Short term health-related quality of life improvement during opioid agonist treatment.

BACKGROUND: Opioid dependence is associated with high levels of morbidity, yet sparse data exists regarding the health-related quality of life (HRQoL) of individuals with opioid dependence, particularly following treatment initiation. To inform cost-effectiveness analyses of treatment modalities, this study investigates short-term changes in HRQoL following enrollment into opioid agonist treatment (OAT), across treatment modalities and patient subgroups. METHODS: Data was analyzed from the Starting Treatment with Agonist Replacement Therapies (START) and Prescription Opioid Addiction Treatment Studies (POATS) randomized controlled trials. Participants included individuals dependent on prescription opioids (POs) or heroin, receiving limited-term or time-unlimited treatment. PO- or heroin-users in START received buprenorphine/naloxone (BUP/NX) or methadone (MET) over 24 weeks. PO-users in POATS received psychosocial care and short-term (4-week) taper with BUP/NX, with non-responders offered subsequent extended (12-week) stabilization and taper. HRQoL was assessed using the short-form SF-6D while in and out of OAT, with distinction between MMT and BUP/NX in START. Linear mixed effects regression models were fitted to determine the independent effects of OAT on HRQoL and characterize HRQoL trajectories. RESULTS: Treatment had a similar immediate and modest positive association with HRQoL in each patient subgroup. The association of OAT on HRQoL was statistically significant in each model, with effect sizes between 0.039 (heroin-users receiving BUP/NX) and 0.071 (PO-users receiving MET). After initial improvement, HRQoL decreased slightly, or increased at a diminished rate. CONCLUSIONS: OAT, whether delivered in time-limited or unlimited form, using BUP/NX or MET, is associated with modest immediate HRQoL improvements, with diminishing benefits thereafter.

The effect of an enhanced employee assistance program (EAP) intervention on EAP utilization.

OBJECTIVE: An enhanced employee assistance program (EAP) intervention was developed that delivers comprehensive EAP outreach services to all employees who may have alcohol-related and other workplace problems; standard EAP materials traditionally targeted at white men were enhanced to include women and minorities. This study evaluates whether the enhanced EAP intervention increased EAP utilization. METHOD: The enhanced EAP intervention was developed at a large community-based not-for-profit EAP located in Rockford, Illinois. Two primary worksites and 16 other newly contracted worksites received the enhanced EAP intervention and served as intervention sites; the 107 other worksites serviced by the EAP were used as comparison sites. We used time series data from 1991 to 1998 and included repeated measures on each firm's quarterly EAP utilization. RESULTS: The enhanced EAP intervention increased the mean number of women and minority cases per worksite by 58%, white male cases by 45% and total EAP cases by 53%. CONCLUSIONS: This study shows that, for a modest cost, the enhanced EAP intervention successfully increased utilization of EAP by all employees, especially utilization by women and minority employees. It also shows that traditional EAP services and outreach materials can be made more appealing to women and minorities without adversely affecting their utilization by white men.

The joint demand for cigarettes and marijuana: evidence from the National Household Surveys on Drug Abuse.

Recent studies have shown that efforts to curb youths' alcohol use, such as increasing the price of alcohol or limiting youths' access, have succeeded but may have had the unintended consequence of increasing marijuana use. This possibility is troubling in light of the doubling of teen marijuana use from 1990 to 1997. What impact will recent increases in cigarette prices have on the demand for other substances, such as marijuana? To better understand how the demand for marijuana and tobacco responds to changes in the policies and prices that affect their use, we explore the National Household Survey on Drug Abuse (NHSDA) from 1990 to 1996. We find evidence that both higher fines for marijuana possession and increased probability of arrest decrease the probability that a young adult will use marijuana. We also find that higher cigarette taxes appear to decrease the intensity of marijuana use and may have a modest negative effect on the probability of use among males.

The effect of Employee Assistance Programs use on healthcare utilization.

OBJECTIVE: To estimate the effect of Employee Assistance Program (EAP) use on healthcare utilization as measured by health claims. DATA SOURCES: A unique data set that combines individual-level information on EAP utilization, demographic information, and health insurance claims from 1991 to 1995 for all employees of a large midwestern employer. STUDY DESIGN: Using "fixed-effect" econometric models that control for unobserved differences between individuals' propensities to use healthcare resources and the EAP, we perform our analyses in two steps. First, for those employees who visited the EAP, we test whether post-EAP claims differ from pre-EAP claims. Second, we combine claims data of individuals who went to an EAP with those of individuals who did not use an EAP to test whether differences in utilization exist between EAP users and nonusers. DATA COLLECTION METHODS: From the EAP we obtained the date of first EAP contact for all employees who used the service, and from the company's human resources department we obtained limited demographic data on all employees. We obtained healthcare utilization claims data on all employees and their dependents from the company's two healthcare plans: a fee-for-service (FFS) plan and a health maintenance organization (HMO) plan. PRINCIPAL FINDINGS: We found that going to an EAP substantially increases both the probability of an alcohol, drug abuse, or mental health (ADM) claim and the number of ADM claims in the same quarter as EAP contact. The increased probability of an ADM claim persists for approximately 11 quarters after the initial contact, while the increased ADM charges persist for approximately six quarters after the initial EAP contact. CONCLUSIONS: Our results strongly suggest that the EAP is able to identify behavioral and other health problems that may affect workplace performance and prompt EAP users to access ADM and other healthcare. Consistent with the stated goals of many EAPs, including the one examined in this study, this process should improve individuals' health, family functioning, and workplace performance.

Symptoms of dependence, multiple substance use, and labor market outcomes.

The prevalence and costs of alcohol and drug disorders pose a serious social concern for policymakers. In this paper, we use data from the National Household Surveys on Drug Abuse (NHSDA) to estimate simple descriptive statistics and analysis of variance (ANOVA) models of the relationship between symptoms of dependence and labor market outcomes for alcohol, cigarettes, marijuana, and other illicit drugs. For men, we find that substance use with symptoms of dependence is associated with both lower employment rates and fewer hours of work. For women, we find that substance use with symptoms of dependence is associated with lower employment rates, but we find no consistent evidence of a relationship between symptoms of dependence and the number of hours worked. Finally, all of our point estimates are smaller in magnitude when we control for multiple substance use, suggesting that comorbidities play a critical role in the relationship between substance use and labor market outcomes. Our results suggest that policymakers and researchers should consider the full spectrum of substance use and dependence rather than focusing on the simple use of a single substance.

The relationship between marijuana initiation and dropping out of high school.

The prevalence of marijuana use among young people has risen rapidly in recent years, causing concern over the potential impact on academic performance of such use. While recent studies have examined the effect of alcohol use on educational attainment, they have largely ignored the potential negative effects of other substances, such as marijuana. This paper examines whether the relationship between the initiation of marijuana use and the decision to drop out of high school varies with the age of dropout or with multiple substance use. Data are from a longitudinal survey of 1392 adolescents aged 16-18 years. The results suggest that marijuana initiation is positively related to dropping out of high school. Although the magnitude and significance of this relationship varies with age of dropout and with other substances used, it is concluded that the effect of marijuana initiation on the probability of subsequent high school dropout is relatively stable, with marijuana users' odds of dropping out being about 2.3 times that of non-users. Implications of these conclusions are considered for both policy makers and researchers.

Cost of employee assistance programs: comparison of national estimates from 1993 and 1995.

The cost and financing of mental health services is gaining increasing importance with the spread of managed care and cost-cutting measures throughout the health care system. The delivery of mental health services through structured employee assistance programs (EAPs) could be undermined by revised health insurance contracts and cutbacks in employer-provided benefits at the workplace. This study uses two recently completed national surveys of EAPs to estimate the costs of providing EAP services during 1993 and 1995. EAP costs are determined by program type, worksite size, industry, and region. In addition, information on program services is reported to determine the most common types and categories of services and whether service delivery changes have occurred between 1993 and 1995. The results of this study will be useful to EAP managers, mental health administrators, and mental health services researchers who are interested in the delivery and costs of EAP services.

The differential effects of alcohol consumption and dependence on adverse alcohol-related consequences: implications for the workforce.

Previous literature has supported the hypothesis that high rates of alcohol consumption are associated with adverse social consequences and that dependence on alcohol has an effect on that relationship. The purpose of this paper is to further specify the alcohol consumption-adverse consequences linkage by developing and estimating a latent variable model that incorporates the mediating effects of loss of control over alcohol consumption. This model is applied to measures for three alcohol-related constructs--consumption, loss of control and adverse consequences--incorporated in the 1991 National Household Survey on Drug Abuse, for members of the primary workforce in the US. The research suggests that workplace decision makers attempting to minimize the adverse workplace consequences of alcohol abuse should implement procedures that assess and respond to alcohol dependency rather than relying exclusively on detection of and intervention with alcohol consumption per se.

Treatment patterns and distribution of low-density lipoprotein cholesterol levels in treatment-eligible United States adults.

To estimate the fraction of United States (U.S.) adults who are eligible for treatment to reduce elevated low-density lipoprotein (LDL) cholesterol levels based on Adult Treatment Panel II (ATP II) guidelines and the percent reduction in LDL cholesterol required by those who qualify for treatment, we analyzed data on 7,423 respondents to Phase 2 of the third National Health and Nutrition Examination Survey (NHANES III) administered between 1991 and 1994. Approximately 28% of the U.S. adult population aged > or = 20 years is eligible for treatment based on ATP II guidelines. Eighty-two percent of adults with coronary heart disease are not at their target LDL cholesterol level of 100 mg/dl. Of those eligible for treatment, 65% report that they receive no treatment. Overall, 40% of people who qualify for drug therapy require an LDL cholesterol reduction of > 30% to meet their ATP II treatment goal. Approximately 75% of those with coronary heart disease who qualify for drug therapy require an LDL cholesterol reduction of >30%. Although elevated LDL cholesterol levels can be treated, prevalence rates in the U.S. adult population remain high. Several recent studies indicate that a considerable percentage of people treated with drug therapy do not reach their treatment goals. The findings in this study provide at least a partial explanation for why many patients receiving therapy do not reach their treatment goals: they require a larger reduction in LDL cholesterol than many therapies can provide.

Alcohol use and wages: new results from the National Household Survey on Drug Abuse.

A recent study published in the Journal of Health Economics by French and Zarkin [French, M.T., Zarkin, G.A., 1995. Is moderate alcohol use related to wages? Evidence from four worksites, Journal of Health Economics 14, 319-344] found evidence of a positive, inverse-U-shaped relationship between wages and alcohol consumption for individuals at four worksites. In this paper, we attempted to replicate French and Zarkin's findings using a combined sample of prime-age workers from the 1991 and 1992 National Household Surveys on Drug Abuse (NHSDA). Whereas French and Zarkin found that individuals who consume approximately 1.5 to 2.5 drinks per day have higher wages than non-drinkers and heavy drinkers, we found no evidence of a turning point at this consumption level for either men or women. Our results do suggest that men who use alcohol have approximately 7% higher wages than men who do not drink, and this apparent wage premium is approximately the same over a wide range of alcohol consumption. For women, the estimated alcohol use premium is approximately half as large as for men and is statistically insignificant.

Latent variable models of alcohol-related constructs.

This study examines the improvement in validity coefficients and structural relationships derived from formally modeling latent variables of adverse alcohol-related constructs. Results of a confirmatory factor analysis of responses from 8,755 participants in the 1988 National Household Survey of Drug Abuse support a three-factor model of alcohol abuse, dependence, and adverse consequences. A comparison of construct intercorrelations shows latent variables to be superior to measurement approaches using unweighted sums, quantity x frequency calculation, and single-item measurement.

Prevalence and consequences of smoking, alcohol use, and illicit drug use at five worksites.

Employers are becoming increasingly concerned about the consequences and costs of substance use in their workplaces. Despite this heightened awareness, little information is available to guide them in setting up worksite-based prevention and assistance programs. Most estimates of the prevalence or consequences of substance use are derived from large national surveys of households or individual persons. The primary contribution of this research to the public health literature is the empirical results from a unique data set. In particular, this study presents results of a survey administered to more than 1,200 employees at five different worksites. Descriptive statistics for the prevalence of smoking, alcohol and illicit drug use, prescription drug misuse, and workplace consequences, such as reduced performance and absenteeism, are reported, as well as findings from a multivariate analysis of substance use prevalence and consequences. Compared with national averages, workers at these five sites tended to have substance use profiles similar to or slightly lower than estimates from large national surveys. The study's estimates may help employers identify the extent of a substance abuse problem in their worksites and specific areas to target for possible intervention.