A major challenge to alcoholism researchers and clinicians is understanding why so few persons with alcohol problems seek treatment, even though such treatments have been shown to be effective. It is known that there are person-specific characteristics that either promote or inhibit seeking and utilizing care, including pressure from others and the stigma of being labeled an alcoholic. As managed care (MC) strategies and structures become the cornerstone of health care delivery, there is concern that MC may be inhibiting persons who need care from seeking it. The long-term objective of this research program is to examine how characteristics of MC programs affect alcohol treatment. This revised application for a developmental R21 grant responds to criticisms of the original application. The project will examine how specific MC factors influence the process of seeking help for alcohol problems. A method of categorizing MC structures and strategies will be implemented so different plans can be compared. MC factors to be compared were selected because they have been shown to influence utilization, and include: (1) client financial responsibility (copay and deductible); (2) characteristics of the gatekeeping structure; and (3) intensity of utilization management. Plans will be compared to subjects' perception of the help-seeking process, operationalized as: (1) the experience of the process of seeking care (i.e., time needed, difficulty encountered); (2) satisfaction with the process; and (3) perceptions of barriers to care. Data (an interview and questionnaires) will be collected from two groups of paid subjects using systematic, naturalistic design: patients seeking treatment for alcohol-related problem and subjects identified as having an alcohol problem who are not seeking treatment. Data will be used to test a structural equation model that will include other individual and system variables that influence help-seeking. Other variables (e.g., problem severity) are measured to build a comprehensive model of help-seeking. The PI has extensive experience in health services research in mental health, but little experience in substance abuse research. He will collaborate with investigators with a proven record of success in conducting research with alcoholics who are served by managed care organizations. This project will enable the PI's transition to the alcohol research field, and will initiate further research.
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