Patients with Alcohol Problems and Chronic Pain: Use of Alcohol and Pain Services

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DESCRIPTION (provided by applicant): This is an exploratory R21 alcohol health services application by a new investigator that aims to identify the individual, provider, organizational, and treatment characteristics associated with the utilization of chemical dependency (CD) treatment, non-cancer chronic pain (CP) treatment, and the occurrence of adverse events in a sample of approximately 25,000 insured adults with non-cancer chronic pain and alcohol problems (CPALs). Alcohol problems are often overlooked in research on chronic pain; the focus has usually been on other substances. Even less is known about their utilization of CD or CP services. CPAL's use of prescribed opioid analgesics and how it may influence their use of CD treatment services has also not been explored. CD and CP treatment have traditionally been very separate, and patients may fall through the "cracks" in the system. We propose a secondary analysis of Northern California Kaiser Permanente (KP) diagnostic, utilization, and pharmacy databases. We will identify the prevalence of alcohol problems in chronic pain patients, and compare chronic pain treatment and adverse events between CPALs and chronic pain patients without alcohol problems (CPwoALs). We will assess a model that examines the roles of individual, provider, and organizational characteristics in the use of CP and CD services (including prescribed opioid analgesic use) for CPALs. Finally, we will examine how treatment dose, in addition to individual, provider and organizational characteristics, is related to the occurrence of adverse events for CPALs. The study offers a unique opportunity to study utilization of CP and CD treatment services by CPALs, to use study findings to develop linkages between CP and CD programs, and ultimately to develop an intervention for these paents. This study will help assess whether patients are receiving treatment, what factors relate to use of services, and whether treatment helps to avoid adverse events for CPALs. We will use linear and non-linear mixed models to investigate utilization and adverse events, which will appropriately handle the correlation among providers and among facilities. Study findings will be used to identify barriers to care for chronic pain patients with alcohol problems, and lay the groundwork for future studies of patient outcomes, and integrated models of CD and CP treatment. We will work with clinicians and the health plan to develop this future research.