While many studies have demonstrated the short-term effectiveness of substance abuse treatment, a major concern of policy-makers and clinicians has to do with the long-term impacts of treatment. This continuation application examines determinants of 7 year trajectories of treatment readmission, substance use, and medical services utilization and cost. Of particular interest is the stability of 6 and 12 month treatment outcomes. The original study randomized 1204 individuals entering an HMO s substance abuse treatment program to two treatment intensities, day hospital and traditional outpatient. We followed those randomized, as well as those who were unwilling or unable to be randomized, thus having a comprehensive sample of the treatment program. We use our findings from the original study to hypothesize clinically and policy relevant predictors of long- term outcomes. We use growth curve models and other analytic approaches to examine the factors influencing 5 and 7 year trajectories of treatment readmission, outcome, utilization and cost. We study the effects of an index treatment and cumulation of treatment and other hypothesized influences on long-term outcomes. We address such research questions as: do the effects of one treatment episode decay over time if not reinforced by changes in social networks and ongoing participation in self-help groups? How do these factors impact long-term utilization and cost? We study explanatory factors or: 1) individual characteristics, such as demographic and severity characteristics, 2) treatment characteristics, such as treatment intensity, length of stay, type of services received, and readmissions; and 3) extra-treatment factors, such as change in social networks and participation in NA/AA, measured over the following 7 years. We have the opportunity to study long-term treatment effects in the large, heterogeneous treatment population of an HMO. The HMO has on-going computerized data to document the dates, type of substance abuse treatment, and length of stay of treatment episodes, as well as all medical services received and costs. We have also collected self-report data on substance abuse treatment utilization and medical services utilization not covered by the health plan. Our multiple data points are important in examining drinking patterns and service interventions, and their 7 year coverage allows for sufficient length of time to examine long-term effects of index treatment episodes and cumulative effects of treatment, other medical services and changes.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA008728-10
Application #
6656832
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Flanzer, Jerry
Project Start
1993-09-30
Project End
2004-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
10
Fiscal Year
2003
Total Cost
$340,145
Indirect Cost
Name
University of California San Francisco
Department
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Chi, Felicia W; Weisner, Constance; Grella, Christine E et al. (2014) Does age at first treatment episode make a difference in outcomes over 11 years? J Subst Abuse Treat 46:482-90
Witbrodt, Jane; Ye, Yu; Bond, Jason et al. (2014) Alcohol and drug treatment involvement, 12-step attendance and abstinence: 9-year cross-lagged analysis of adults in an integrated health plan. J Subst Abuse Treat 46:412-9
Parthasarathy, Sujaya; Chi, Felicia W; Mertens, Jennifer R et al. (2012) The role of continuing care in 9-year cost trajectories of patients with intakes into an outpatient alcohol and drug treatment program. Med Care 50:540-6
Sterling, Stacy; Chi, Felicia; Hinman, Agatha (2011) Integrating care for people with co-occurring alcohol and other drug, medical, and mental health conditions. Alcohol Res Health 33:338-49
Chi, Felicia W; Parthasarathy, Sujaya; Mertens, Jennifer R et al. (2011) Continuing care and long-term substance use outcomes in managed care: early evidence for a primary care-based model. Psychiatr Serv 62:1194-200
Chou, Chih-Ping; Chi, Felicia; Weisner, Constance et al. (2010) Initial Status in Growth Curve Modeling for Randomized Trials. J Drug Issues 40:155-172
Weisner, Constance; Hinman, Agatha; Lu, Yun et al. (2010) Addiction treatment ultimatums and U.S. health reform: A case study. Nordisk Alkohol Nark 27:685-698
Chi, Felicia W; Weisner, Constance M (2008) Nine-year psychiatric trajectories and substance use outcomes: an application of the group-based modeling approach. Eval Rev 32:39-58
Satre, Derek D; Blow, Frederic C; Chi, Felicia W et al. (2007) Gender differences in seven-year alcohol and drug treatment outcomes among older adults. Am J Addict 16:216-21
Mertens, Jennifer R; Weisner, Constance M; Ray, G Thomas (2005) Readmission among chemical dependency patients in private, outpatient treatment: patterns, correlates and role in long-term outcome. J Stud Alcohol 66:842-7

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