Alcohol Trajectories and Service Use in Young Adults: Nine Years Post Treatment

描述（由申请人提供）：本卫生服务研究响应PA-07-066：酒精使用障碍：治疗、服务研究和恢复（RO 1），拟研究年轻成人临床队列中酒精使用的长期轨迹、相关社会结局、服务使用和成本。这是一个二次分析的样本（N=419）的青少年谁进入化学品依赖（CD）治疗在2000年和2002年之间的私人管理式医疗保健计划。6个月、1年、3年、5年和7年的随访数据可用，我们目前正在NIAAA补充基金和Kaiser Permanente研究部门的支持下收集9年的数据。使用9年数据，将在青春期至青年期的重要成熟期测量完整样本（基线时年龄为13-18岁，拟定研究的年龄为22-27岁）。很少有纵向研究通过这么长的随访时间检查整个发育期的治疗样本。到9岁时，研究样本已经有时间经历重大的生活转变（即婚姻，为人父母），与一般人群样本相比，治疗样本的这些转变的作用可能不同。该研究解决了文献中的重大空白：我们研究了卫生服务对长期结果的作用，而轨迹文献没有这样做。我们提出了一种创新的方法来研究卫生服务使用的影响，通过定义和测试一个模型的持续护理，包括初级保健（PC）和专业CD/心理健康服务的组合使用疾病管理方法。我们还研究了长期医疗服务和成本的轨迹，这些也没有被研究过。最后，我们研究缺乏保险的长期结果和服务的使用/成本在这个弱势群体的酒精和其他药物问题的历史，影响健康和获得护理的一个关键问题。这一年龄组的无保险率最高，这是一个重要的健康差距问题。我们的概念框架是基于卫生服务和发展的角度。具体来说，我们研究了一个多变量模型的个人（人口统计学和问题特征，发展转型），治疗（CD服务和持续护理）和额外的治疗特征（家庭环境，同伴环境，12步参与），以及它们如何与轨迹的酒精使用和相关的结果超过9年。我们也使用这个模型在我们的医疗服务和成本轨迹的分析。我们使用最先进的分析技术，包括潜在增长模型，以解决具体的研究问题。这项研究的结果对确定青年长期康复的重要因素，制定有针对性的干预计划，以及卫生系统将能够利用研究结果制定持续的康复护理方法具有重要意义。与健康保险相关的发现对卫生改革和政策有重要意义。 公共卫生相关性：这项研究是对一组22-27岁的年轻人进行的二次分析，这些年轻人在青少年时期接受了化学品依赖治疗，现在已经治疗9年了。我们研究了重要的生活过渡、缺乏医疗保险和医疗服务使用（包括持续护理模式）与酒精使用的长期轨迹和相关结果、医疗服务和成本的关系。

DESCRIPTION (provided by applicant):This health services study, responding to PA-07-066: Alcohol Use Disorders: Treatment, Services Research, and Recovery (RO1), proposes to study the long-term trajectories of alcohol use, related social outcomes, service use and cost in a clinical cohort of young adults. This is a secondary analysis of a sample (N=419) of adolescents who entered chemical dependency (CD) treatment in a private managed care health plan between 2000 and 2002. Follow-up data are available at 6 months, 1, 3, 5, and 7 years, and we are currently collecting 9-year data with support from NIAAA supplemental funds and Kaiser Permanente's Division of Research. With the 9 year data, the full sample (aged 13-18 years at baseline, aged 22-27 years for the proposed study) will have been measured during the important maturation period of adolescence to young adulthood. Few longitudinal studies have examined treatment samples through this developmental period with this long of a follow-up. By 9 years, the study sample has had the time to experience significant life transitions (i.e. marriage, parenthood), and the role of these transitions may be different for a treatment sample compared to general population samples. The study addresses significant gaps in the literature: We examine the role of health services on long-term outcomes, which the trajectories literature has not done. We propose an innovative approach to examine the impact of health services use by defining and testing a model of Continuing Care that includes a combination of primary care (PC) and specialty CD/mental health services using a disease-management approach. We also examine trajectories of long-term medical services and costs, which have also not been examined. Finally, we study lack of insurance on long-term outcomes and service use/costs in this vulnerable group with a history of alcohol and other drug problems, a key issue impacting health and access to care. This age group has the highest uninsured rates and it is an important health disparities issue. Our conceptual framework is based on a health services and a developmental perspective. Specifically, we examine a multivariate model of individual (demographics and problem characteristics, developmental transitions), treatment (CD services and Continuing Care) and extra-treatment characteristics (family environment, peer environment, 12-step participation) and how they relate to trajectories of alcohol use and related outcomes over 9 years. We also use this model in our analysis of medical service and cost trajectories. We use state-of-the art analytic techniques, including latent growth models, to address specific research questions. Findings from this study have implications for identifying factors important for long-term recovery for youth, for developing targeted intervention programs, and health systems will be able to use findings to develop a continuing care approach to recovery. Findings related to health insurance have significant implications for health reform and policy. PUBLIC HEALTH RELEVANCE: This study is a secondary analysis of a cohort of young adults aged 22-27 who entered chemical dependency treatment as adolescents, and who are now 9 years post treatment. We examine the relationship of important life transitions, lack of health insurance, and health services use, including a Continuing Care model, to long- term trajectories of alcohol use and related outcomes, medical services and cost.