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

描述（由申请人提供）：本健康服务研究响应PA-07-066：酒精使用障碍：治疗、服务研究和恢复（RO1），提出研究年轻人临床队列中酒精使用的长期轨迹、相关的社会结果、服务使用和成本。这是对2000年至2002年间在私人管理医疗保健计划中接受化学依赖（CD）治疗的青少年样本（N=419）的二次分析。随访数据为6个月、1年、3年、5年和7年，在NIAAA补充基金和Kaiser Permanente研究部的支持下，我们目前正在收集9年的数据。根据9年的数据，整个样本（基线年龄为13-18岁，拟议研究年龄为22-27岁）将在青春期到青年期的重要成熟时期进行测量。很少有纵向研究通过这么长时间的随访来检查治疗样本。到9岁时，研究样本已经有时间经历重大的生活转变（即结婚，为人父母），这些转变的作用对于治疗样本来说可能与一般人群样本不同。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，这是轨迹文献没有做的。我们提出了一种创新的方法，通过定义和测试持续护理模型来检查卫生服务使用的影响，该模型包括使用疾病管理方法的初级保健（PC）和专业CD/精神卫生服务的组合。我们还研究了长期医疗服务和成本的轨迹，这也没有被研究过。最后，我们研究了这一有酒精和其他药物问题历史的弱势群体缺乏长期结果和服务使用/成本保险，这是影响健康和获得护理的关键问题。这一年龄组的未参保率最高，这是一个重要的健康差异问题。我们的概念框架以保健服务和发展观点为基础。具体而言，我们研究了个体（人口统计学和问题特征、发展转变）、治疗（CD服务和持续护理）和额外治疗特征（家庭环境、同伴环境、12步参与）的多变量模型，以及它们与9年来酒精使用轨迹和相关结果的关系。我们也用这个模型来分析医疗服务和成本轨迹。我们使用最先进的分析技术，包括潜在增长模型，来解决具体的研究问题。这项研究的结果对确定青少年长期康复的重要因素、制定有针对性的干预计划和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。与健康保险相关的研究结果对健康改革和政策具有重要意义。

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.