This competing continuation application responds to PA 06-258, """"""""Alcohol Use Disorders: Treatment, Services Research and Recovery,"""""""" and extends a longitudinal study of 1,204 managed care Chemical Dependency (CD) patients. The proposed study follows a life span developmental approach to understanding alcohol problems and recovery and is highly relevant to the research priorities of the NIAAA 5- year strategic plan. The original study was a randomized trial comparing day hospital to outpatient patients on clinical effectiveness and medical utilization and costs, and included interviews at baseline, 6 and 12 months, and 5, 7, 9, and 11 years, and continuous automated utilization and cost data. We propose to follow the sample at 13 and 15 years. Changes we have observed overtime have been non-linear. These additional follow-ups are essential to achieve stable estimates of alcohol and drug trajectories over time, using modeling techniques that are amenable to study change such as latent class growth analyses and latent curve growth models. We examine: 1) the course of recovery as individuals move from one life stage to another, 2) a health plan continuing care approach that includes CD treatment, medical and psychiatric services, 3) mortality and medical and psychiatric problems, 4) alcohol and drug trajectories in relationship to life course events as they affect utilization and cost, and 5) how health care disparities affect outcomes. We also conduct qualitative interviews with a sub-sample of 60 participants who represent strata of life stages by gender and remission. We use a developmental/life-course perspective integrated with a conceptual framework comprising domains of: individual, treatment, and extra-treatment characteristics. We will examine our sample as they move from one age group at baseline to another at 15-year (e.g., our youngest age group (aged 18-29 at baseline) will be 33-44). This allows us to examine questions pertinent to each life phase, for a better understanding of maturation and other life course effects and their interaction with alcohol and drug use, medical problems, mortality and service use. The study has important implications for developing a continuing care approach addressing long-term recovery.
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