This Renewal Application responds to the National Institute on Alcohol Abuse and Alcoholism PA-08- 263, Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse (R01). The study examines a significant scientific and policy issue that alcohol and drug research has not adequately addressed: what are the effects of having a family member with alcohol or drug dependence (AODD)? What are the effects on health and psychosocial problems of family members and the additional health services they use, and what are the resulting costs to the health system? The original study compared enrollees in a large health plan who have a family member diagnosed with AODD to family members of individuals without an AODD and family members of individuals with other chronic conditions (diabetes and asthma), using large matched samples. We propose to examine whether findings from the original study of higher costs and more health conditions among family members of persons with AODD (and reduced family costs after the index AODD member receives successful AODD treatment) persist over time in order to better estimate the full cost of these families to health systems. We use the large, well-matched health plan cohorts from the original study, in which we analyzed data from 1 year before the date of the index family member's AODD diagnosis to 2 years after. We propose to examine 5 additional years of data, for a total study period of 8 years. We use innovative techniques with electronic medical record and other health plan data to examine medical conditions of family members and to estimate utilization changes due to treatment. To understand the long-term trends in utilization and costs of AODD family members and compare them to other demographically similar cohorts, we will use generalized linear models (for yearly comparison) and hierarchical linear models (for analysis of multi-year trends). We will examine the relationships of the index patient's dependence type, receiving AODD treatment, and co-occurring medical and psychiatric conditions to the utilization and costs of their family members, examining cost for children and adult family members separately. We will also compare AODD family members with family members of individuals without AODD, and with family members of patients with diabetes and asthma over the 8 years. Using the cohort of adolescents with AODD, we examine the health conditions and costs of their siblings and parents. Finally, through chart review and other health plan data, we determine if the child family members of AODD adults are less likely to receive optimal preventive care, or are more likely to have records indicating family, legal, or school problems than children in the comparison families. The study has high significance for critical issues such as placing interventions in primary care, screening for family problems in pediatrics, treating family members as part of AODD services, and for health policy (including AODD benefits in the list of high value health care services, with low cost-sharing).

Public Health Relevance

The study examines the medical conditions and health care utilization and costs of family members of adults and adolescents with alcohol or drug dependence (AODD) over 8 years, comparing them with family members of individuals without AODD and with family members of diabetes and asthma patients. It uses innovative IT methods and has significant clinical and policy implications for placing interventions in primary care, screening for family problems in pediatrics, and treating family members as part of AODD services.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA015183-05
Application #
8436315
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Roach, Deidra
Project Start
2004-08-01
Project End
2015-02-28
Budget Start
2013-03-01
Budget End
2015-02-28
Support Year
5
Fiscal Year
2013
Total Cost
$316,837
Indirect Cost
$9,000
Name
University of California San Francisco
Department
Psychiatry
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Ray, G Thomas; Mertens, Jennifer R; Weisner, Constance (2014) Comparison of health care needs of child family members of adults with alcohol or drug dependence versus adults with asthma or diabetes. J Dev Behav Pediatr 35:282-91
Weisner, Constance; Parthasarathy, Sujaya; Moore, Charles et al. (2010) Individuals receiving addiction treatment: are medical costs of their family members reduced? Addiction 105:1226-34
Weisner, Constance; Lu, Yun; Hinman, Agatha et al. (2009) Substance use, symptom, and employment outcomes of persons with a workplace mandate for chemical dependency treatment. Psychiatr Serv 60:646-54
Ray, G Thomas; Mertens, Jennifer R; Weisner, Constance (2009) Family members of people with alcohol or drug dependence: health problems and medical cost compared to family members of people with diabetes and asthma. Addiction 104:203-14
Ray, G Thomas; Mertens, Jennifer R; Weisner, Constance (2007) The excess medical cost and health problems of family members of persons diagnosed with alcohol or drug problems. Med Care 45:116-22