Biomedical subjects

Jennifer R Mertens

Publications and source records attributed to Jennifer R Mertens.

11 recordsLinked to original sources

PubMed2007

The excess medical cost and health problems of family members of persons diagnosed with alcohol or drug problems.

BACKGROUND: Having a family member with substance use problems affects family functioning, which may lead to increased medical problems and increased health care utilization and costs in the other family members. AIM: We sought to estimate the excess medical costs and prevalence of diagnosed health conditions of family members of persons with an alcohol or drug diagnosis (AOD) compared with the family members of similar persons without an AOD. METHODS: Using a large health plan's administrative databases, we identified persons who received an AOD between 2001 and 2004 and a similar group of persons with no AOD during that time. Using a hierarchical linear mixed model, we compared the cost and utilization of the family members of the AOD and non-AOD patients in the 2 years prior to the AOD patient's first AOD. Using logistic regression, we determined whether the family members of patients with AODs were more likely than comparison family members to be diagnosed with medical conditions. RESULTS: Family members of patients with AODs had greater health care costs than comparison family members in the second year before the index date (490 dollars) and in the year before the index date (433 dollars). This was the case for both adult and child family members. They also were more likely to be diagnosed with many medical conditions, especially substance abuse and depression. CONCLUSIONS: Family members of patients with AODs have greater health care costs and are more likely to be diagnosed with a number of medical conditions than family members of similar persons without an AOD.

Adolescent↗

PubMed2005

Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs.

BACKGROUND: There exists substantial evidence that individuals with alcohol and drug disorders have heightened comorbidities and health care costs. However, little is known about the larger population of "hazardous" drinkers (those whose consumption increases their "risk of physical and psychological harm") and drug users. METHODS: A sample of 1,419 patients from HMO primary care clinics was screened for hazardous drinking and drug use. Health plan databases were used to examine medical conditions and health care costs of hazardous drinkers and drug users in the year prior to screening, in comparison to 13,347 patients from the same clinics, excluding those screened. RESULTS: We found a prevalence of 7.5% for hazardous drinking and 3.2% for drug use in primary care (10% had at least one of the two problems). Hazardous drinkers and drug users had heightened prevalences for eight medical conditions, including costly conditions such as injury and hypertension, and psychiatric conditions. Medical costs for the year examined were not higher, except for those who also had psychiatric conditions. CONCLUSIONS: The prevalence of hazardous drinking and drug use was similar to hypertension and diabetes. Hazardous drinkers and drug users' heightened medical conditions, especially those related to alcohol and drug abuse, indicate that screening and brief intervention at this lower threshold of hazardous drinking and drug use will detect individuals with health risks sooner. Optimal treatment and prevention of some medical disorders may require identification and intervention of underlying hazardous alcohol or drug use.

Adult↗

PubMed2005

Relationship between use of psychiatric services and five-year alcohol and drug treatment outcomes.

OBJECTIVE: The objective of this study was to examine the relationship between use of psychiatric services and alcohol and drug treatment outcomes five years after such treatment. It was anticipated that receipt of psychiatric services would predict long-term abstinence. METHODS: A sample of 604 outpatients from a managed care organization's chemical dependency program was interviewed about substance use and severity of psychiatric symptoms at baseline and at five years. Patients were required to have at least three years of membership in the health plan during the five years after intake. Severity of psychiatric symptoms was categorized as zero, low, middle, or high. Use of psychiatric services was ascertained on the basis of administrative data from the health plan. Logistic regression analysis was used to assess the relationship between receipt of psychiatric services during the five years after intake and abstinence at five years. Results were adjusted for individual, treatment, and extra-treatment characteristics; severity of psychiatric symptoms at baseline; and other contacts with the health system. RESULTS: Patients who received a threshold level of psychiatric services (an average of at least 2.1 hours a year) were significantly more likely to be abstinent at five years than patients who received less than 2.1 hours a year. CONCLUSIONS: The use of psychiatric services among patients with chemical dependency is associated with enhanced long-term outcomes.

Adolescent↗

PubMed2005

Readmission among chemical dependency patients in private, outpatient treatment: patterns, correlates and role in long-term outcome.

OBJECTIVE: Similar to other chronic conditions, chemical dependency is a chronic, relapsing condition. Yet predominant treatment models do not provide ongoing, long-term treatment services; readmission is the available long-term care for alcohol and drug patients. We examine readmission patterns and the role of readmission in 5-year outcome in chemical dependency patients in a private, integrated health plan. METHOD: We used health plan utilization databases and self-report at 5-year follow-up to measure readmission and routine primary care services in 647 chemical dependency outpatients from a private health plan. Logistic regression was used to examine whether readmission and primary medical care predicted abstinence at 5 years. RESULTS: Controlling for demographic characteristics and dependence type, higher odds for past-year alcohol and drug abstinence at 5 years following treatment was predicted by having been readmitted in the first 4 years after index episode (odds ratio =1.59, p = .006). Receiving routine medical care predicted past 30-day (but not past-year) abstinence at 5-year follow-up. CONCLUSIONS: The relationship of readmissions to better outcome at 5 years suggests that long-term continuing care may benefit patients' long-term outcomes. More research is needed on the relationship of primary medical care to long-term outcome in chemical dependency patients.

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

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

Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls.

BACKGROUND: Substance abuse and health problems seem to be inextricably related. Yet, prior research on the health conditions related to substance abuse is largely focused on alcohol and is from patients treated in publicly funded programs, inpatients, and the general population. METHODS: This study compares the prevalence of medical and psychiatric conditions among 747 substance abuse patients and 3690 demographically matched controls from the same health maintenance organization, and examines whether any heightened prevalence for substance abuse patients (relative to controls) varies according to demographic subgroups and type of substance. RESULTS: Approximately one third of the conditions examined were more common among substance abuse patients than among matched controls, and many of these conditions were among the most costly. We also found that pain-related diagnoses, including arthritis, headache, and lower back pain, were more prevalent among such patients, particularly those dependent on narcotic analgesics. CONCLUSIONS: Our findings point to the importance of examining comorbid medical conditions and substance abuse in both primary and specialty care. Our findings regarding pain-related diagnoses among patients dependent on narcotic analgesics highlight the need for linkages between primary care and substance abuse treatment. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of an underlying substance abuse disorder.

Adult↗

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

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↗

PubMed2002

Coping among individuals seeking private chemical dependence treatment: gender differences and impact on length of stay in treatment.

BACKGROUND: Length of stay in treatment and coping skills are both predictive of chemical dependence and abuse treatment outcomes. However, little is known about whether coping strategies are related to length of stay in treatment. Because predictors of length of stay in treatment vary by gender, it also may be reasonable to expect gender differences in coping strategies as well as in the relationship between coping and LOS in treatment. METHODS: We examined gender differences in baseline coping strategies, and coping strategies as predictors of length of stay in treatment, among 747 (433 men, 314 women) individuals who entered chemical dependence and abuse treatment in a private, managed care facility. RESULTS: Women reported using more emotional discharge (behavioral attempts to reduce tension by expression of negative feelings), cognitive avoidance (cognitive attempts to avoid thinking realistically about the problem), resigned acceptance (cognitive attempts to react to the problem by accepting it), and seeking support/guidance (behavioral attempts to seek information, guidance, or support). Gender differences for emotional discharge disappeared after we controlled for depressive symptom and drug problem severities. Greater use of seeking alternative rewards (behavioral attempts to get involved in substitute activities and create new sources of satisfaction), less use of emotional discharge, and older age were significant predictors of longer length of stay, with no gender differences found. CONCLUSIONS: This study provides evidence for identifying and decreasing the use of emotional discharge early in treatment, possibly through the use of intervention strategies such as anger management, cognitive restructuring, or motivational interviewing, as well as encouraging an increase in participation in alternative activities.

Adaptation, Psychological↗

PubMed2002

Effects of managed care on alcohol and other drug (AOD) treatment.

The article represents the proceedings of a symposium at the 2001 RSA Meeting in Montreal, Canada. The organizer/chair was Stephen Magura. The presentations examined: (1) How managed care organization policies may affect enrollees' use of alcohol and other drug (AOD) treatment, by Constance Horgan and associates; (2) The determinants of patients' access to and utilization of AOD treatment in a large health maintenance organization, by Jennifer R. Mertens and Constance Weisner; (3) The impact on treatment access and costs of a statewide carve-out for AOD treatment for Medicaid, by Donald Shepard and associates; and (4) The predictive validity of a new patient assessment technology developed, in part, to better justify AOD treatment in response to the demands of managed care, by Stephen Magura and associates.

Alcoholism↗