Integrating primary medical care with addiction treatment: a randomized controlled trial.
TLDR
Individuals with SAMCs benefit from integrated medical and substance abuse treatment, and such an approach can be cost-effective.Abstract:
ContextThe prevalence of medical disorders is high among substance abuse patients,
yet medical services are seldom provided in coordination with substance abuse
treatmentObjectiveTo examine differences in treatment outcomes and costs between integrated
and independent models of medical and substance abuse care as well as the
effect of integrated care in a subgroup of patients with substance abuse–related
medical conditions (SAMCs)DesignRandomized controlled trial conducted between April 1997 and December
1998Setting and PatientsAdult men and women (n = 592) who were admitted to a large health maintenance
organization chemical dependency program in Sacramento, CalifInterventionsPatients were randomly assigned to receive treatment through an integrated
model, in which primary health care was included within the addiction treatment
program (n = 285), or an independent treatment-as-usual model, in which primary
care and substance abuse treatment were provided separately (n = 307) Both
programs were group based and lasted 8 weeks, with 10 months of aftercare
availableMain Outcome MeasuresAbstinence outcomes, treatment utilization, and costs 6 months after
randomizationResultsBoth groups showed improvement on all drug and alcohol measures Overall,
there were no differences in total abstinence rates between the integrated
care and independent care groups (68% vs 63%, P =
18) For patients without SAMCs, there were also no differences in abstinence
rates (integrated care, 66% vs independent care, 73%; P = 23) and there was a slight but nonsignificant trend of higher costs
for the integrated care group ($36796 vs $32409, P
= 19) However, patients with SAMCs (n = 341) were more likely to be abstinent
in the integrated care group than the independent care group (69% vs 55%, P = 006; odds ratio [OR], 190; 95% confidence interval
[CI], 122-297) This was true for both those with medical (OR, 338; 95%
CI, 168-680) and psychiatric (OR, 210; 95% CI, 104-425) SAMCs Patients
with SAMCs had a slight but nonsignificant trend of higher costs in the integrated
care group ($47081 vs $42795, P = 14) The incremental
cost-effectiveness ratio per additional abstinent patient with an SAMC in
the integrated care group was $1581ConclusionsIndividuals with SAMCs benefit from integrated medical and substance
abuse treatment, and such an approach can be cost-effective These findings
are relevant given the high prevalence and cost of medical conditions among
substance abuse patients, new developments in medications for addiction, and
recent legislation on parity of substance abuse with other medical benefitsread more
Citations
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Journal ArticleDOI
Neurobiologic Advances from the Brain Disease Model of Addiction
TL;DR: It is concluded that neuroscience continues to support the brain disease model of addiction, which has led to the development of more effective methods of prevention and treatment and to more informed public health policies.
Review Article: Neurobiologic Advances from the Brain Disease Model of Addiction
TL;DR: Volkow et al. as mentioned in this paper reviewed recent advances in the neurobiology of addiction to clarify the link between addiction and brain function and to broaden the understanding of addiction as a brain disease.
Integration of Mental Health/Substance Abuse and Primary Care
Mary Butler,Robert L. Kane,Donna D. McAlpine,Roger G. Kathol,Steven S. Fu,Hildi Hagedorn,Timothy J Wilt +6 more
TL;DR: There is a reasonably strong body of evidence to encourage integrated care, at least for depression, and there is no discernible effect of integration level, processes of care, or combination on patient outcomes for mental health services in primary care settings.
Journal ArticleDOI
The Addiction Severity Index at 25: origins, contributions and transitions.
TL;DR: The conceptual and practical importance of the ASI's multi-dimensional approach to measuring addiction severity, as illustrated by two case presentations, and how this measurement approach has led to some important findings regarding the prediction and measurement of addiction treatment effectiveness are reviewed.
Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence
TL;DR: The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
References
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Drinking patterns and problems of the "stably insured": a study of the membership of a health maintenance organization.
Constance Weisner,Carol Conell,Enid M. Hunkeler,Dorothy Rice,A. T. McLellan,Teh-wei Hu,Bruce Fireman,Charles Moore +7 more
TL;DR: Analysis of drinking patterns and association with other behavioral and social problems within the membership of a health maintenance organization suggests that in private managed care populations, particular behavioral indicators may be more important than demographic characteristics in screening for problem drinkers.
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Financing and Payment Reform for Primary Health Care and Substance Abuse Treatment
Richard Kunnes,Robert G. Niven,Thomas Gustafson,Neil Brooks,Saul M. Levin,Margaret Edmunds,Jeanne G. Trumble,Molly Joel Coye +7 more
TL;DR: Some of the financing and coverage barriers to comprehensive treatment for alcohol and other drug abuse are discussed to discuss some innovative mechanisms for providing and financing comprehensive services; and some directions for public policy are suggested to support the development of new practice models that emphasize cost-effectiveness and efficiency of care.
Journal Article
Medical consequences of cocaine.
TL;DR: Managing cocaine-induced disease requires careful identification and the use of alpha-adrenergic blocking agents, in addition to standard therapy and referral to specialists to manage cocaine withdrawal.