HEALTH SERVICES UTILIZATION AND ALCOHOL RELATED PROBLEMS

这项研究描述了特定的流行病学和遗传影响。 在决定寻求酒精中毒治疗后，并检查 对整体卫生服务使用的后果(不限于酒精中毒 治疗)已治疗的与未治疗的酒精中毒。该项目有四个 目标：(1)具体说明与以下项目相关的超额卫生服务利用率 酒精滥用或依赖的发展；(2)评估其影响 论就诊与不就诊的整体卫生服务利用 对酗酒或依赖的专业护理；(3)确定其他 社会结果(例如婚姻破裂、失业、收入损失) 已治疗和未治疗的酒精滥用或依赖；以及(4)纳入 遗传和环境因素对健康模型的影响 因酗酒或依赖而导致的服务利用。解决了目标问题 通过收集和分析相关的卫生服务利用数据 从2400个血缘关系相同的基因样本中 来自越南时代双胞胎(VET)登记处的双胞胎，包括2200对 双胞胎中至少有一人有酒精依赖史或 虐待。目标1和目标3的一部分将通过比较未受影响的 以及来自MZ和DZ对的受影响的双胞胎，他们一生都不和谐 酗酒史。目标2(以及目标3的一部分)将由 与酒精中毒史相符的MZ和DZ配对的比较 但对于接受治疗的不和谐，以及对和谐的影响 没有治疗的配对也是一致的。目标4将得到解决 使用所有的双胞胎。因为这些配对已经被识别出来了 最近使用另一项诊断面试计划进行面试 研究项目，广泛的相关人口统计学、精神病学和 酒精和其他物质的使用和依赖数据刚刚成为 支持拟议的调查的现有资料。一部电话 与每一对双胞胎的面谈将收集最新的精神病数据 对药物使用、酗酒和依赖以及抑郁的评估， 酒精和非酒精相关护理的保健服务利用情况；以及 卫生服务利用的预测因素。电话采访， 由天普大学调查研究所进行， 自1987年以来一直担任职业教育与培训登记处数据收集工作的承包商 由于研究样本在全国范围内分散，且成本较高 一次面对面的采访。将使用这两种方法分析数据 流行病学和生物识别遗传技术。双胞胎设计 解决治疗结果中合适的对照组的问题 对遗传和家庭环境的评估和控制 精神病患者对酒精问题易感性的贡献 发病率。使用基于人口的双胞胎登记避免了偏见 与确定疾病或治疗有关 利用率，从而最大限度地提高普适性。因此，一个全面的 可对影响卫生服务利用的因素进行分析。

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.