Employer-sponsored health plans in 2006 provided limited coverage for substance-abuse treatment and did not provide the same level of benefits for substance abuse as those given for medical and surgical benefits, according to a study published Thursday in the journal Health Affairs, the Washington Times reports. In 2005, about 22.2 million Americans age 12 or older were “dependent” on or “abused” drugs or alcohol, and three out of four of those workers were employed full or part time. For the study, researchers used data from a supplement to the employer health benefits survey released last year by the Kaiser Family Foundation and the Health Research and Educational Trust.

According to the Health Affairs study, cost-sharing in 2006 was higher for substance-abuse treatment programs compared with other care. Workers on average paid a $443 deductible for substance-abuse treatment and about a $300 deductible for medical-surgical services. The study found 19% of U.S. workers’ health plans in 2006 did not place limits on doctor visits or hospital stays related to substance abuse, compared with about 50% of plans in 1989 that included equivalent benefits for substance abuse and medical treatment.

From 1991 to 2003, private insurers’ spending on substance-abuse treatment declined from 22% of overall medical services to 10%, while the portion paid for by Medicare and Medicaid has increased. Substance abuse spending totaled $20.7 billion in 2003 — one-third of all health care spending.

According to the study, “The rise of managed care plans and their associated benefit design (utilization controls and cost-sharing) may be a factor in the relative decline of spending by private plans.” Jon Gabel, a senior fellow at the National Opinion Research Center and an author of the Health Affairs study, said, “People who try to get care for substance abuse but aren’t successful most often say that cost is the reason,” adding, “The economic costs of not treating substance abuse can be many times the costs of treatment. Yet the higher cost-sharing for substance-abuse problems that many workers face can discourage them from seeking treatment” (Lopes, Washington Times, 6/8).


The study is available online.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Problem drinking in Western societies contributes to disease and death as well as social and economic woes. Yet only a small number of people with alcohol problems – 10 to 20 percent – ever seek and participate in treatment. This study examined the real-world effectiveness of a 24/7 free-access, anonymous, interactive, and Web-based self-help intervention called Drinking Less (DL) at minderdrinken.nl. Findings show that DL can help problem drinkers in the privacy of their own homes.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“We were concerned that so few problem drinkers access the help they need,” said Heleen Riper, a senior scientist at the Trimbos Institute and the Vrije Universiteit in the Netherlands, as well as corresponding author for the study.

“This may not come as a surprise, given that addiction services predominantly focus on severely dependent people.”

“Web-based interventions can provide a cheap and easily accessible intervention for the large majority of problem drinkers who are not treated,” noted Reinout W. Wiers, professor of developmental psychopathology at the University of Amsterdam.

Riper and her colleagues wanted to expand the use of DL – a self-help intervention for adults without therapeutic guidance – from a clinical trial to the community. “DL consists of motivational, cognitive-behavioral, and self-control information and exercises,” she said. “It helps problem drinkers decide if they really want to change their problem drinking and, if so, helps them set realistic goals for achieving a change in their drinking behavior, providing tools and exercises to maintain these changes, or deal with relapse if it occurs.”

The study authors recruited 378 (199 females, 179 males) of the 1,625 community-based people who used DL from May to November 2007 to complete an online survey six months later. All lived in the Netherlands; the vast majority, 91.5 percent, was of Dutch origin. Outcome measures included alcohol consumption during the preceding four weeks, and mean weekly alcohol consumption. The collected data were then compared with those from the previous trial of DL.

“The observed effectiveness of DL in a randomized, controlled trial setting was maintained when we offered the intervention to the general population in a real-world setting,” said Riper. “After six months, participants decreased their mean weekly alcohol consumption, and 18.8 percent changed their drinking patterns to ‘low risk drinking.’ For 84 percent of the participants, this was their first professional contact for problem drinking. Furthermore, more than half was female, indicating that this form of help is highly acceptable for female problem drinkers.”

Dutch guidelines for “low-risk drinking” are: for men, drinking less than 21 standard units per week, or six or more units at least one day per week; and for women, drinking less than 14 standard units per week, or four or more units at least one day a week. One standard unit contains 10 g of ethanol. In contrast, American standard drinks contain more alcohol, about 14 g. Thus, Dutch guidelines in terms of American drinks would mean: less than 15 drinks per week and no more than five in a row for men; and for women, no more than 10 drinks per week and no more than three in a row.

Both Riper and Wiers believe these findings from the Netherlands could easily be applied to a North American population. “This research is all about real world applications,” said Wiers. “Similar websites could easily be translated and/or developed in other countries.”

“While Web-based and digital interventions might not be effective for everyone,” added Riper, “almost 20 percent of our participants were able to change their problem drinking to low-risk, while others became aware of their problems and were more willing to seek professional guidance. Our study also indicated that Web-based treatment like this is effective for people with different educational backgrounds.”

Riper recommended that interventions such as DL become the “first step” to a collective approach to problem drinking in which online and offline services become integrated. “Web-based self-help ??¦ should be seen as an additional form of service next to existing services,” she said. “It could be used as a stand-alone intervention, expanded with therapeutic guidance for those who are ready for it, or used to mitigate waiting times. It also provides accessibility for populations who live in low-density areas where professional services are scarce. Alone it cannot change the world, but it could help to make a difference once integrated.”

Wiers agreed. “I think that this is an important first step in internet-delivered interventions for alcohol abuse and dependence,” he said. “I foresee that in the future these cognitive motivational approaches could be augmented by other approaches that can be delivered over the internet, such as interventions that directly interfere with cognitive processes in alcohol problems. In addition, internet-based treatments can become part of the aftercare of regular treatment, helping to prevent relapse back home, one of the major challenges in treating alcohol-use disorders.”

Source:

Heleen Riper, Ph.D.
Trimbos Institute

Reinout W. Wiers, Ph.D.
University of Amsterdam
Alcoholism: Clinical & Experimental Research

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), marks World AIDS Day on December 1st with the launch of its new, national public service campaign to educate Hispanic teens on the link between non-injection drug use and HIV transmission. The campaign features an innovative television spot blending English and Spanish; a Webisode series that will launch soon on hiv.drugabuse ; outdoor, transit and print placements; and community events and partnerships.

The new Hispanic spots, “After the Party,” build on an earlier English series, but continue the storyline from the point of view of a teen who used drugs and alcohol, engaged in risky behavior and now has HIV. In the new series, a young woman calls on her aunt for comfort and support. Rather than simply translating the original spots that were launched in 2005, NIDA incorporated culturally relevant scenarios that would resonate with the Hispanic audience-in this case, turning to family in times of distress. There are two versions of the new series-one set for Spanish-language television stations and a bilingual set for English-language stations located in markets with large Hispanic populations.

The award-winning “Text Message” spot, which continues to run on stations across the country, was endorsed by The Ad Council, screened in film festivals, was featured in the Dallas Transit system and in Washington Metropolitan Area Transit Authority (WMATA), and aired in Times Square.

“Drug use and alcohol consumption disrupt the parts of the brain that people use to weigh risks and benefits before making decisions,” said NIDA Director Dr. Nora Volkow. “Research has shown that substance use increases the chances of engaging in risky sexual behavior-such as unprotected sex-that can lead to HIV. This campaign urges teens to learn more about the risks of risky behavior and drives them to our Website.”

Hispanic youth are potentially at risk for contracting HIV/AIDS. They currently represent 16 percent of the US teenage population, but over the next decade this diverse and multicultural group is expected to grow by 25 percent. According to data from the Centers for Disease Control and Prevention, Hispanics/Latinos accounted for 18 percent of the 37,367 new HIV/AIDS diagnoses in the 33 states that have long-term, confidential name-based HIV reporting.

Materials for NIDA’s Hispanic campaign include bilingual and Spanish television public service ads (PSAs) in 15-, 30- and 60-seconds; Web pages in Spanish on the hiv.drugabuse site; English and Spanish print PSAs, promotional cards, posters, and Web banners. This holiday season, the PSA is running on the CBS Super Screen in New York City’s Times Square and inside New York City buses that travel through areas with large Hispanic populations.

NIDA also has participated in community-based events and collaborations during the phased rollout of the campaign. The Washington, D.C., Department of Health HIV/AIDS Administration recently shared NIDA’s campaign materials with community partners through its Youth and HIV/AIDS Prevention Initiative. NIDA also participated in Fiesta D.C. on September 30th, and the D.C. Metropolitan National Latino AIDS Awareness Day on October 15th.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at drugabuse .

The National Institutes of Health (NIH) – The Nation’s Medical Research Agency – includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih.

The Massachusetts Senate last week approved by voice vote a bill (S 1312) — which is sponsored by state Sen. Robert O’Leary (D) — that would authorize the nonprescription sale of syringes to people age 18 and older as a means of reducing the spread of HIV, hepatitis C and other bloodborne diseases, the Springfield Republican reports (Ring, Springfield Republican, 6/2). The state House in November 2005 voted to approve similar legislation (H 4176), which would require pharmacists dispensing the needles to provide a brochure created by the state Department of Public Health with information about the proper use and disposal of syringes and needles, the risk of contracting bloodborne diseases through such devices and the state’s toll-free number for HIV/AIDS and hepatitis C information. The bill also would decriminalize possession of a hypodermic needle (Kaiser Daily HIV/AIDS Report, 5/2). The state Senate also voted 34-1 to approve an amendment sponsored by Sen. Bruce Tarr (R) that would criminalize the act of buying needles with the intent to resell them. To go to Gov. Mitt Romney (R) for consideration, the bill will have to be approved a couple more times in the state Senate and again in the House, the Republican reports (Springfield Republican, 6/2). Romney likely will veto the bill, his spokesperson Eric Fehrnstrom, said, adding that the governor “believes that removing prescription controls on hypodermic needles … encourages heroin use” (Kaiser Daily HIV/AIDS Report, 5/2).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Studies have suggested that infants exposed to methamphetamines while in the womb can suffer irreversible brain damage, although the exact effects of these drugs during pregnancy have been hard to pinpoint due to many other negative behaviors that often occur in meth users.

Now, using a guinea pig model that can assess neural changes in offspring born to mothers given methamphetamine during an otherwise normal pregnancy, Dr. Sanika Samuel Chirwa provides new evidence for the cognitive damage of these drugs.

In preliminary studies, Chirwa and colleagues found that guinea pig pups born to mothers that had received 1 mg/day of methamphetamine during pregnancy exhibit an impaired ability to distinguish novel objects from items they had seen before. This lack of recognition correlated with changes in the brain region, the hippocampus, associated with memory formation.

Source: Sarah Goodwin

American Society for Biochemistry and Molecular Biology

Individuals with problem gambling behavior have personality profiles similar to the profiles of those with alcohol, marijuana and nicotine-associated addictive disorders, according to an article in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

It has been difficult to identify personality traits associated with problem gambling because most previous studies have drawn subjects from those seeking treatment for a gambling disorder, who are unlikely to be representative of the majority of individuals in the community with gambling problems, according to background information in the article. Previous studies have also shown problem gambling associated with alcohol dependence and suggested an association with drug and nicotine dependence as well.

Wendy S. Slutske, Ph.D., of the University of Missouri-Columbia, and colleagues compared personality assessments obtained in 1991-1992 for 939 young adults (475 men and 464 women) from Dunedin, New Zealand, who were 18 years old, with diagnoses of problem gambling and alcohol, cannabis [marijuana] and nicotine dependence in the previous year based on structured interviews conducted when the individuals were 21 years old in 1993-1994. The researchers conducted two analyses of the data. In the first, the researchers examined the associations between problem gambling and each of three substance abuse disorders (alcohol, cannabis and nicotine). In the second, the researchers examined the independent association of 10 basic aspects of personality variation with problem gambling and each of the three substance addictive disorders.

“Past-year problem gambling was significantly associated with past-year alcohol dependence, cannabis dependence, and nicotine dependence,” the authors report. “The associations between problem gambling and the three substance use disorders were similar in magnitude and were nearly as large as the well-established association between alcohol and nicotine dependence.” Young adults with a problem gambling diagnosis in the year before they turned 21 were, on average, more likely to have high scores for negative emotionality and for impulsive and risk-taking behavior on personality tests taken at age 18 years, the researchers found. “In particular, young adults with a diagnosis of problem gambling were characterized by negative emotions such as nervousness or worry, anger or aggressiveness, feeling mistreated or victimized, and unconstrained behaviors of risk-taking, impulsivity, and rebelliousness,” they write.

“A focus on more basic traits, such as individual differences in personality, is a promising approach for understanding the high rate of comorbidity [conditions which occur together] of pathological and problem gambling with other addictive disorders,” the authors write. “In the present study, the personality profile associated with problem gambling was strikingly similar to the profiles associated with alcohol, cannabis, and nicotine dependence,”

(Arch Gen Psychiatry. 2005; 62: 769-775. Available pre-embargo to the media at jamamedia.)

Editor’s Note: The Dunedin Multidisciplinary Health and Development Research Unit is supported by the New Zealand Health Research Council. This study was supported by grants from the National Institutes of Health, Bethesda, Md., the William T. Grant Foundation, New York and the United Kingdom Medical Research Council, London, England.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelationsjama-archives.

A new study led by Simon Coulton, Professor of Health Services Research at the Centre for Health Services Studies, University of Kent, aims to improve services for over 55s caught up in ‘risky drinking’.

Traditionally, risky drinking in young men and women receives most attention but the ageing process means that older people experience alcohol-related problems at lower consumption levels. It is now estimated that 60% of older people coming into hospital because of repeated falls, confusion, chest infections and heart failure have undiagnosed alcohol problems.

Professor Coulton’s study, which is funded by the NHS National Institute for Health Research Health Technology Assessment Programme, aims to determine whether screening by GPs followed by brief psychosocial interventions, which are stepped up in intensity, can help.

He explained: ‘After identifying those who need help, the first step is behavioural counselling. If further help is required then the client is offered three sessions of motivational therapy. The third step is referral to specialist services.’

Professor Coulton also states that the existing evidence appears to show that, if offered treatment, older people are more likely to benefit from it. However, this is currently an under-researched area and, with the older population in the UK growing fast, one of increasing urgency.

The study, which will be conducted in association with the University of York, will compare a large group of people who receive the stepped treatment programme with a similar group who only receive minimal help. It will also investigate the economic benefits of the stepped approach.

KENT UNIVERSITY
Canterbury
Kent
CT2 7NZ
ukc.ac

Most older gay and bisexual men enrolled in a long-term study of HIV used recreational drugs infrequently over a 10-year period, report University of Pittsburgh Graduate School of Public Health researchers at the XVIII International AIDS Conference.

The study explored the drug use habits of 1,378 HIV-positive and negative gay and bisexual men, ages 44 to 63, enrolled in the Pitt Men’s Study, part of the Multicenter AIDS Cohort Study (MACS), which began in 1983 and is the longest-running National Institutes of Health-funded investigation of HIV/AIDS.

Study researchers surveyed participants about their use of recreational drugs (poppers, crack, cocaine, methamphetamine and ecstasy) between 1998 and 2008. They found that 79 percent of participants reported infrequent drug use, and three subgroups emerged: nearly 6 percent who reported consistently high drug use; more than 7 percent who increased their drug use; and 7 percent who decreased their use of drugs.

“We know that drug use among men who have sex with men contributes to a host of health problems, including HIV infection, but we know very little about how drug use changes as these men age,” said Jessica G. Burke, Ph.D., study author and assistant professor, Department of Behavioral and Community Health Sciences, Pitt’s Graduate School of Public Health. “Previous studies have linked drug use in gay men to risky sexual behaviors and to higher rates of HIV infection, but most of these studies have focused primarily on specific time-points and on younger men.”

According to Dr. Burke, the data will provide needed insights to develop interventions for preventing and treating drug use among gay and bisexual men as they age. Moving forward, she will be combining these results with qualitative data collected through interviews with participants about their experiences with drugs.

“Although a majority of participants reported infrequent drug use, three subgroups of men displayed distinct patterns of use over 10 years of midlife. Understanding more about these subgroups and the factors that lead to drug use will give us a better understanding of how we can address this behavior among similar individuals.”

Study co-authors include Sin How Lim, Ph.D., Michael Marshal, Ph.D., Anthony Silvestre, Ph.D., Steven Albert, Ph.D., and Ronald Stall, Ph.D., all of the University of Pittsburgh; and David Ostrow, Ph.D., of the Chicago MACS and David Ostrow and Associates. The study was funded by the National Institutes of Health.

Source:
Clare Collins
University of Pittsburgh Schools of the Health Sciences

Researchers at Wake Forest University Baptist Medical Center are the first in the U.S. to develop an HIV prevention and intervention program for adolescent runaways that focuses on their strengths.

Liz Arnold, Ph.D., assistant professor of psychiatry and behavioral medicine, presented the details of this 15-month pilot program at the National HIV Prevention Conference in Atlanta.

The Runaway Youth Project is based on a Strengths-Based Case Management (SBCM) model. For example, if a teen doesn’t excel in a certain subject in school, but is strong in another, the case manager would help the participant to identify the skills he has developed in his stronger area, and show him how he can apply those same skills to his more challenging areas. Arnold says that what makes the SBCM model unique is that programs that are currently implemented are deficit-focused models. These programs examine the teens’ problems instead of their strengths and try to fix those problems.

The SBCM was originally developed for adults with severe mental illness or substance abuse problems. SBCM is used in various locations throughout the country, but this is the first time the model has been used in the U. S. with a population besides adults.

“Teenagers are very focused on what’s going on in their lives at the present time as this is part of their developmental state,” said Arnold. “That’s why focusing on their strengths and tying them into their future goals shows kids that putting themselves at risk for HIV or other health problems can jeopardize reaching those goals. All youth have strengths, but it’s about tapping into these and using them to empower the youth to realize their potential.”

Arnold and her colleagues used the SBCM model and specifically focused on the youth as the primary target of intervention, as opposed to the family.

“Typical programs involve family-focused intervention, and these have met with limited success. With our project, the family is involved to the degree that they are receptive to being involved in the program, but it’s really focused on helping the adolescent, and then letting those positive changes filter down to the family,” said Arnold.

Other components of this model include collaborating with law enforcement to recruit participants so that they can target the teens before they become homeless.

“Once the teen is homeless, their chances of HIV risk greatly increase,” said Arnold. “Because this model focuses on early intervention — when they’ve only run away one to three times — it was really important to work with the officers who would talk to the kids and their families and refer them to us early into the trajectory of runaway behavior. We operated under the assumption that early intervention is better than waiting until the problems escalate to the point where successful intervention becomes more difficult.”

Arnold and her colleagues recruited participants ages 12 to 15 who had run away but returned home. It involved 12 months of intervention with three months of follow-up. The researchers met the participants out in the community as opposed to an office setting, and recruited staff with strong interpersonal and clinical skills.

“The kids were very receptive to having an adult role model. That connection with their case manager was a pivotal piece,” said Arnold.

“The goal of the study was to see if you can actually use this model with this population. Is it something that’s feasible to use and acceptable to adolescent runaways? The answer is yes.”

The project was funded by a grant from the National Institute on Drug Abuse.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine. The system comprises 1,238 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of “America’s Best Hospitals” by U.S. News & World Report.

Source: Shannon Koontz

Wake Forest University Baptist Medical Center

A new study finds that adults who legally were able to purchase alcohol before the age of 21 in their states are more likely than others are to be alcoholics or addicted to drugs.

Researchers are not certain how to explain the difference, but it is possible that a higher drinking age could cut back on the intensity of alcohol use before the age of 21, said lead study author Karen Norberg, M.D., a research instructor in psychiatry at Washington University in St. Louis.

Regardless of the explanation, the findings suggest “that there are very long-term benefits to a higher drinking age,” Norberg said.

From the Vietnam era until the mid-1980s, many states allowed people to purchase alcohol at the age of 18. However, a federal law pressured states to boost the drinking age to 21, and all did with the exception of Louisiana, which finally followed suit in the 1990s.

In the new study, Norberg and colleagues looked at surveys of 33,869 people born in the United States between 1948 and 1970. They examined the records to see if there were differences in alcoholism and drug abuse rates depending on when states allowed individuals to buy booze.

The study findings appear in an early online edition of the December issue of Alcoholism: Clinical and Experimental Research.

After adjusting their statistics to prevent things like the ethnicity of the respondents from skewing the results, the researchers found that those who lived in states that allowed drinking before age 21 were 1.3 times more likely to have suffered recently from alcoholism. They were also 1.7 times more likely to have had a recent drug abuse problem.

Norberg said lower drinking ages might have a “peer effect,” since that makes it easier to find friends of one’s age to drink with. “If the drinking age is at 21, it will be a little harder to find some friends to go out with. You’ll probably drink less often and have a smaller number of drinks.”

Traci Toomey, an associate professor who studies alcohol use at the University of Minnesota, said the study is “thoughtful” and provides strong evidence that lower drinking ages do lead to more drinking problems later on.

However, she said, “It is not possible to rule out all other potential explanations ??¦ given the many intervening years.”

Toomey also cautioned that higher drinking ages are not the only way to reduce alcohol problems in society. Loopholes that allow people under 21 to drink should close, she said, and the excise tax on alcohol should increase.

Norberg, KE, Bierut LJ, Grucza RA. Long term effects of minimum drinking age laws on past-year alcohol and drug use disorders. Alcoholism: Clinical and Experimental Research 33(12), 2009.

Source: Health Behavior News Service