Biomedical subjects

Constance Weisner

Publications and source records attributed to Constance Weisner.

35 records · Page 2Linked to original sources

PubMed2004

Pathways to chemical dependency treatment for adolescents in an HMO.

This study examines pathways to chemical dependency (CD) treatment for adolescents in a prepaid health plan, including factors influencing treatment referral and access. Data were collected from 419 adolescent CD treatment intakes ages 13 to 18 in a large, private health plan. The study examines predictors of referral from different sources and of mental health treatment prior to CD treatment. Referral patterns, problem severity, and psychiatric comorbidity differed by gender. Being male (p < .05) and higher scores on the Youth Self-Report (YSR) externalizing scale (p < .01) predicted a justice system referral. Using more types of substances predicted referral by medical and mental health providers (p < .05) and self-referral (p < .01). Higher YSR internalizing scores predicted referral from mental health (p < .01) and self-referral (p <.01). Being White versus African American (p < .05) or Latino (p < .01), older (p < .05), and having higher YSR internalizing scores (p < .05), a conduct disorder (p < .01), or a family member with a substance use problem (p < .01) predicted a mental health visit prior to CD intake. The findings raise questions regarding the role of health plans, clinicians, families, schools, and community agencies in referring and treating adolescents with substance use problems. They suggest that improved coordination of care may promote more integrated treatment practices, which could decrease substance use, mental health, and medical problem severity.

Adolescent↗

PubMed2004

Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program.

AIMS: This study compared 5-year treatment outcomes of older adults to those of middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome. DESIGN: Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline). MEASUREMENTS: Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records. FINDINGS: Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years; female gender was also significant. CONCLUSIONS: Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.

Adolescent↗

PubMed2004

Family environment factors and substance abuse severity in an HMO adolescent treatment population.

To examine how parental limit setting, family conflict, and perception of family experience influence severity of alcohol and drug problems, and important gender differences in these relationships, we interviewed consecutive intakes, aged 12 to 18 years, at 4 chemical dependency programs of a large group-model nonprofit health maintenance organization (HMO) (n=419). The Family Conflict, Limit Setting, and Positive Family Experience scales correlated with substance dependence (p<0.01, p<0.01, p<0.05, respectively). Depression also correlated with family conflict (p<0.01), absence of limit setting (p<0.01), poor family experience (p<0.01) and dependence symptoms (p<0.01). Number of substance-using friends correlated with number of dependence symptoms (p<0.01). Gender differences included the following: (1) girls scoring higher in family conflict (p=0.0002), negative perceptions of family experience (p<0.0017), and lower in absence of limit setting (p<0.0001); (2) how family environment predicted problem severity: absence of limit setting was significant for boys and girls but family conflict for boys only; (3) girls had more dependence symptoms (p=<0.0001), psychiatric diagnoses (e.g., depression (p<0.0003), anxiety (p<0.0002), conduct disorder (p=0.07)), and substance-abusing family members (53 % versus 39%; p=0.006). To conclude, family and peers influence severity of alcohol and drug problems in adolescents.

Adolescent↗

PubMed2004

Does marital status predict long-term drinking? Five-year observations of dependent and problem drinkers.

OBJECTIVE: Married individuals have lower rates of problem drinking, but little is known about this relationship in the context of other factors. This longitudinal analysis examines marital status with other individual predisposing, problem severity and social predisposing characteristics to understand its strength in predicting alcohol consumption over 5 years. METHOD: A probability sample of dependent (n = 600) and problem (n = 992) drinkers was recruited through consecutive adult intakes from a Northern California county's alcohol and drug treatment programs and through a general population survey. Annual volume of drinks consumed over a 5-year period-measured at baseline, and at 1, 3 and 5 years later-was estimated in four nested models using maximum likelihood estimation via PROC MIXED. RESULTS: In simpler models that examined only marital status, married individuals drank significantly less than those never married (p < .01 for problem drinkers and p < .05 for dependent drinkers); however, when our models added individual predisposing, problem severity and social predisposing characteristics, marital status was no longer significant in predicting a trajectory of decreased drinking. For problem drinkers, the following characteristics were more important than marital status in predicting alcohol consumption over the 5 years: individual predisposing characteristics (age, p < .001; income, p < .001; education, p < .001; and age of initiation of regular alcohol use, p < .001), problem severity (number of alcohol dependence symptoms, p < .001; number of alcohol-related social consequences, p < .001; and higher drug severity, p < .05) and social predisposing characteristics (family member with an alcohol problem, p < .05; the size of heavy alcohol- and drug-using social network, p < .05; and chemical dependency treatment in the prior year, p < .001). For those who were alcohol dependent, income (p < .05), number of alcohol dependence symptoms (p < .001), higher drug severity (p < .05) and a heavy alcohol- and drug-using social network (p < .05 ) were more important than marital status in predicting consumption. CONCLUSIONS: In longitudinal models, individual predisposing, problem severity and social predisposing characteristics are more important than marital status in predicting alcohol consumption.

Adult↗

PubMed2004

Gender differences in treatment outcomes for alcohol dependence among older adults.

OBJECTIVE: This study examined clinical characteristics and treatment outcomes of older alcohol-dependent men and women in a mixed-age private outpatient chemical dependency program. METHOD: The sample comprised 92 patients aged 55 to 77 (63 men and 29 women). The measures consisted of demographic characteristics, alcohol and drug use and dependence, drinking history, health status, psychiatric symptoms, length of stay in treatment, use of Alcoholics Anonymous and 6-month treatment outcomes. RESULTS: The women reported later initiation of heavy drinking (5+ drinks per occasion) than the men, but had similar drinking levels at the treatment intake interview. At the 6-month follow-up, 79.3% of women reported abstinence from alcohol and drugs in the prior 30 days versus 54.0% of men (p = .02). Greater length of stay in treatment predicted abstinence at 6 months. Among those who were not abstinent, none of the women reported heavy drinking in the 30 days prior to follow-up, whereas nonabstinent men reported a mean (SD) of 4.0 (9.2) heavy drinking days (p = .025). CONCLUSIONS: The results suggest that older women may have better drinking outcomes compared with older men, following treatment for alcohol dependence.

Aged↗

PubMed2003

Short-term alcohol and drug treatment outcomes predict long-term outcome.

INTRODUCTION: Although addiction is recognized as a chronic, relapsing condition, few treatment studies, and none in a commercially insured managed care population, have measured long-term outcomes. We examined the relationship of 6-month treatment outcomes to abstinence 5 years post-treatment, and whether the predictors of abstinence at 5 years were different for those who were, and were not, abstinent at 6 months. METHODS: The sample (N=784) is from an outpatient (day hospital and traditional outpatient) managed care chemical dependency program. Subjects were interviewed at baseline, 6 months, and 5 years. Logistic regression analysis was used to assess which individual, treatment and extra-treatment characteristics predicted alcohol and drug abstinence at 5 years. RESULTS: Abstinence at 6 months was an important predictor of abstinence at 5 years. Among those abstinent at 6 months, predictors of abstinence at 5 years were older age, being female, 12-step meeting attendance, and recovery-oriented social networks. Among those not abstinent at 6 months, being alcohol dependent rather than drug dependent, 12-step meeting attendance, treatment readmission, and recovery-oriented social networks predicted abstinence at 5 years. CONCLUSION: Our findings demonstrate a clear association between short-term and long-term treatment success. In addition, these results strongly support the importance of recovery-oriented social networks for those with good short-term outcomes, and the beneficial impact of readmission for those not initially successful in treatment.

Adolescent↗

PubMed2003

How important is treatment? One-year outcomes of treated and untreated alcohol-dependent individuals.

AIMS: To compare representative treatment and untreated samples of alcohol-dependent individuals in rates of abstinence and non-problematic use at 1-year follow-up. PARTICIPANTS AND DESIGN: A total of 482 alcohol-dependent adults in a northern California county identified through a probability survey of problem drinkers in the general population (n = 111) or a survey of consecutive admissions to public and private substance abuse programs (n = 371) were interviewed in person at baseline and by telephone at 1 year. MEASUREMENTS: Logistic regression models were used to predict 30-day abstinence and 12-month non-problematic alcohol use. RESULTS: At follow-up, alcohol-dependent individuals in the treatment sample had higher abstinence rates and non-problematic use outcomes than those in the untreated general population sample. In logistic regression models of the merged samples, being in the treatment sample was related strongly and positively to abstinence and non-problematic use. Having more drug users and heavy drinkers in one's social network, higher psychiatric comorbidity, and more social consequences were inversely related to abstinence and non-problematic use in the treatment sample. The number of drug users and heavy drinkers in one's social network was also inversely related to abstinence in both the treatment and untreated general population samples. Results predicting non-problematic use were similar. CONCLUSIONS: These results are consistent with other studies that examine treatment effectiveness in the absence of a controlled trial. Although natural recovery also occurs, alcohol-dependent individuals benefit from treatment. Co-occurring psychiatric problems continue to be major barriers to treatment effectiveness. An emphasis on changing social networks to be conducive to recovery could heighten both clinical effectiveness and prevention efforts within communities.

Adult↗

PubMed2003

Services integration and cost-effectiveness.

Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these services. This symposium presents some recent studies in this area. The small but growing body of studies in this area has great potential to inform public policy debates.

Alcoholism↗

PubMed2003

Missed opportunities in addressing drinking behavior in medical and mental health services.

BACKGROUND: Epidemiological and clinical literature point to the importance of screening for alcohol problems in medical and psychiatric settings. However, little is known about which problem drinkers seek help from those services or about the characteristics of those who have their drinking addressed. METHODS: We interviewed a probability sample of adult dependent and problem drinkers in the general population (n = 672) and consecutive admissions to chemical dependency programs in a northern California county (n = 926). We reinterviewed them 1 year later and measured medical and mental health visits and whether their drinking was addressed during the visit. RESULTS: Almost two-thirds of problem drinkers had a medical visit, and approximately one-third had a mental health visit, yet drinking was not often discussed, especially during medical visits. Many of those more likely to have a visit were not more likely to have their drinking addressed. Women and individuals older than 40 years had more medical and mental health visits [odds ratio (OR), 1.71; p < 0.001 and OR, 1.55; p < 0.001, respectively, for women; OR, 1.57; p < 0.05 and OR, 1.64; p < 0.05, respectively, for age >/=40 years], but were not more likely to have their drinking addressed in either setting, and women were less likely than men to have their drinking addressed in mental health settings (OR, 0.62; p < 0.05). Those with higher alcohol severity and those who had attended chemical dependency treatment during the previous year were more likely to have their drinking addressed in each setting. Insurance status predicted medical, but not mental health, visits and was not related to having drinking addressed in either setting. CONCLUSIONS: Drinking behavior was not routinely addressed by medical and mental health practitioners for dependent and problem-drinking men and women who presented in public and private medical and mental health settings.

Adolescent↗

PubMed2003

Utilization and cost impact of integrating substance abuse treatment and primary care.

OBJECTIVE: To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. RESEARCH DESIGN: Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO's primary care clinics independently from substance abuse treatment. SUBJECTS: Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. MEASURES: Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. RESULTS: For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from 431.12 US dollars to 200.03 US dollars (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. CONCLUSIONS: (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.

Adult↗

PubMed2003

Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program.

OBJECTIVE: This study examined how well older chemical dependency patients succeed in treatment relative to middle-aged and younger patients in a mixed-age private HMO outpatient program. To predict successful outcome, we tested a model incorporating age group differences in individual, treatment and extratreatment factors. METHOD: The sample included 89 patients aged 55 and over, 379 patients aged 40 to 54, and 736 patients aged 18-39 (N = 1,204). Baseline measures included DSM-IV substance misuse diagnoses, Addiction Severity Index (ASI), psychiatric symptom checklist, sources of suggestion to enter treatment, treatment history and motivation. Outcome measures were abstinence rates and ASI score 6 months posttreatment. RESULTS: At baseline, older adults showed higher levels of alcohol dependence, lower rates of drug dependence and lower psychiatric symptoms relative to younger individuals. Source of suggestions to enter treatment differed by age. Older and middle-aged patients were more likely to have an abstinence goal and to stay in treatment longer than younger adults. At 6 months posttreatment, 55% of older adults reported abstinence in the preceding 30 days, versus 59% of middle-aged adults and 50% of younger adults (p = .035). CONCLUSIONS: Lower rates of dependence and hostility, and greater abstinence motivation and length of stay in treatment--all of which were associated with greater age--positively affect prognosis of older adults in treatment.

Adolescent↗

PubMed2003

The persistent influence of social networks and alcoholics anonymous on abstinence.

OBJECTIVE: The role of changes in Alcoholics Anonymous (AA) involvement and social networks in relation to abstinence following substance abuse treatment is studied. Specifically, the role of AA and network support for abstinence are examined in relation to their effect on changes in abstinence states between follow-ups. METHOD: Study sites were 10 representative public and private alcohol treatment programs in a northern California county. A recruitment of 367 men and 288 women seeking treatment were interviewed at intake and re-interviewed 1 and 3 years later to collect information about alcohol consumption, dependence symptoms, social support for reducing drinking, number of heavy drinkers in the social network and AA involvement. RESULTS: Significant predictors of 90-day abstinence at both the 1- and 3-year follow-up interviews included AA involvement in the last year, percentage of heavy or problem drinkers in the social network, percentage encouraging alcohol reduction and AA-based support for reducing drinking. Panel models estimated an increase in AA participation between 12 and 36 months posttreatment increased the odds of abstinence at 3 years by 35% above those at 12 months. The only significant mediator of AA's effect on abstinence was the number of AA-based contacts supporting reduced drinking, which reduced the magnitude of the relationship by 16%. CONCLUSIONS: AA involvement and the type of support received from AA members were consistent contributors to abstinence 3 years following a treatment episode. The enduring effects observed from supportive networks demonstrate the importance of ongoing mechanisms of action that contribute to an abstinent lifestyle.

Adult↗

PubMed2003

The role of community services and informal support on five-year drinking trajectories of alcohol dependent and problem drinkers.

OBJECTIVE: The purpose of this study was to examine how informal support and community services impact the course of alcohol disorders by examining the trajectories of alcohol consumption over 5 years in dependent and problem drinkers. METHOD: Alcohol dependent adults (n = 600) and problem drinkers (n = 992) were identified through probability surveys in the general population and in public and private treatment programs throughout a California county. Participants were interviewed at baseline and again 1, 3 and 5 years later. Models controlling for demographic characteristics, problem severity, community services and recovery-oriented social networks were estimated, using a multi-level, mixed model to predict alcohol consumption over time. RESULTS: A significant trend of reduced drinking over time was observed for both dependent and problem drinkers. Recovery-oriented social networks and AA participation predicted decreased consumption for both groups. Contacts with medical, mental health, welfare and legal systems were predictive of reduced consumption for problem drinkers. In the dependent group, only contacts with mental health agencies marginally predicted decreased consumption. CONCLUSIONS: Findings point to the importance of developing mechanisms for better identifying problem drinkers in the course of contacts with health and social service systems and for facilitating use of self-help groups and positive changes in social networks. Development of recovery-oriented social networks should be emphasized to extend the benefits of treatment for dependent individuals.

Adult↗

PubMed2002

A prospective study of the factors influencing entry to alcohol and drug treatment.

Much is known about factors related to entering alcohol and drug treatment, but most research comprises cross-sectional "snapshots" in time. It is not known whether the reasons for entering treatment endure when problem drinkers are studied over time. This study contracts characteristics predicting treatment entry in a cross-sectional analysis at baseline with a longitudinal perspective at 1- and 3-year follow-up interviews. Sociodemographic characteristics were less important in the longitudinal analysis. In contrast to the social consequences important at the baseline interview, physiologic symptoms of alcohol dependence and interventions by medical professionals were prominent at later interview points. The findings have implications for interventions by health professionals, both for the development of early interventions targeting individuals to treatment and for a continuing care service model.

Adult↗

PubMed2002

Who goes to alcohol and drug treatment? Understanding utilization within the context of insurance.

OBJECTIVE: This study assesses the differential roles of demographic characteristics, problem severity, motivational factors and insurance in entrance into alcohol and drug treatment. METHOD: A probability sample of adult problem and dependent drinkers from a Northem California county (N = 672) and consecutive adult intakes from the county's public (n = 298) and private (n = 628) alcohol and drug treatment programs. Interviewers conducted telephone screening for individuals meeting problem-drinking criteria in the general population; in-person interviews were conducted for those who screened positive, and also for individuals entering treatment. RESULTS: Insurance did not play an independent role in treatment entry. In logistic regression analysis, using a model from the medical utilization literature, black ethnicity (odds ratio [OR] = 2.98, p < .001); older age (OR = 4.67, p < .001); less education (OR = 1.81, p < .01); legal (OR = 7.46, p < .001) and work (OR = 3.57,p <.001) pressures; higher psychiatric (OR = 4.03,p <.001) and drug (OR = 3.04,p <.001) severity; and social consequences (OR = 1.35, p < .01) predicted treatment entry. Interventions from legal sources (OR = 6.22, p < .01) were related to entering treatment for the uninsured; legal (OR = 7.02, p < .001), workplace (OR = 6.01, p < .001) and family (OR = 1.62, p < .05) pressures were related for the insured. CONCLUSIONS: Social consequences, rather than severity of dependence, in both insured and uninsured problem drinkers are important predictors of treatment entry when traditional utilization measures are controlled. Public programs play a crucial part in the alcohol and drug treatment system, and their viability is important as health policy changes.

Adult↗

PubMedDate not supplied

Alcohol consumption, risk of injury, and high-cost medical care.

This study examined the effect of alcohol use on the probabilities of injury, inpatient hospital stay, and emergency department visit. Data were obtained from a sample of adults (N = 1219) recruited from a Northern California county. Alcohol use measures included number of drinks, heavy drinking days, and an indicator variable for problem drinking. Models were estimated for men and women separately while controlling for confounders. Results indicate that most alcohol use measures were not significantly related to injury probability or medical care utilization. Among the exceptions, problem drinking was a significant positive predictor of any emergency department visit for both sexes. When drinkers during the past year were divided into light, moderate, and heavy drinking groups and compared to lifetime abstainers, all male drinkers had a higher probability of injury, and light and moderate female drinkers had a lower probability of an emergency department visit.

Adult↗

PubMedDate not supplied

Psychiatric symptoms, impaired function, and medical care costs in an HMO setting.

More information is needed regarding the medical care utilization and costs of individuals who report depressed mood, persistent anxiety, brief anxiety, panic, and trouble controlling violent behavior. We present findings from a 1-year prospective follow-up study of a stratified random sample of adult HMO enrollees (N = 10,377) originally interviewed by telephone. A strong association was observed between these psychiatric symptoms, associated impaired function, and general medical care costs during the year following the interview. After controlling for age, gender, race, medical conditions, and smoking, the mean costs of general medical care were $1,948 for respondents who reported none of the psychiatric symptoms or impaired function: $3,006 for respondents with all 5 symptoms but no impaired function; and $3,906 for those with all 5 symptoms and pervasive functional impairment. Persistent anxiety and depressed mood had the greatest impact on total general medical costs, while impaired function was associated with increased likelihood of hospital admission and emergency room use. We conclude that depressed mood, persistent anxiety, and related impaired function are associated with substantial increases in the use and cost of general medical care.

Adolescent↗