APPLICANT S ABSTRACT: We propose to compare the health services use and costs of three groups of individuals from a community sample who participated in the St. Louis Epidemiologic Catchment Area (ECA) study between 1980 and 1983. Selected on the basis of their alcohol status at two ECA interviews, these groups consist of 243 Stable Alcoholics, 243 Problem Drinkers, and 226 who no alcohol problems or heavy drinking ( unaffected ). New data to be collected by telephone interview, include health use and costs and is based on self-report, record review, and updated diagnostic data on alcoholism, depression, anxiety (panic, social phobia, agoraphobia), smoking history, nicotine dependence, and illicit use of substances. Data will be collected at two 6 month intervals from the follow-up to obtain information about health services use and costs over those two 6 month periods. Health service use is operationalized as traditional - visits to physicians, hospitals, emergency care, and alternative - visits to chiropractors, acupuncturists, self-help groups, naturopaths, homeopaths, herbalists, spiritualists, and healers. Abstraction of billing records will provide cost data for one 12-month and two 6-month periods. Operationalization of costs includes charges for: inpatient admissions, outpatients visits including emergency care, prescribed and over-the-counter medications, laboratory exams and diagnostic procedures, and visits to alternative services providers and products or devices provided. New data together with ECA data will be used to determine whether Stable Alcoholics have excess traditional and alternative health service use and costs compared to Problem Drinkers and Unaffected, to compare models of traditional and alternative health services use over time among the three groups to determine whether models are similar across groups, to compare the three groups in terms of models of health services utilization behavior based on the Health Behavior Model (HBM); and to construct the HBM in alcoholics by alcohol symptom severity classes, and compare these to HBM obtained with Problem Drinkers and Unaffected. This research will contribute needed information about the use of health services and associated costs of community alcoholics in order to anticipate the demands that aging alcoholics will place on the health care system.
