Dual recovery among people with serious mental illnesses and substance problems: a qualitative analysis.

Objective: Individuals with serious mental illnesses are more likely to have substance-related problems than those without mental health problems. They also face more difficult recovery trajectories as they cope with dual disorders. Nevertheless, little is known about individuals' perspectives regarding their dual recovery experiences.

Methadone maintenance and the cost and utilization of health care among individuals dependent on opioids in a commercial health plan.

Background: Few health plans provide maintenance medication for opioid dependence. This study assessed the cost of treating opioid-dependent members in a commercial health plan and the impacts of methadone maintenance on costs of care.

Methods: Individuals with diagnoses of opioid dependence (two or more diagnoses per year) and at least 9 months of health plan eligibility each year were extracted from electronic health records for the years 2000 through 2004 (1,518 individuals and 2,523 observations across the study period-some individuals were in multiple years).

Drinking Patterns, Gender and Health II: Predictors of Preventive Service Use.

Background: 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 drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until becoming ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships.

Drinking Patterns, Gender and Health I: Attitudes and Health Practices.

Background: 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 and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status.

Methods: A stratified random sample of adult health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female).

Drinking Patterns, Gender and Health III: Avoiding vs. Seeking Healthcare.

Background: 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 willingness to seek care. Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care.

Methods: A stratified random sample of health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female).

Development of the Patient Activation Measure for mental health.

Our objective was to adapt the physical health Patient Activation Measure (PAM) for use among people with mental health conditions (PAM-MH). Data came from three studies among people with chronic mental health conditions and were combined in Rasch analyses. The PAM-MH's psychometric properties equal those of the original 13-item PAM.

Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results.

Objective: Recommendations for improving care include increased patient-clinician collaboration, patient empowerment, and greater relational continuity of care. All rely upon good clinician-patient relationships, yet little is known about how relational continuity and clinician-patient relationships interact, or their effects on recovery from mental illness.

Methods: Individuals (92 women, 85 men) with schizophrenia, schizoaffective disorder, affective psychosis, or bipolar disorder participated in this observational study.

"Not getting tanked": definitions of moderate drinking and their health implications.

Background: People encounter large amounts of sometimes-inconsistent information about risks and benefits of alcohol consumption, and about what constitutes "low-risk" or "moderate" drinking.

Methods: We used 150 in-depth interviews linked to questionnaire data to learn how people define moderate drinking and to describe the relationships between definitions, attitudes, and beliefs about moderate drinking and individuals' drinking patterns.

Results: People adhere to definitions of moderate alcohol consumption that could put them, or others, at risk for short- or long-term negative consequences of drinking.

Medical cost-offset following treatment referral for alcohol and other drug use disorders in a group model HMO.

The purpose of this study was to determine whether specialty alcohol and other drug (AOD) treatment is associated with reduced subsequent medical care costs. AOD treatment costs and medical costs in a group model health maintenance organization (HMO) were collected for up to 6 years on 1,472 HMO members who were recommended for specialty AOD treatment, and on 738 members without AOD diagnoses or treatment. Addiction Severity Index measures were also obtained from a sample of 293 of those recommended for treatment.

Substance abuse treatment duration for Medicaid versus commercial clients in a health maintenance organization.

Background: As Medicaid clients have come to be enrolled in managed care, concerns have arisen about the ability of private sector systems to meet the needs of enrollees with substance abuse problems.

Objectives: This project describes treatment initiation and duration for Medicaid and commercial substance abuse treatment clients in a large health maintenance organization (HMO).

Research Design: This study was a prospective secondary analysis of information from HMO databases.

Cost-effectiveness of an intervention to prevent depression in at-risk teens.

Contact: Depression is common in adolescent offspring of depressed parents and can be prevented, but adoption of prevention programs is dependent on the balance of their incremental costs and benefits.

Objective: To examine the incremental cost-effectiveness of a group cognitive behavioral intervention to prevent depression in adolescent offspring of depressed parents.

Design: Cost-effectiveness analysis of a recent randomized controlled trial.

Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.

Objective: To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine medical care.

Methods: Both smoking and nonsmoking teens, 14 to 17 years of age, who were being seen for routine visits were eligible for this 2-arm controlled trial. Staff members approached teens in waiting rooms of 7 large pediatric and family practice departments within a group-practice health maintenance organization.

Gender-based structural models of health care costs: alcohol use, physical health, mental health, and functioning.

Background: Most models of health services use or costs include gender as a covariate, combining data for men and women in analyses. This strategy may obscure differences in underlying processes producing differential health care use by men and women, particularly in examinations of factors that affect health care use and differ by gender (e.g.

Depressed mood and smoking experimentation among preteens.

The authors examined children's depressed mood, parental depressed mood, and parental smoking in relation to children's smoking susceptibility and experimentation over 20 months in a cohort of 418 preteens (ages 10-12 at baseline) and their parents. Depressed mood in preteens was strongly related to experimentation but not to susceptibility. In cross-sectional analyses parental depressed mood was related to children's experimentation, but in longitudinal analyses parental depressed mood at baseline did not differentiate children who experimented from those who did not.

Gender differences in the relationships between multiple measures of alcohol consumption and physical and mental health.

Background: Epidemiological research examining health consequences of alcohol consumption generally relies on average volume consumed, yet examinations of drinking patterns show different dimensions of use associated with different health outcomes. Gender differences in metabolism and body composition may lead to gender-specific consequences of drinking frequency, quantity consumed per occasion, average amount consumed, and drinking pattern. Inconsistent results suggest gender differences are not well understood.

Gender differences in outcomes in an HMO-based substance abuse treatment program.

This study examined gender differences in treatment outcomes and outcomes predictors among 155 men and 81 women attending a gender-sensitive substance abuse treatment program. Bivariate analyses indicated women improved more than men in social/family and daily functioning domains, but differences disappeared after controlling for baseline characteristics. Multivariate models predicting treatment outcomes revealed that, across Addiction Severity Index domains, outcomes for men were predicted primarily by mental health and medical conditions, severity of the substance abuse problem, and treatment com- pletion.

Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force.

Background: Primary health care visits offer opportunities to identify and intervene with risky or harmful drinkers to reduce alcohol consumption.

Purpose: To systematically review evidence for the efficacy of brief behavioral counseling interventions in primary care settings to reduce risky and harmful alcohol consumption.

Data Sources: Cochrane Database of Systematic Reviews, Database of Research Effectiveness (DARE), MEDLINE, Cochrane Controlled Clinical Trials, PsycINFO, HealthSTAR, CINAHL databases, bibliographies of reviews and included trials from 1994 through April 2002; update search through February 2003.

The problem is getting us to stop. What teens say about smoking cessation.

Background: Low participation and high dropout in many teen cessation programs may be due to lack of fit between teens' needs and the way programs are delivered. Qualitative studies, designed to identify and understand preferences of intervention participants and barriers to participation, offer opportunities to customize programs and improve their reach and effectiveness.

Methods: Two sets of focus groups with high school students were held in the Portland, OR, metropolitan area to elicit reactions to two smoking cessation programs and discuss motivations for and experiences with quitting.

Depression, functional status, treatment for psychiatric problems, and the health-related practices of elderly HMO members.

Purpose: To study relationships between depression, functional limitations, psychiatric treatment, and the health-related practices of elderly individuals.

Design: Cross-sectional, observational study based on survey data (response rate = 90%) analyzed using multiple linear and logistic regression models.

Setting: Kaiser Permanente Northwest, a large nonprofit HMO.

Tobacco use patterns and attitudes among teens being seen for routine primary care.

Purpose: To describe the tobacco-related attitudes, behaviors, and needs of smoking and nonsmoking teens being seen for routine pediatric care and to identify predictors of tobacco use.

Design: Cross-sectional survey of adolescent primary care patients who completed self-administered questionnaires in medical office waiting rooms while waiting for routine care visits.

Setting: A group-practice HMO in the Pacific Northwest.

Structural models of gender, alcohol consumption, and health.

Background: Gender differences exist in patterns of alcohol consumption and in the health and social effects of alcohol use, but little is known about gender differences in how alcohol use is affected by mental and physical health conditions.

Methods: We used structural equation modeling techniques to examine gender differences in the relationships among alcohol consumption, physical and mental health, functional status, and social and demographic characteristics. Data were obtained from a random sample of the adult membership of a health maintenance organization in the U.

Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program.

We studied gender differences in treatment process indicators among 293 HMO members recommended for substance abuse treatment. Treatment initiation, completion, and time spent in treatment did not differ by gender, but factors predicting these outcomes differed markedly. Initiation was predicted in women by alcohol diagnoses; in men, by being employed or married.