 |
ADDICTION POLICY
Research Update
|
|
Winter 2009
|
 |
New Knowledge Assets
Four New Knowledge Assets on Major Substance Abuse Topics Now Available
The Substance Abuse Policy Research Program has added four new Knowledge Assets to its website (www.saprp.org). Each Knowledge Asset addresses a major substance abuse policy issue. The assets are written by leading researchers in the field and reviewed by a team of experts. The new assets are on:
1. Drug Testing of Adolescents in Schools (http://saprp.org/KnowledgeAssets/knowledge_detail.cfm?KAID=16)
2. Drug Treatment for Drug Abusing Criminal Offenders (http://saprp.org/KnowledgeAssets/Knowledge_Detail.cfm?KAID=17)
3. Racial and Ethnic Inequalities in Substance Abuse Treatment (http://saprp.org/KnowledgeAssets/Knowledge_Detail.cfm?KAID=11), and
4. Syringe Access Interventions for Injection Drug Users (http://saprp.org/KnowledgeAssets/Knowledge_Detail.cfm?KAID=15)
Drug Testing Adolescents in Schools: Evidence Lacking to Support Trend
The Supreme Court has affirmed it and the federal government has provided tens of millions dollars to support it. But according to a new Knowledge Asset, there are no formal studies published to date that show random drug testing of adolescents in schools is an effective way to stop substance abuse.
For example, one large study compared students in schools that required random drug testing to those in schools that did not. It found no difference in marijuana or other illicit drug use. Even when there was evidence that might suggest benefits—and it was rare and inconclusive—the gains appear to come at a cost. Researchers report that the experience of going through drug testing may actually increase the risk of future drug use.
Researchers also warn that testing is not necessarily a benign activity. There is evidence of students ingesting potentially toxic levels of substances, such as niacin, in an effort to mask the presence of drugs.
Drug Treatment Instead of Jail Time: Ideal and Reality
California and Arizona both have laws that make certain non-violent drug offenders eligible for treatment instead of jail time. While the idea of treatment for non-violent criminals has growing appeal, a Knowledge Asset on the issue finds the research thus far, which is mainly focused on California’s experience, reports mixed results.
On one hand, many more non-violent offenders are being referred to treatment facilities. However, in California, only about 71 percent of those referred actually show up. Also, in California, studies note that offenders eligible for treatment are more likely to be rearrested for drug or property crimes, possibly because they get to spend more time in the community.
There is evidence from both the California and Arizona initiatives that, at least in the short-run, the programs save taxpayer dollars, mainly because treating drug offenders is cheaper than incarcerating them.
Racial and Ethnic Disparities in Substance Abuse Treatment: A Familiar Story
There is abundant evidence of racial and ethnic disparities in both access to health care and quality of care. A Knowledge Asset reports on a growing body of research showing those same inequalities can be found in the world of substance abuse treatment.
For example, research shows that, with the exception of Asian Americans, ethnic minorities struggling with substance abuse are less likely than Caucasians to receive treatment services. Economics account for some of the differences, but not all of them. One national study found that even when accounting for a lack of health insurance, Caucasians were still three times more likely to get treatment than African Americans.
Meanwhile, evidence from clinical trials shows similar treatment outcomes between difference racial and ethnic groups.
Syringe Access Interventions: Clean Needles and Muddy Laws
HIV infections spread by injecting illegal drugs with dirty needles or syringes account for one-third of AIDS cases in the US. But in most of the country, federal and state authorities have blocked efforts to make it easier for addicts to obtain sterile syringes.
A Knowledge Asset looks at a range of studies on syringe access and finds abundant evidence that allowing addicts to exchange their dirty needles for sterile syringes can reduce HIV transmission. Furthermore, studies show that syringe exchange programs do not increase drug use or crime and can actually make it more likely addicts will seek treatment.
Meanwhile, studies show that confusion, by both addicts and law enforcement professionals, regarding the legality of possessing a syringe has discouraged participation in exchange programs. Some addicts fear—with justification, researchers say—that getting needles from an exchange program increases their chances of arrest for possession of drug paraphernalia.
|
Access to Alcohol is Linked to Race and Income
Despite all federal, state, and local interventions, underage drinking continues to be a serious problem. The highest prevalence of alcohol dependence in the U.S. population is among people ages 18 to 29, who typically started drinking earlier in their teenage years.
A California-based study has found access to alcohol is linked to race and income. Specifically, minority and lower-income families have significantly higher access to alcohol than their Caucasian or middle-class counterparts.
In addition, the researchers also found that proximity has an especially high influence on youth: having alcohol outlets within walking distance from their homes are associated with two adverse behaviors among adolescents: binge drinking and driving after drinking. In other words, simply by living closer to alcohol retailers like liquor stores, poor, minority teens are at a greater risk for engaging in life-threatening alcohol-related activities.
Interestingly, overall, minorities have lower drinking rates than Caucasians, but concentration of alcohol sales may cause minority and low-income residents to suffer disproportionately from alcohol-related problems not necessarily from their own drinking. Living near alcohol outlets may expose them to risks such as violent crimes, drunk driving, and assault violence.
Authors Khoa Dang Truong, PhD, and Roland Sturm, PhD, with the Pardee RAND Graduate School in Santa Monica, California investigated the quantity and locational pattern of alcohol retailers in small areas around individual homes (from 0.1 mile to 2.0 miles) and then examined a plausible relationship between alcohol environments and adolescent drinking. The data covers the whole state of California.
They found consistent evidence of sociodemographic disparities in alcohol environments. Alcohol availability, measured by mean and median number of active alcohol license, is significantly higher around residences of minority and lower-income families.
“For instance, within 0.5 miles, there is on average 5.5 outlets around white residences compared to 6.4, 8.6, and 9.5 outlets around residences of black, Hispanic, and Asian respondents,” says Truong.
Within each race, people in a lower income group have more alcohol outlets surrounding their home than people in a higher income group.
“Based on our estimated model, changing the number of outlets within 0.5 miles from 9.5 (the environment of Asian adolescents) to 5.5 (the environment of white adolescents) for these adolescents would reduce binge drinking from 6.4 percent to 5.6 percent and driving after drinking from 7.9 percent to 6.0 percent,” says Truong.
Both types of alcohol outlets, off-sale (for consumption elsewhere, like liquor stores) and on-sale (for consumption on premises, like restaurants) can contribute to adolescent drinking.
“These differential alcohol environments may exacerbate health disparities across socio-demographic groups. Living in close proximity to alcohol outlets is itself a risk factor for youth,” says Truong.
In California, retail licenses are not typically approved within 100 feet of a residence or within 600 feet of schools, public playgrounds and nonprofit youth facilities, but proximity by itself is not sufficient to deny a license.
This study suggests that more attention on the proximity rule is needed and environmental interventions need to curb opportunities for youth to get alcohol from commercial sources, whether being through tightening licensure or enforcing minimum age drinking laws, the authors say.
The findings were published in the December 2009 online edition of the American Journal of Public Health. This research was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.
If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at cvieira@burnesscommunications.com.
|
Substance Abuse Adds Millions to Medicaid’s Total Health Care Costs
Comprehensive Study of Medicaid Records Finds Substance Abuse Increases the Cost of Other Health Problems
People with substance abuse disorders cost Medicaid hundreds of millions of dollars annually in medical care, suggesting that early interventions for substance abuse could not only improve outcomes but also save substantial amounts of money, according to a comprehensive study released today. The study examined records of nearly 150,000 people in six states.
“Substance abuse probably costs Medicaid programs a lot more than they think,” said Robin E. Clark, PhD, associate professor of family medicine & community health of the Center for Health Policy and Research at the University of Massachusetts Medical School. “We found that the medical care costs for all health problems among those with substance abuse issues are quite significant, which means that there could be a huge cost savings if prevention or early treatment programs were started to improve the health of substance abusers.”
The most striking finding, Clark said, was that as the patients with substance abuse disorders got older, the medical care costs increased at a far higher rate than behavioral health costs.
“It suggests that there are not a lot of substance abuse services that successfully target the older age group, and that there could be substantial savings and health benefits by focusing on these populations,” he said.
Clark’s study, “The Impact of Substance Use Disorders on Medical Expenditures for Medicaid Beneficiaries with Behavioral Health Disorders,” published December 30 in the online edition of the journal Psychiatric Services, was funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program (SAPRP). The study looked at records from 148,457 people in Arkansas, Colorado, Georgia, Indiana, New Jersey, and Washington in 1999. It used claims for Medicaid benefits of those with behavioral health diagnoses, and compared those who had and did not have substance abuse disorders. Clark said, “Although more recent data were unavailable at the study’s beginning, there is no reason to believe the relationships we observed here would be different with current Medicaid claims.” The study broke new ground by examining medical costs, such as treatment for asthma, diabetes and cardiovascular disease, of those with substance abuse disorders. Earlier studies may have underestimated Medicaid costs for those with such disorders because they did not factor in the medical care expenditures.
The study found that 29 percent of the Medicaid patients were diagnosed with substance abuse disorders in the six states, ranging from a low of 16.1 percent in Arkansas to 37.1 percent in New Jersey and 39.6 percent in Washington. For people with substance abuse disorders, the six states alone paid $104 million more for medical care and $105.5 million more for behavioral health care than for those patients who did not have an alcohol or drug abuse diagnosis. If the findings were extrapolated to the entire country, the extra costs for those with substance abuse disorders would easily run into the hundreds of millions of dollars.
The researchers said possible explanations for the higher medical costs included generally higher prevalence of physical illness among older people, the cumulative health impact of long-term substance abuse, greater reluctance among older adults to seek addiction treatment in specialty settings, and more severe chronic disease among older adults with addictions.
All six states showed that medical care and behavioral health care costs were higher with those who abused drugs and alcohol compared to those who did not. But the median Medicaid cost per state varied widely.
In New Jersey, people classified as having severe mental illness and a substance abuse disorder cost a median of $5,345 for behavioral health, compared to a median of $1,601 for a person without a substance abuse disorder. In Washington, though, the cost for someone with a substance abuse disorder was less than half that – $2,131 – versus $795 for someone without those disorders. These spending differences reflect wide variation in coverage of behavioral health treatment across states. The researchers said that providers in states with poor coverage may bill for treatment under different diagnostic codes in order to receive reimbursement.
If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at cvieira@burnesscommunications.com.
|
Kids Who Watch R-rated Movies are More Likely to Smoke
Washington, DC – A new study finds that kids who are allowed to watch R-rated movies are much more likely to believe it’s easy to get a cigarette than those who aren’t allowed to watch such films.
“We don’t know why this is so. It may have to do with a parenting style that is permissive of activities that are not age-appropriate. Or it may be an outcome of all the smoking scenes in R-rated movies,” says lead author of the study Chyke Doubeni, PhD, with the University of Massachusetts Medical School. The study appears in the February 21 issue of the American Journal of Preventive Medicine.
“But we do know that kids who believe it is easy to get a cigarette are at risk of smoking. Our prior research has already shown that kids who perceive cigarettes as readily accessible are more likely to end up as regular smokers,” Doubeni said.
The researchers found that parental permission to watch R-rated movies was one of the strongest predictors of the perception that cigarettes are available, about as strong as having friends that smoked. If allowed to watch R-rated films, nonsmokers were almost twice as likely, and smokers were almost three times as likely to say it would be easy for them to get cigarettes.
The researchers looked at data from the second Development and Assessment of Nicotine Dependence in Youth, a four-year study of 1246 sixth-grade students in Massachusetts who were interviewed 11 times from 2002 to 2006. Students were asked if they agreed or disagreed with the statement: “It would be easy for me to get a cigarette.” They were also asked “Is anybody allowed to smoke inside your home?” and “How often do your parents let you watch movies or videos that are rated R?”
The study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.
“Parents need to be mindful about the movies their children watch for a variety of obvious reasons. This study points out one more reason for not allowing children to watch movies that are not appropriate for their age,” added co-author Dr. Joseph DiFranza with the University of Massachusetts Medical School.
The study also found that having a favorite tobacco advertisement was significantly associated with perceived accessibility, as was knowing the Joe Camel cartoon mascot for Camel cigarettes. Unsurprisingly, kids with parents who smoke or allow smoking in the home tended to think it would be very easy to obtain cigarettes.
“This implies that parental smoking likely contributes to youth smoking through increased perceived accessibility,” says Doubeni. “Parents need to understand that your kids are more likely to get cigarettes if you smoke, particularly if you smoke in the home or allow someone else to smoke in the home.”
If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at cvieira@burnesscommunications.com.
|
Adolescents Are Undertreated for Addiction
New Study Finds Few High-Quality Programs for Teens Are Available
Only about 10 percent of adolescents needing help for substance abuse problems actually enter treatment, partly because of the lack of adolescent-only services in the nation’s treatment system, according to a new study. The study also found that very few of the available addiction programs for teens received high marks for quality.
“We have known that out of 1.4 million teens needing help for substance abuse, one-tenth of those get treatment, says author Hannah Knudsen, PhD, with the University of Kentucky. “Part of this treatment gap may be driven by the limited availability of adolescent-only treatment services. Less than one-third of addiction programs in the U.S. have a specialized program for adolescents.”
The study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation and appears in the March 2009 issue of the Journal of Substance Abuse Treatment.
“Despite the public health significance of adolescent substance abuse and the knowledge that treatment can be effective for this group, services for them are less available than for adults,” Knudsen says. “It means we lose our chance at early intervention, and that families may be unable to find services for their children in their communities.”
Her study also found wide variations in quality among adolescent-only programs. Knudsen analyzed nine ‘domains’ of quality offered by the programs, including things like whether families are encouraged to be involved in the treatment process or whether programs offer an array of comprehensive services. She found that only a small number of them scored high in each domain. The average treatment program in this national random sample of 154 treatment programs received a medium-ranking score in overall quality.
“The lack of comprehensive services in substance abuse programs for teens raises questions about whether teens will get what they need, since we know they are likely to have co-occurring psychiatric conditions and to engage in HIV risk behaviors,” says Knudsen.
However, when programs offered more intensive treatment services, such as residential or inpatient treatment, the treatment quality ranking tended to be higher. But such programs are in the minority. Seventy percent of adolescent substance abuse programs only treat addicted teens on an outpatient basis, according to her study.
“For parents who are looking for high-quality programs that offer the most comprehensive array of services, a good proxy indicator is whether that organization has an inpatient or residential level of care,” says Knudsen.
Knudsen also wanted to know whether certain program characteristics “would make it more or less likely that they accept adolescents into treatment programs that include only teens.” She found certain types of programs were more likely to exclude adolescents from admission, such as programs that relied heavily on governmental funding and those that were based in hospitals. She also found that larger treatment organizations and those accredited by external organizations such as the Joint Commission were less likely to bar adolescents from admission.
“This suggests that states may not be devoting enough funding towards adolescent substance abuse programs, and that privately funded programs may be more likely to admit teens who are still covered by their families’ insurance,” says Knudsen.
In addition, the data suggest that some treatment programs mix teens and adults. The practice runs contrary to the recommendations of the U.S. government’s Center for Substance Abuse Treatment (CSAT). Knudsen said such situations can create problems because adolescents are at a different stage of life than adults. They are typically living with their families, have shorter histories of substance abuse, and they need services to be tailored to their stage of cognitive development.
If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at cvieira@burnesscommunications.com.
|
|
If you wish to unsubscribe from
this newsletter, please send an email to
research_update@saprp.org
with "unsubscribe" in the subject line.
Substance Abuse Policy Research Program
One Leadership Place • Greensboro NC 27140
www.saprp.org
• Tel. 336.286.4548
|
