Who goes to alcohol and drug treatment? Understanding utilization within the context of insurance.

OBJECTIVE This study assesses the differential roles of demographic characteristics, problem severity, motivational factors and insurance in entrance into alcohol and drug treatment. METHOD A probability sample of adult problem and dependent drinkers from a Northem California county (N = 672) and consecutive adult intakes from the county's public (n = 298) and private (n = 628) alcohol and drug treatment programs. Interviewers conducted telephone screening for individuals meeting problem-drinking criteria in the general population; in-person interviews were conducted for those who screened positive, and also for individuals entering treatment. RESULTS Insurance did not play an independent role in treatment entry. In logistic regression analysis, using a model from the medical utilization literature, black ethnicity (odds ratio [OR] = 2.98, p < .001); older age (OR = 4.67, p < .001); less education (OR = 1.81, p < .01); legal (OR = 7.46, p < .001) and work (OR = 3.57,p <.001) pressures; higher psychiatric (OR = 4.03,p <.001) and drug (OR = 3.04,p <.001) severity; and social consequences (OR = 1.35, p < .01) predicted treatment entry. Interventions from legal sources (OR = 6.22, p < .01) were related to entering treatment for the uninsured; legal (OR = 7.02, p < .001), workplace (OR = 6.01, p < .001) and family (OR = 1.62, p < .05) pressures were related for the insured. CONCLUSIONS Social consequences, rather than severity of dependence, in both insured and uninsured problem drinkers are important predictors of treatment entry when traditional utilization measures are controlled. Public programs play a crucial part in the alcohol and drug treatment system, and their viability is important as health policy changes.

[1]  T. Mcguire,et al.  Parity for Mental Health and Substance Abuse Care Under Managed Care , 1998, The journal of mental health policy and economics.

[2]  R. Andersen,et al.  The national profile of access to medical care: where do we stand? , 1984, American journal of public health.

[3]  R. Caetano,et al.  DSM-IV alcohol dependence in a treatment sample of white, black, and Mexican-American men. , 1996, Alcoholism, clinical and experimental research.

[4]  R. Caetano.  The association between severity of DSM-III-R alcohol dependence and medical and social consequences. , 1993, Addiction.

[5]  David Mechanic,et al.  Sex, Illness, Illness Behavior, and the Use of Health Services , 1976 .

[6]  R. Caetano,et al.  Predictors of help seeking among a longitudinal sample of the general population, 1984-1992. , 1997, Journal of studies on alcohol.

[7]  D. Metzger,et al.  The Fifth Edition of the Addiction Severity Index. , 1992, Journal of substance abuse treatment.

[8]  M. Hertzman.  Broadening the base of treatment for alcohol problems: a report which deserves to be debated. "Our vision": Chapter 1 of the Institute of Medicine Report. , 1991, British journal of addiction.

[9]  R. Room,et al.  Trends in the treatment of alcohol problems in the US general population, 1979 through 1990. , 1995, American journal of public health.

[10]  H. Yahr.  A national comparison of public- and private-sector alcoholism treatment delivery system characteristics. , 1988, Journal of studies on alcohol.

[11]  H. Raat,et al.  Demand for alcohol treatment by problem drinkers. , 1992, Journal of substance abuse treatment.

[12]  L. Schmidt,et al.  Gender disparities in treatment for alcohol problems. , 1992, JAMA.

[13]  L. Schmidt,et al.  The Community Epidemiology Laboratory: studying alcohol problems in community and agency-based populations. , 1995, Addiction.

[14]  D. Polcin,et al.  Factors associated with coercion in entering treatment for alcohol problems. , 1999, Drug and alcohol dependence.

[15]  L. Schmidt,et al.  Rethinking access to alcohol treatment. , 2001, Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism.

[16]  R. Caetano,et al.  The association between DSM-III-R alcohol dependence, psychological distress and drug use. , 1995, Addiction.

[17]  M. Hilton,et al.  Alcohol in America : drinking practices and problems , 1992 .

[18]  C. Weisner,et al.  Integrating primary medical care with addiction treatment: a randomized controlled trial. , 2001, JAMA.

[19]  L. Schmidt,et al.  Developments in alcoholism treatment. , 1993, Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism.

[20]  C. Weisner,et al.  Drinking problems and self-reported criminal behavior, arrests and convictions: 1990 US alcohol and 1989 county surveys. , 1995, Addiction.

[21]  J. Wiley,et al.  Addiction and Welfare Dependency: Interpreting the Connection , 2002 .

[22]  R. Caetano.  The factor structure of the DSM-III-R and ICD-10 concepts of alcohol dependence. , 1990, Alcohol and alcoholism.

[23]  M. Hilton.  Demographic characteristics and the frequency of heavy drinking as predictors of self-reported drinking problems. , 1987, British journal of addiction.

[24]  R. Andersen,et al.  A framework for the study of access to medical care. , 1974, Health services research.

[25]  C. Weisner,et al.  Predictors of substance abuse treatment retention among women and men in an HMO. , 2000, Alcoholism, clinical and experimental research.

[26]  M. Hilton,et al.  'When you were drinking' vs. 'in the past 12 months': the impact of using different time frames in clinical and general populations. , 1999, Addiction.

[27]  C. Weisner.  Toward an alcohol treatment entry model: a comparison of problem drinkers in the general population and in treatment. , 1993, Alcoholism, clinical and experimental research.

[28]  B. Grant.  Toward an alcohol treatment model: a comparison of treated and untreated respondents with DSM-IV alcohol use disorders in the general population. , 1996, Alcoholism, clinical and experimental research.

[29]  R. Frank,et al.  Managing Managed Care : Quality Improvement in Behavioral Health , 1997 .

[30]  R. Andersen.  Revisiting the behavioral model and access to medical care: does it matter? , 1995, Journal of health and social behavior.

[31]  J. Wiley,et al.  Substance abuse and the course of welfare dependency. , 1998, American journal of public health.

[32]  L. Midanik,et al.  Trends in social consequences and dependence symptoms in the United States: the National Alcohol Surveys, 1984-1995. , 2000, American journal of public health.

[33]  T. Hu,et al.  The outcome and cost of alcohol and drug treatment in an HMO: day hospital versus traditional outpatient regimens. , 2000, Health services research.

[34]  T. McGovern,et al.  Trends in the Treatment of Alcohol Problems , 2002 .

[35]  L. Schmidt,et al.  Expanding the frame of health services research in the drug abuse field. , 1995, Health services research.