Sterling, Stacy
Research interests include addiction treatment and mental health services, adolescent behavioral health, and implementation science.
Young-Wolff, Kelly
Research interests include behavioral interventions for complex patients with multiple psychiatric and addictive disorders.
Klatsky, Arthur L.
Research interests include the relations between drinking alcoholic beverages and health.
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-naĂŻve 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 PPARÎł 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 (PPARÎł) 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 PPARÎł receptor agonist, on the abuse liability of oxycodone among nondependent opioid users.
AIMS: Activation of PPARÎł 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…