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Objective: The emergency department (ED) visit provides a window of opportunity for screening and linkage to services for inner-city adults with substance-use disorders (SUDs). This article examines predictors of intervention attendance among ED patients who screen positive for an SUD (alcohol or other drug). Method: As part of a large randomized control trial, medical and injured patients (ages 19-60) in an inner-city ED completed a computerized screening survey. Based on random assignment, those screening positive for an SUD either were scheduled to attend a post-discharge intervention or received a referral brochure. Interventions (brief motivational intervention vs. case management intervention) focused on linking participants to substance-use treatment. Independent variables assessed included demographics, ED visit reason, health functioning, readiness to change, self-efficacy, and substance use. Intervention attendance (yes/no) was the dependent variable. Results: Overall, 957 (62.3% male; 58.3% African-American; [M.sub.age] = 33.2 years) were randomized to interventions (brief motivational intervention/case management intervention) and are the focus of subsequent analyses. There were no differences in the pattern of predictors of intervention attendance for brief motivational intervention versus case management intervention. Bivariate analyses compared those who attended the post-ED intervention with those who did not attend. Participants who attended the intervention (50%) were significantly more likely to be older, unmarried, insured, unemployed, and in the 'action' stage of change. Conclusions: The present findings highlight the relative importance of assessing and attending to readiness to change as well as demographic factors such as insurance and employment (and potentially associated barriers) in ED-based screening, brief intervention, and referral to treatment protocols., PRIOR RESEARCH DEMONSTRATES THAT alcohol and drug users are more likely to seek emergency department (ED) care than are nonusers (Cherpitel and Bazargan, 2003; Cunningham et al., 2003; Fuda and [...]

Objective: Substance use is associated with poor mental health, but little is known regarding how use of multiple substances is associated with mental health, particularly longitudinally, in community studies. This article examines this issue in a large (N = 710), natural-history study of rural stimulant (cocaine and/or methamphetamine) users in three states. Method: Respondent-driven sampling recruited recent (past-30-day) stimulant users in three counties each in Arkansas, Kentucky, and Ohio. Participants were interviewed every 6 months for 3 years. Mental health was measured by the Brief Symptom Inventory, and prior 6 months' substance use was measured for 17 possible substances. Data analysis used generalized estimating equations for longitudinal data with the Global Severity Index of the Brief Symptom Inventory as the dependent variable at each interview and substance use as predictor variables measured by number of substances used in the past 6 months and, separately, the 17 individual substances, adjusting for use of substance-use treatment, demographics, and recruitment site. Results: On average, both Global Severity Index score and use of many substances declined over the course of study. Global Severity Index score was significantly associated with (a) greater number of substances used in the past 6 months (p < .0001) and (b) use of crack cocaine, methamphetamine, and nonprescription use of prescription painkillers and tranquilizers. Conclusions: Multiple and specific substances appear to incrementally increase psychological distress. Users of cocaine and methamphetamine are present in rural areas; these associations with poor psychological health raise concerns regarding availability of local treatment services for individuals with mental-health problems, as well as substance abuse. (J. Stud. Alcohol Drugs, 71, 258-267, 2010), WIDESPREAD USE OF METHAMPHETAM1NE and cocaine has become a recent phenomenon in many rural areas of the United States, with some rural states overwhelmed dealing with the legal consequences and [...]

Objective: This study examined whether particular dimensions of religiousness are prospectively associated with the development or maintenance of an alcohol-use disorder (AUD) among at-risk drinkers or persons with a history of problem drinking. Method: A prospective cohort study was conducted among at-risk drinkers identified through a population-based telephone survey of adults residing in the southeastern United States. The cohort was stratified by baseline AUD status to determine how several dimensions of religiousness (organized religious attendance, religious self-ranking, religious influence on one's life, coping through prayer, and talking with a religious leader) were associated with the development and, separately, the maintenance or remission of an AUD over 6 months. Multiple logistic regression analyses were conducted to estimate the odds of developing versus not developing an AUD and maintaining versus remitting from an AUD while adjusting for measures of social support and other covariates. Results: Among persons without an AUD at baseline, more frequent organized religious attendance, adjusted odds ratio ([OR.sub.adj]) = 0.73, 95% CI [0.55, 0.96], and coping through prayer, [OR.sub.adj] = 0.63, 95% CI [0.45, 0.87], were associated with lower adjusted odds of developing an AUD. In contrast, among persons with an AUD at baseline, no dimension of religiousness was associated with the maintenance or remission of an AUD. Conclusions: The findings of this study suggest that religious attendance and coping through prayer may protect against the development of an AUD among at-risk drinkers. Further research is warranted to ascertain whether these or other religious activities and practices should be promoted among at-risk drinkers., THE INFLUENCE OF RELIGIOUSNESS on personal health status and health behaviors has long garnered interest among philosophers, researchers, and health care practitioners (Levin et al., 1997). A large body of [...]

Objective: This study focused on the prevalence and predictors of psychological aggression, physical aggression, and injury rates in nonintimate partner relationships in a substance-use disorder treatment sample. Method: The sample included 489 (76% men, 24% women) participants who completed screening measures for inclusion in a randomized control trial for an aggression-prevention treatment. Primary outcome measures included rates of past-year psychological aggression, physical aggression, and injury (both from the participant to nonpartners and from nonpartners to the participant). Potential predictors included individual factors (e.g., age, gender), developmental factors (e.g., family history of drug use, childhood physical abuse), and recent factors (e.g., depression, cocaine use). Results: Rates of participant-to-nonpartner psychological aggression (83%), physical aggression (61%), and injury (47%) were high, as were rates of nonpartner-to-participant aggression. Bivariate analyses revealed significant relationships between the aggression outcomes and most of the individual, developmental, and recent factors. However, multivariate analyses (zero-inflated Poisson regression) revealed that age, treatment status, current symptoms of depression, heavy periods of drinking, and cocaine use were related most frequently to the occurrence of aggression to and from nonpartners. Conclusions: Nonpartner aggression may be as common within a substance-use disorder sample as partner aggression, and it is associated with heavy drinking episodes, cocaine use, and depressive symptoms. The findings highlight the need for the development of effective violence interventions addressing violence in nonpartner relationship types., IN THE YEAR 2000, APPROXIMATELY 4 out of 10 .victims of police-reported violence defined their relationship with the perpetrator as that of a friend or acquaintance (Federal Bureau of Investigation, [...]

Objective: This study examined service use and costs associated with receiving intensive outpatient (IOP) substance-use treatment. Method: Veterans Affairs national databases were used to identify all veterans receiving IOP substance-use treatment in fiscal year (FY) 1999. Changes in the use of health services (2 years pretreatment compared with 2 years posttreatment) were examined. Three IOP treatment groups were defined: (1) veterans attending 1-5 IOP visits (n = 2,384), (2) 6-14 IOP visits (n = 2,940), and (3) ≥ 15 IOP visits (n = 3,005). In addition, a demographically matched no-treatment group was defined as veterans in primary care with a substance-use diagnosis and no substance-use treatment in FY 1999 (n = 7,328). General medical, psychiatric, and substance-use encounters in inpatient and outpatient settings were retrieved for the 4 years. Generalized estimating equations analyses were used to compare changes in service use across the three IOP groups controlling for demographic characteristics and comorbidity. Results: Total outpatient visits increased in all three treatment groups after IOR with the largest increase observed in the group with ≥ 15 visits (mean visits = 5, 44, and 57, respectively). In comparison, total visits decreased in the no-treatment group (-7). This pattern was similar across settings (general medical, psychiatric, and substance use). Total inpatient days decreased among the four groups, with the no-treatment group having the least amount of decrease (mean change in days = .34, .32, .18, and .03, respectively). Analysis of cost data showed similar findings. Conclusions: Results indicated that more intense IOP treatment is associated with increases in subsequent psychiatric, substance-use, medical, and total outpatient care and decreases in expensive inpatient care. (J Stud Alcohol Drugs 68: 510-518, 2007), RESULTS OF THE MOST RECENT large-scale, national mental health epidemiological research--the National Comorbidity Study-Replication--identified high community prevalence of substance-use disorders. This study, conducted from 2001 to 2003 using structured psychiatric [...]

Objective: Use and production of methamphetamine (MA) has dramatically increased in the United States, especially in rural areas, with concomitant burdens on the treatment and criminal justice systems. However, cocaine is also widely used in many rural areas. The purpose of this article is to contrast MA and cocaine users in three geographically distinct rural areas of the United States. Method: Participants were recent not-in-treatment adult cocaine and MA users living in rural Ohio, Arkansas, and Kentucky, who were recruited by a referral recruitment method for sampling hidden community populations. Participants were interviewed for demographics, drug and alcohol use, criminal justice involvement, and psychological distress (Brief Symptom Inventory). Results: The sample of 706 comprised 29% nonwhite and 38% female participants; the average age was 32.6 years; 58% had a high school education or higher, and 32% were employed. In the past 6 months, they had used either MA only (13%), cocaine only (52%), or both (35%). MA users were seldom (8.2%) nonwhite, but type of stimulant use did not vary by gender. Combined MA/cocaine users reported significantly greater use of alcohol and other drugs, including marijuana and nonprescribed opiates and tranquilizers, and reported significantly higher psychological distress. MA users (with or without cocaine use) had greater odds of recent criminal justice involvement compared with cocaine-only users. Conclusions: There is a clear need for accessible substance-use treatment and prevention services in rural areas of the United States, including services that can address MA, cocaine, polydrug use, and mental health needs. There is a particular need of these services for polydrug users., ALTHOUGH FIRST SYNTHESIZED IN GERMANY and Japan in the late 1800s, methamphetamine (MA) became more widely known in the United States when it was used, manufactured, and distributed by motorcycle [...]

Objective: Cost-effectiveness analyses using preference-weighted health status as the measure of effectiveness allow for the direct comparison of cost-effectiveness ratios for physical and mental health interventions. However, these analyses are not commonly used for substance use-disorders interventions. We conducted a methodological evaluation of the relationship between preference-weighted health status and 6-month substance use-disorders treatment outcomes. Method: The design was an observational study of clients receiving substance use-disorders treatment. Fifteen high-volume treatment centers within a regional managed behavioral health care organization participated. There were 165 subjects (117 men, 48 women) diagnosed with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, substance dependence in the analysis. Baseline and 6-month data included substance-use quantity, frequency, and diagnostic criteria and preference-weighted Medical Outcomes Study Short Form-36 scores based on visual analog scale (VAS) and standard gamble (SG) conversion formulas. Results: Controlling for sociodemographic variables, VAS change for early remission at 6 months was 0.107 (p = .0002) (reference category continued dependence). SG change for early remission at 6 months was 0.041 (p < .0004). Using heavy drinkers as the reference category, VAS preference-weighted change was 0.062 (p =. 10) for abstinent and 0.112 (p = .01) for moderate drinkers. SG preference-weighted change was 0.027 (p = .08) for abstinent and 0.046 (p = .01) for moderate drinkers. Conclusions: These findings support the construct validity of preference-weighted health status in substance use-disorders treatment. Direct comparisons of the cost-effectiveness of substance use-disorders treatment with other mental or physical health interventions are critical during times of limited health care resources., SUBSTANCE USE-DISORDERS OUTCOMES affect a wide range of domains, including productivity, wages, fulfillment of societal responsibilities (e.g., as parent, partner, or spouse), social, criminal justice, mental and physical health, and [...]

Objective: The purpose of this study was to examine differences between healthcare use and associated costs in rural and urban at-risk drinkers. Method: Primary healthcare utilization and cost data were collected from 1995 to 1998 on rural (n = 215) and urban (n = 228) cohorts of drinkers residing in six southeastern states who met criteria for at-risk drinking. Data were obtained through subject interview and from abstracts of medical and pharmacy records. Results: Overall healthcare costs were not significantly different between the rural and urban cohorts. For subjects who incurred any hospital costs (including emergency room [ER] visits), however, costs were significantly greater (p < .01) for rural patients (median = $2,561) than for urban patients (median = $865). Hospital costs associated with patients' ER visits and any subsequent admissions were also greater (p < .01 ) for rural patients (median = $1,004) than for urban patients (median = $512). Use of healthcare services was significantly more likely to occur among women (p < .0001), individuals with lower overall self-reported physical health (p < .01) and individuals with health insurance (p < .0001). Among subjects who used healthcare services, greater costs were significantly associated with older age (p < .05), being female (p < .0001), having lower overall physical health (p < .0001) and having health insurance (p < .01). Conclusions: While overall healthcare costs are not significantly different between rural and urban residents in this sample of at-risk drinkers, there are some notable differences in the costs associated with inpatient and ER services., PROBLEM DRINKING is recognized as a significant cause of morbidity and mortality in the United States. It has been estimated that one in five men and one in ten women [...]

Objective: The purpose of this study was to examine predictors of changes in drinking and drinking consequences in untreated at-risk drinkers in a community sample. Method: Four waves of telephone interviews were conducted at 6-month intervals with a probability sample of at-risk drinkers in the rural and urban South (initial N 733). Participants were interviewed at each wave regarding concurrent drug use, psychopathology and social support, as well as alcohol service use. Individuals reporting receiving services for drinking (n 69) were dropped from the analyses. Longitudinal data were analyzed for predictors of quantity and frequency of drinking, 'safe' drinking levels and diagnoses of recent alcohol disorder. Simultaneous and lagged models were fit for each dependent variable. Results: Over the period of study, drinking quantity and alcohol diagnoses decreased, and safe drinking increased. Only a few variables, including drug use and rural residence, predicted change over time for some outcomes. Remaining significant effects associated with drinking outcomes were constant throughout the study. Women and participants scoring high on religiosity experienced better outcomes; illegal drug use and social consequences of drinking were associated with worse outcomes. Rural residents maintained higher drinking quantity and were less likely to be safe drinkers than urban residents were. Psychiatric comorbidity was significantly associated only with drinking quantity. Conclusions: These data distinguish which at-risk drinkers might benefit from short or delayed interventions in primary care or community settings, and which should receive more intensive, targeted interventions and be encouraged to enter formal treatment as soon as possible., WE KNOW LITTLE ABOUT the predictors of the short-term course of problem drinking in untreated individuals. Problem drinking is generally conceptualized as drinking that puts an individual at risk for [...]

Objective: We know little about the short-term course of drinking, particularly the stability or instability of at-risk drinking in untreated drinkers. Because few at-risk drinkers obtain help for their drinking, it is important to understand the short-term fluctuations between at-risk drinking and full-fledged alcohol use disorders, as well as remission of at-risk drinking. Method: We used four waves of data (each 6 months apart) from a probability community sample of 733 at-risk drinkers in six states in the southern United States to determine variation in abstinence, drinking patterns and alcohol use disorders over a 2-year period. For this analysis, we excluded those who reported receiving services for drinking during the 2-year study period (retrospectively at baseline), leaving a sample size of 664 (444 male); 479 (306 male) completed all four interviews. Results: Although the majority (88%) of the sample was nonabstinent throughout the study, we found significant decreases in average number of drinks per drinking day and recent (past 6 months) alcohol disorders, and an increase in 6-month abstinence. Almost 30% of those with no recent alcohol disorder at baseline (n = 280) later met diagnostic criteria in at least one interview. Of those with a recent alcohol disorder at baseline (n = 199), one third met criteria in at least two subsequent interviews. Conclusions: There is some evidence for short-term progression from at-risk drinking to alcohol disorder. However, there is stronger evidence for declining problems and a fluctuation in and out of recovery and relapse, which may reflect an effort to maintain controlled drinking. Understanding this short-term course is important for primary and secondary prevention efforts and for screening of at-risk drinking in primary care and in the workplace. (J. Stud. Alcohol 62: 580-588, 2001), ********** MANY STUDIES have looked at the long-term (i.e., over a period of several years or more) course of drinking in adults and adolescents. Findings from these studies indicate that [...]

Inpatient alcoholism treatment may be associated with an increase in subsequent hospitalizations for substance abuse care. About 85,000 male alcoholics who were hospitalized in 1987 received five different treatments. Total utilization of health care services three years before treatment, and three years after, was compared. All the treatment groups showed an increase in the number of both inpatient and outpatient visits. In most of the groups this resulted from less inpatient medical care but substantially more admissions for substance abuse care. Men who completed formal treatment programs showed the greatest increases due to this trend., ABSTRACT. Objective: The purpose of the study was to evaluate changes in health care utilization associated with inpatient alcoholism treatment in alcoholics of low- socioeconomic status with different histories of [...]

A model to predict early re-admission to alcoholism treatment was examined with a second independent sample. A high-risk alcoholism relapse (HAR) model based on chronicity of heavy drinking, daily alcohol consumption and previous treatment history, was compared with three established alcoholism typologies for descriptive and predictive validity. The typologies for predicting early relapse was not as effective as the HAR model.

Objective: The purpose of this study was to identify a community sample of rural and urban at-risk drinkers, to compare them in terms of sociodemographics, access measures and severity of illness, and to study them prospectively to identify rural/urban differences in use of 12-month alcoholism treatment services. Method: A brief telephone screening interview of over 12,000 respondents in six southern states identified a sample of at-risk drinkers. A baseline interview was administered to 733 individuals (67% men, 50% rural residents) that obtained information on substance use and psychiatric disorders, psychosocial factors, social support, four dimensions of access to alcoholism treatment services and prior alcoholism service use. Interviews at 6 and 12 months obtained self-reports of subsequent receipt of alcoholism treatment services. Results: We identified modest differences between rural and urban at-risk drinkers. The rural sample was significantly less well-educated and reported significantly less affordability, accessibility and acceptability of some treatment services (p [is less than] .05). Rural at-risk drinkers also appeared to possess significantly greater illness characteristics, including more lifetime DSM-IV criteria for alcohol use disorders, more frequent recent alcohol disorders and more chronic medical problems (p [is less than] .05). The longitudinal sample comprised 579 participants, of whom 7% reported receiving some form of alcoholism treatment services in the year after the initial interview. In bivariate analysis, rural drinkers in the sample reported greater use of help for their drinking, more use of psychiatrists and more use of inpatient, outpatient and ER treatment settings than did their urban counterparts. However, significant independent predictors of 12-month alcoholism treatment use in multiple logistic regression were female gender (OR = 0.3), greater social support (OR = 2.2) and illness or severity characteristics including recent diagnosis of alcohol dependence (OR = 3.3), social consequences of drinking (OR = 1.7), concurrent medical problems (OR = 2.1) and prior treatment experience (OR = 4.4). Conclusions: We found modest differences among rural and urban at-risk drinkers and some evidence of greater barriers to treatment and greater illness severity among rural inhabitants. Further research is needed to know whether community interventions with social networks and other interventions to improve social support may help bring at-risk drinkers into treatment in both urban and rural settings as well as provide other support for sobriety. (J. Stud. Alcohol 61: 267-277, 2000), WE KNOW LITTLE about the processes and predictors of treatment entry for individuals with alcohol use disorders, particularly for those living in rural areas. Much of what we know about [...]