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The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients

Division of Research, Kaiser Permanente Medical Care Program, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States.
Drug and Alcohol Dependence (Impact Factor: 3.28). 07/2008; 98(1-2):45-53. DOI: 10.1016/j.drugalcdep.2008.04.007
Source: PubMed

ABSTRACT Health problems are prevalent in chemical dependency (CD) treatment populations, and often precede reductions in substance use among untreated populations. Few studies have examined whether medical problems predict better long-term outcomes in treated individuals, or how primary care utilization and CD/primary care service integration affects long-term outcomes among those with health problems.
In a sample of 598 CD patients in a private health plan, logistic regression models examined whether substance abuse-related medical conditions (SAMCs), integrated medical and CD care, and on-going primary care predicted remission of CD problems at 5 years.
Those with SAMCs were no more likely than others to be remitted at 5 years except among young adults and those with medical, but not psychiatric SAMCs. Higher levels of medical problem severity at intake and receiving integrated CD and primary care in the index treatment episode predicted remission in the full sample and among those with SAMCs. Among those with SAMCs, individuals with ongoing medical care - 2-10 primary care visits - in the 5 years following intake were more likely to be remitted at 5 years than those with fewer visits.
This study highlights the potentially important role of medical services in the long-term treatment of CD disorders. CD treatment may benefit from a disease management approach similar to that recommended for other chronic medical problems: specialty care when the condition is severe followed by services in primary care when the condition is stabilized.

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    • "Integrated models have been shown to be cost-effective for individuals who have substance use related medical conditions (Weisner, Mertens, Parthasarathy, Moore, & Lu, 2001). Mertens et al. (2008) studied a sample of private health care plan enrollees with substance use related medical conditions and demonstrated that having between two to ten primary care visits was predictive of remission of substance dependence after five years of followup . Samet et al. (2001) have reviewed the benefits of integrating primary care and substance user services and describe various models that can be implemented within today's health care delivery system. "
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    • "The primary AOD outcome was prior-year remission , measured at 5, 7, and 9 years. Remitted individuals were those who either reported abstaining in the past year or those who were non–problem users as follows: They (a) used alcohol but had no days of drinking fi ve or more drinks in a day and drank only four times per month or less in the past year, or used marijuana but not more than once per month in the past year; (b) had no other drug use in the past year; (c) had no problems with friends or family, violent behavior, or suicidal ideations in the month before the interview; and (d) had not been arrested, in jail/prison, under electronic home surveillance, or to a probation or parole offi cer in the year before the interview (Mertens et al., 2008). This is consistent with other " remission " defi nitions (Moos and Moos, 2003). "
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    • "utilization in the second and third years not paid for by KP following intake was measured using self-report data from the 3-year interview. Analyses conducted in another KP sample of young adults aged 18 to 25 years old found substantial agreement between self-report and administrative data (Mertens et al., 2008). "
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