HEALTH SERVICES UTILIZATION AND ALCOHOL RELATED PROBLEMS

这项研究的特点是特定的流行病学和遗传影响 在决定寻求治疗酒精中毒，并检查 对整体卫生服务使用的后果（不限于酗酒 酒精中毒治疗与未治疗的比较。该项目有四个 目标：（1）明确与下列情况相关的过度卫生服务利用 酒精滥用或依赖的发展;（2）评估影响 寻求和不寻求的总体卫生服务利用 （3）对酒精滥用或依赖的专业护理;（4）确定其他 社会效益（如婚姻破裂、失业、收入损失） 治疗和未治疗的酒精滥用或依赖;以及（4）纳入 遗传和环境的变异来源到模型的健康 酒精滥用或依赖的服务利用。目标得到解决 通过收集和分析相关的卫生服务利用数据， 从2400个兄弟和同卵的基因信息样本中， 从越南时代双胞胎（VET）登记处抽取的双胞胎对，包括2200 双胞胎中至少有一个有酒精依赖史， 虐待目标1和部分目标3）将通过比较未受影响的 和受影响的双胞胎从MZ和DZ对谁是不和谐的终身 酗酒史。目标2（和目标3的一部分）将由以下方面进行评估： 比较酗酒史一致的MZ和DZ对 但接受治疗的不一致，以及受影响的一致 也是一致的，没有治疗。将处理目标4 利用所有的双胞胎因为这些对已经被识别出来， 最近使用诊断面试时间表进行了面试， 研究项目，广泛的相关人口统计学，精神病学， 酒精和其他物质的使用和依赖数据刚刚成为 支持拟议的调查。电话 对每一对双胞胎的采访将收集更新精神病学的数据。 评估药物使用、酒精滥用和依赖以及抑郁症， 用于酒精和非酒精相关护理的卫生服务利用率， 卫生服务利用的预测因子。电话采访， 由天普大学调查研究所进行， 自1987年以来，VET注册数据收集的承包商被选中 由于研究样本的国家分散性， 一个面对面的采访。将使用以下两种方法分析数据 流行病学和生物统计遗传技术。双胞胎设计 解决了治疗结果中适当对照组的问题 遗传和家庭环境的评估和控制 精神科合作对酒精问题易感性的贡献 发病率。使用基于人群的双胞胎登记可避免偏倚 与确定疾病或治疗有关 利用率，从而最大限度地提高普遍性。因此， 分析影响卫生服务利用的因素。

This research characterizes specific epidemiologic and genetic influences upon the decision to seek treatment for alcoholism, and examines the consequences for overall health services use (not limited to alcoholism treatment) of treated versus untreated alcoholism. The project has four aims: (1) specify the excess health services utilization associated with the development of alcohol abuse or dependence; (2) assess the effects upon overall health services utilization of seeking and not seeking professional care for alcohol abuse or dependence; (3) determine other social outcomes (eg. marital breakdown, unemployment, income loss) of treated and untreated alcohol abuse or dependence; and (4) incorporate genetic and environmental sources of variance into models of health services utilization for alcohol abuse or dependence. Aims are addressed by collecting and analyzing pertinent health services utilization data from a genetically informative sample of 2400 fraternal and identical twin pairs drawn from the Vietnam Era Twin (VET) Registry, including 2200 pairs where at least one twin has a history of alcohol dependency or abuse. Aim 1 and part of Aim 3) will be addressed by comparing unaffected and affected twins from MZ and DZ pairs who are discordant for lifetime history of alcoholism. Aim 2 (and part of Aim 3) will be assessed by comparing MZ and DZ pairs who are concordant for history of alcoholism but discordant for receiving treatment, as well as concordant affected pairs who are also concordant for no treatment. Aim 4 will be addressed using all the twins. Because these pairs have already been identified and recently interviewed using the Diagnostic Interview Schedule for another research project, a broad set of relevant demographic, psychiatric, and alcohol and other substance use and dependence data have just become available which supports the proposed investigation. A telephone interview with each twin will collect data updating psychiatric assessments of drug use, alcohol abuse and dependence, and depression, health services utilization for alcohol and non-alcohol related care, and predictors of health services utilization. The telephone interview, conducted by the Institute for Survey Research of Temple University, contractor for data collection on the VET registry since 1987, was chosen because of the national dispersion of the study sample, and the high cost of a face-to-face interview. Data will be analyzed using both epidemiological and biometrical genetic techniques. A twin design addresses the problem of appropriate control group in treatment outcome assessments, and controls for genetic and family environmental contributions to susceptibility to alcohol problems of psychiatric co- morbidity. The use of a population-based twin registry avoids biases associated with ascertaining either on disorder or on treatment utilization, thus maximizing generalizability. Thus a comprehensive analysis of factors influencing health services utilization may be made.