influence of social networks and alcoholics anonymous on abstinence
OBJECTIVE: The role of changes in Alcoholics Anonymous (AA) involvement and social networks in relation to abstinence following substance abuse treatment is studied. Specifically, the role of AA and network support for abstinence are examined in relation to their effect…
Missed opportunities in addressing drinking behavior in medical and mental health services
BACKGROUND: Epidemiological and clinical literature point to the importance of screening for alcohol problems in medical and psychiatric settings. However, little is known about which problem drinkers seek help from those services or about the characteristics of those who have…
Marijuana use and injury events resulting in hospitalization
PURPOSE: Information on the potential relation between marijuana use and the incidence of hospitalized injury is extremely limited. The purpose of this effort was to investigate the potential for this association. METHODS: A retrospective study was conducted in a large…
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…
Services integration and cost-effectiveness
Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these…
Changes in smoking status among substance abusers: baseline characteristics and abstinence from alcohol and drugs at 12-month follow-up
The impact of change in smoking status on 12-month substance abuse (SA) treatment outcomes was examined among an HMO population seeking SA treatment. Of the 749 participants who entered the study at baseline, 649 (86.9%) were retained at the 12-month…
The role of religion, spirituality and alcoholics anonymous in sustained sobriety
Spirituality or belief in a higher being is an integral part of Alcoholics Anonymous (AA). This study examines the role of religiosity in AA involvement and long-term sobriety in a representative sample of 587 men and women interviewed upon entering…
Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes
OBJECTIVE: To evaluate the effect of Early Start, a managed care organization's obstetric clinic-based perinatal substance abuse treatment program, on neonatal outcomes. STUDY DESIGN: Study subjects were 6774 female Kaiser Permanente members who delivered babies between July 1, 1995 and…
Who goes to alcohol and drug treatment? Understanding utilization within the context of insurance
OBJECTIVE: This study assesses the differential roles of demographic characteristics, problem severity, motivational factors and insurance in entrance into alcohol and drug treatment. METHOD: A probability sample of adult problem and dependent drinkers from a Northem California county (N =…
Cardiovascular consequences of marijuana use
This review describes what is known about effects of marijuana and cannabinoids in relation to human physiological and disease outcomes. The acute physiological effects of marijuana include a substantial dose-dependent increase in heart rate, generally associated with a mild increase…
Interaction of dietary folate intake, alcohol, and risk of hormone receptor-defined breast cancer in a prospective study of postmenopausal women
Alcohol intake is an established risk factor for breast cancer, but the underlying mechanism remains unknown. Four recent studies have described interactions of alcohol and low folate intake. We examined this interaction on the risk of postmenopausal breast cancer stratified…
Coping among individuals seeking private chemical dependence treatment: gender differences and impact on length of stay in treatment
BACKGROUND: Length of stay in treatment and coping skills are both predictive of chemical dependence and abuse treatment outcomes. However, little is known about whether coping strategies are related to length of stay in treatment. Because predictors of length of…
Is insulin sensitivity a causal intermediate in the relationship between alcohol consumption and carotid atherosclerosis?: the insulin resistance and atherosclerosis study
OBJECTIVE: A J-shaped association has been demonstrated between alcohol consumption and atherosclerosis. Insulin resistance, also a risk factor for atherosclerosis, has been shown to have a similar J-shaped association with alcohol intake. This raises the question of whether insulin sensitivity…
Alcohol drinking and risk of hemorrhagic stroke
In view of conflicting prior reports, we prospectively studied associations between alcohol consumption and subsequent hospitalization for hemorrhagic stroke (HS) in 431 persons. Alcohol use was determined at examinations in 1978-1984 among 128,934 members of a prepaid health plan. Cox…
A prospective study of the factors influencing entry to alcohol and drug treatment
Much is known about factors related to entering alcohol and drug treatment, but most research comprises cross-sectional 'snapshots' in time. It is not known whether the reasons for entering treatment endure when problem drinkers are studied over time. This study…
Effects of managed care on alcohol and other drug (AOD) treatment
The article represents the proceedings of a symposium at the 2001 RSA Meeting in Montreal, Canada. The organizer/chair was Stephen Magura. The presentations examined: (1) How managed care organization policies may affect enrollees' use of alcohol and other drug (AOD)…
Utilization of health services among patients referred to an alcohol treatment program
This study assessed utilization of health services among 1,317 adults referred to an outpatient Psychiatry Department alcohol treatment program from July, 1988 through December, 1989. The mean number of visits/year for 1 year before and 4 years after treatment referral…
Integrating primary medical care with addiction treatment: a randomized controlled trial
CONTEXT: The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment. OBJECTIVE: To examine differences in treatment outcomes and costs between integrated and independent models of medical…
Alcohol consumption patterns and health care costs in an HMO
We examined the relationship between patterns of alcohol consumption and health care costs among adult members of the Kaiser Permanente Medical Care Program (KPMCP) in Northern California. A telephone survey of a random sample of the KPMCP membership aged 18…
Patterns of cigarette smoking and alcohol use among lesbians and bisexual women enrolled in a large health maintenance organization
OBJECTIVES: This study compared the prevalence of cigarette smoking and alcohol use among lesbians and bisexual women with that among heterosexual women. METHODS: Logistic regression models were created with data from an extensive member health survey at a large health…
The provision of services for alcohol problems: a community perspective for understanding access
Alcohol use is related to numerous health and social problems. The article describes the prevalence of alcohol problems and dependence across a county and its institutions. While high rates of problem drinking were found across health, mental health, criminal justice,…
Factors affecting the initiation of substance abuse treatment in managed care
AIMS: A long-standing concern of clinicians in addiction treatment is that a large number of individuals who are admitted to treatment do not return to actually begin the program. We identified characteristics that predict treatment initiation. DESIGN: In-person structured interviews…
Association of outpatient alcohol and drug treatment with health care utilization and cost: revisiting the offset hypothesis
OBJECTIVE: This study examines the hypothesis that treatment reduces medical utilization and costs of patients with substance use problems. METHOD: Adult patients (N = 1.011; 67% men) entering the outpatient chemical dependency recovery program at Sacramento Kaiser Permanente over a…
Improving alcoholism treatment across the spectrum of services
This article represents the proceedings of a symposium at the 2000 RSA Meeting in Denver, Colorado. The chair was Michael E. Hilton. The presentations were (1) The effects of brief advice and motivational enhancement on alcohol use and related variables…
Early Start: an obstetric clinic-based, perinatal substance abuse intervention program
Maternal substance abuse is a serious problem with significant adverse effects to mothers, fetuses, and children. The Early Start Program provides pregnant women in a managed care organization with screening and early identification of substance abuse problems, early intervention, ongoing…
Predictors of substance abuse treatment retention among women and men in an HMO
BACKGROUND: Although prior research has examined predictors of treatment retention in public alcohol and drug treatment programs, little is known about factors that influence treatment retention in an insured outpatient population. Because there is growing evidence that the factors which…
The outcome and cost of alcohol and drug treatment in an HMO: day hospital versus traditional outpatient regimens
OBJECTIVE: To compare outcome and cost-effectiveness of the two primary addiction treatment options, day hospitals (DH) and traditional outpatient programs (OP) in a managed care organization, in a population large enough to examine patient subgroups. DATA SOURCES: Interviews with new…
Addiction severity index data from general membership and treatment samples of HMO members. One case of norming the ASI
The Addiction Severity Index (ASI) is a widely used interview among substance-dependent populations in treatment. Its value as a treatment planning and evaluation tool has been diminished by the lack of comparative data from nonclinical samples. The present study included…
Alcohol drinking patterns and medical care use in an HMO setting
The objective of this study was to examine the association of medical care use (outpatient visits and hospitalization) with alcohol drinking patterns in a large health maintenance organization (HMO). Data were gathered from a random sample of 10,292 adult respondents…
Drinking patterns and problems of the ‘stably insured’: a study of the membership of a health maintenance organization
OBJECTIVE: This article describes drinking patterns and examines the prevalence of heavy drinking and alcohol problems, and their association with other behavioral and social problems within the membership of a health maintenance organization, a setting in which increasing numbers of…