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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA010359-17
Application #
7884169
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Lowman, Cherry
Project Start
1994-09-20
Project End
2012-06-30
Budget Start
2010-07-01
Budget End
2011-06-30
Support Year
17
Fiscal Year
2010
Total Cost
$600,001
Indirect Cost
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
Kline-Simon, Andrea H; Chi, Felicia W; Mertens, Jennifer R et al. (2017) Trajectories of remission and mortality over 13 years after intake to substance use treatment. Am J Drug Alcohol Abuse 43:583-590
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
Kline-Simon, Andrea H; Weisner, Constance M; Parthasarathy, Sujaya et al. (2014) Five-year healthcare utilization and costs among lower-risk drinkers following alcohol treatment. Alcohol Clin Exp Res 38:579-86
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
Jessup, Martha A; Ross, Thekla Brumder; Jones, Ashley L et al. (2014) Significant life events and their impact on alcohol and drug use: a qualitative study. J Psychoactive Drugs 46:450-9
Mertens, Jennifer R; Kline-Simon, Andrea H; Delucchi, Kevin L et al. (2012) Ten-year stability of remission in private alcohol and drug outpatient treatment: non-problem users versus abstainers. Drug Alcohol Depend 125:67-74
Avalos, Lyndsay Ammon; Mulia, Nina (2012) Formal and informal substance use treatment utilization and alcohol abstinence over seven years: is the relationship different for blacks and whites? Drug Alcohol Depend 121:73-80
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
Witbrodt, Jane; Mertens, Jennifer; Kaskutas, Lee Ann et al. (2012) Do 12-step meeting attendance trajectories over 9 years predict abstinence? J Subst Abuse Treat 43:30-43
Tsoh, Janice Y; Chi, Felicia W; Mertens, Jennifer R et al. (2011) Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes. Drug Alcohol Depend 114:110-8

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