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Wen H, Cummings JR, Hockenberry JM, Gaydos LM, Druss BG. State parity laws and access to treatment for substance use disorder in the United States: implications for federal parity legislation. JAMA Psychiatry 2013; 70:1355-62. [PMID: 24154931 PMCID: PMC4047825 DOI: 10.1001/jamapsychiatry.2013.2169] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. However, prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. OBJECTIVE To examine the effect of state-level SUD parity laws on state-aggregate SUD treatment rates and to shed light on the impact of the recent federal SUD parity legislation. DESIGN, SETTING, AND PARTICIPANTS We conducted a quasi-experimental study using a 2-way (state and year) fixed-effect method. We included all known specialty SUD treatment facilities in the United States and examined treatment rates from October 1, 2000, through March 31, 2008. Our main source of data was the National Survey of Substance Abuse Treatment Services, which provides facility-level information on specialty SUD treatment. INTERVENTIONS State-level SUD parity laws during the study period. MAIN OUTCOMES AND MEASURES State-aggregate SUD treatment rates in (1) all specialty SUD treatment facilities and (2) specialty SUD treatment facilities accepting private insurance. RESULTS The implementation of any SUD parity law increased the treatment rate by 9% (P < .001) in all specialty SUD treatment facilities and by 15% (P = .02) in facilities accepting private insurance. Full parity and parity only if SUD coverage is offered increased the SUD treatment rate by 13% (P = .02) and 8% (P = .04), respectively, in all facilities and by 21% (P = .03) and 10% (P = .04), respectively, in facilities accepting private insurance. CONCLUSIONS AND RELEVANCE We found a positive effect of the implementation of state SUD parity legislation on access to specialty SUD treatment. Furthermore, the positive association is more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment.
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Affiliation(s)
- Hefei Wen
- Department of Health Policy and Management, Rollins School of Public Health
| | - Janet R. Cummings
- Department of Health Policy and Management, Rollins School of Public Health
| | | | - Laura M. Gaydos
- Department of Health Policy and Management, Rollins School of Public Health
| | - Benjamin G. Druss
- Department of Health Policy and Management, Rollins School of Public Health
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Amaro H, Raj A, Reed E, Ulibarri M. Getting Personal: Progress and Pitfalls in HIV Prevention Among Latinas. PSYCHOLOGY OF WOMEN QUARTERLY 2011; 35:655-670. [PMID: 22539868 PMCID: PMC3334297 DOI: 10.1177/0361684311426692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hortensia Amaro
- Institute on Urban Health Research, Bouve' College of Health Sciences, Northeastern University
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Coviello DM, Zanis DA, Wesnoski SA, Lynch KG, Drapkin M. Characteristics and 9-month outcomes of discharged methadone maintenance clients. J Subst Abuse Treat 2011; 40:165-74. [PMID: 21036510 PMCID: PMC3057508 DOI: 10.1016/j.jsat.2010.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 09/16/2010] [Accepted: 09/22/2010] [Indexed: 11/20/2022]
Abstract
This study is a secondary data analysis of a clinical trial assessing the effectiveness of outreach case management (OCM) in linking discharged methadone patients back into treatment. The original trial assessed the effectiveness of the OCM intervention compared to a passive referral among methadone clients who needed treatment postdischarge but had not reengaged. The purpose of this study was to assess the characteristics and long-term outcomes of all clients who were discharged from methadone maintenance treatment including those who had reengaged in treatment. A total of 230 methadone clients were interviewed 3 months and then again at 9 months following discharge from treatment. Compared with participants who needed treatment but had not reengaged (NoTx: 56%), those who had successfully reenrolled in treatment (Tx; 44%) were more likely to be female, not married, and unemployed; had a longer history of sedative use; reported more psychiatric hospitalizations; and were originally enrolled in a community-based rather than a Veterans Administration program. Despite having more severe problems, the Tx group had fewer opioid-positive urines and reported less IV drug use at 9 months postdischarge compared to the NoTx group. The findings highlight the importance of rapid treatment reengagement.
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Affiliation(s)
- Donna M Coviello
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abrams GB, Etkind P, Burke MC, Cram V. Sexual Violence and Subsequent Risk of Sexually Transmitted Disease Among Incarcerated Women. JOURNAL OF CORRECTIONAL HEALTH CARE 2008. [DOI: 10.1177/1078345807313797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gina Baral Abrams
- School of Social Work, Boston University
- Princeton University, Princeton, New Jersey
| | - Paul Etkind
- Division of STD Prevention, Massachusetts Department of Public Health, Boston
- Division of Public Health and Community Services, City of Nashua, New Hampshire
| | - M. Christine Burke
- Division of STD Prevention, Massachusetts Department of Public Health, Boston
- Massachusetts Department of Public Health, Boston
| | - Virginia Cram
- Division of STD Prevention, Massachusetts Department of Public Health, Boston
- Commonwealth Medicine, University of Massachusetts Medical School, Worcester
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Coustasse A, Singh KP, Trevino FM. Disparities in access to healthcare: the case of a drug and alcohol abuse detoxification treatment program among minority groups in a Texas hospital. Hosp Top 2007; 85:27-34. [PMID: 17405422 DOI: 10.3200/htps.85.1.27-34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors analyzed ethnic/racial disparities in healthcare access and length of stay from a defined population of individuals seeking medical detoxification services at a hospital in Texas. Results indicated Blacks were more likely to be insured compared with Whites, mostly by public insurance, but this did not hold for Hispanics, who were about three times more likely to be uninsured compared with Blacks. In addition, the authors observed lower median of length of stay in the Medicaid category among Hispanics. These results can be explained by aggressive case management, sociocultural barriers, or discriminatory practices, both intentional and unintentional.
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Affiliation(s)
- Alberto Coustasse
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
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6
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Quality-Directed Activities and Barriers to Quality in Social Service Organizations. ACTA ACUST UNITED AC 2007. [DOI: 10.1300/j147v31n02_05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kertesz SG, Larson MJ, Cheng DM, Tucker JA, Winter M, Mullins A, Saitz R, Samet JH. Need and non-need factors associated with addiction treatment utilization in a cohort of homeless and housed urban poor. Med Care 2006; 44:225-33. [PMID: 16501393 DOI: 10.1097/01.mlr.0000199649.19464.8f] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research on addiction treatment utilization in indigent samples mainly has been retrospective, without measures of addictive consequences, social network influences, and motivation. Prospective assessment of factors influencing utilization could inform policy and clinical care. OBJECTIVE We sought to identify factors associated with utilization of addiction treatment and mutual help groups among substance-dependent persons with high rates of homelessness. RESEARCH AND METHODS This was a prospective cohort of patients detoxified from alcohol or drugs at baseline who were followed for 2 years in a randomized clinical trial of linkage to primary care (n = 274). Outcomes included utilization of Inpatient/Residential, Outpatient, Any Treatment, and Mutual Help Groups. Predictor variables in longitudinal regression analyses came from the literature and clinical experience, organized according to theoretical categories of Need, and non-Need (eg, Predisposing and Enabling). RESULTS Many subjects used Inpatient/Residential (72%), Outpatient (62%), Any Treatment (88%) or Mutual Help Groups (93%) at least once. In multivariable analyses, addictive consequences (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.12-1.71), motivation (OR 1.32, 95% CI 1.09-1.60), and female gender (OR 1.80, 95% CI 1.13-2.86) were associated with most treatment types (ORs are for Any Treatment). Homelessness was associated with Residential/Inpatient (for Chronically Homeless vs. Housed, OR 1.75, 95% CI 1.04-2.94). Living with one's children (OR 0.51, 95% CI 0.31-0.84) and substance-abusing social environment (OR 0.65, 95% CI 0.43-0.98) were negatively associated with Any Treatment. CONCLUSIONS In this cohort of substance-dependent persons, addictive consequences, social network variables, and motivation were associated with treatment utilization. Non-need factors, including living with one's children and gender, also were significant.
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Affiliation(s)
- Stefan G Kertesz
- Divisions of Preventive and General Internal Medicine, University of Alabama at Birmingham School of Medicine, AL 35294-4410, USA.
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Needels K, James-Burdumy S, Burghardt J. Community case management for former jail inmates: its impacts on rearrest, drug use, and HIV risk. J Urban Health 2005; 82:420-33. [PMID: 16014874 PMCID: PMC3456061 DOI: 10.1093/jurban/jti092] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Dramatically increasing incarceration rates in the United States have led to large concentrations of formerly imprisoned people in poverty-stricken urban areas. Therefore, identifying ways to help inmates who exhibit multiple, serious problems and who are at great risk of experiencing poor postrelease outcomes is especially important to urban communities, as well as to service providers and policymakers concerned about these communities. Our research provides evidence about the effectiveness of one strategy, called Health Link, which recruited adult women and adolescent men while they were incarcerated in a New York City jail and offered case management services during the especially challenging first year after release. About 1,400 participants who enrolled during a 3-year period were randomly assigned either to a group that was eligible for intensive discharge planning services and community-based case management services or to a group eligible for less-intensive discharge planning and no community-based services. We investigated whether the availability of these services reduced rates of drug use, HIV risk, and rearrest. Using data from interviews and hair analysis to measure impacts during a 1-year follow-up period after clients' release from jail, we detected increased participation in drug treatment programs and weak evidence for reduced drug use. However, we did not observe reductions in rearrest rates or in activities with high risk of HIV infection. We conclude that a well-executed case management program can make modest differences in a few short-term outcomes of former inmates. However, the intervention did not lead to the hoped-for changes across a range of outcomes that would clearly indicate greater success in community reintegration or improved health.
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Affiliation(s)
- Karen Needels
- Mathematica Policy Research, Inc., P.O. Box 2393, Princeton, NJ 08543-2393, USA.
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Shanahan CW, Lincoln A, Horton NJ, Saitz R, Winter M, Samet JH. Relationship of depressive symptoms and mental health functioning to repeat detoxification. J Subst Abuse Treat 2005; 29:117-23. [PMID: 16135340 DOI: 10.1016/j.jsat.2005.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 05/19/2005] [Accepted: 05/27/2005] [Indexed: 11/20/2022]
Abstract
To better understand residential detoxification use, we assessed the roles of depressive symptoms (DS) and mental health functioning (MHF) on repeat detoxification. A prospective cohort of residential detoxification patients (N=400) without primary medical care was followed over 2 years at 6-month intervals. Subsequent detoxification admissions were examined using a statewide administrative database and DS (Center for Epidemiologic Studies Depression Scale) and MHF (SF-36 mental component summary subscale) measurements at follow-up. Incidence rate ratios of return to detoxification were estimated using multivariable longitudinal Poisson regression. In separate analyses, greater DS and worse MHF predicted higher detoxification use rates. Clinically significant worsening (10 points) of DS and MHF on objective scales predicted a 20% increased rate of detoxification readmission. Male sex, heroin as a problem substance, and race/ethnicity each predicted detoxification use. These data suggest that identifying individuals with DS or worse MHF after detoxification may provide opportunities for clinical intervention to reduce recurrent residential detoxification.
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Affiliation(s)
- Christopher W Shanahan
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA.
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Hepatitis C prevention and treatment for substance users in the United States: acknowledging the elephant in the living room. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2004. [DOI: 10.1016/j.drugpo.2003.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Van Ness PH, Davis WR, Johnson BD. Socioeconomic marginality and health services utilization among Central Harlem substance users. Subst Use Misuse 2004; 39:61-85. [PMID: 15002944 DOI: 10.1081/ja-120027766] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The article examines whether decrements in socioeconomic measures in a poor, substance using population predict changes in health services utilization. The sample consisted of 658 "hard drug" (crack, powder cocaine, and heroin) users drawn from Central Harlem in New York City during 1998 and 1999. Chain referral and social networking were used in order to gain access to hidden users. The sample was stratified according to operational measures indicating socioeconomic marginality, one calculated using indices of income, education, and employment and another designed to measure lived homelessness. Rates of self-reported utilization of 10 health services were compared across strata. In this sample socioeconomic marginality reflected by low levels of income, education, and employment sometimes predicts greater rates of health services utilization and, in other cases, it predicts lower rates. When the sample is stratified according to an operational measure of homelessness, the gradient of greater utilization and self-reported morbidity for the homeless is more marked and consistent. Results are supportive of a public health model of drug user treatment that recommends that it occur as part of an integrated strategy addressing poverty, homelessness, violence, and related social problems.
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Affiliation(s)
- Peter H Van Ness
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA.
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Abstract
OBJECTIVES This article examines drumming activities as complementary addiction treatments and discusses their reported effects. METHODS I observed drumming circles for substance abuse (as a participant), interviewed counselors and Internet mailing list participants, initiated a pilot program, and reviewed literature on the effects of drumming. RESULTS Research reviews indicate that drumming enhances recovery through inducing relaxation and enhancing theta-wave production and brain-wave synchronization. Drumming produces pleasurable experiences, enhanced awareness of preconscious dynamics, release of emotional trauma, and reintegration of self. Drumming alleviates self-centeredness, isolation, and alienation, creating a sense of connectedness with self and others. Drumming provides a secular approach to accessing a higher power and applying spiritual perspectives. CONCLUSIONS Drumming circles have applications as complementary addiction therapy, particularly for repeated relapse and when other counseling modalities have failed.
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Affiliation(s)
- Michael Winkelman
- Department of Anthropology, Arizona State University, Tempe 85287-2402, USA.
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Logan TK, Walker R, Cole J, Leukefeld C. Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications. REVIEW OF GENERAL PSYCHOLOGY 2002. [DOI: 10.1037/1089-2680.6.4.325] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.
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Freudenberg N. Adverse effects of US jail and prison policies on the health and well-being of women of color. Am J Public Health 2002; 92:1895-9. [PMID: 12453803 PMCID: PMC1447348 DOI: 10.2105/ajph.92.12.1895] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In the past few decades, US policies have led to an unprecedented increase in the number of people behind bars. While more men than women are incarcerated, the rate of increase for women has been higher. Evidence of the negative impact of incarceration on the health of women of color suggests strategies to reduce these adverse effects. Correctional policies contribute to disparities in health between White women and women of color, providing a public health rationale for policy change. Specific roles for health professionals include becoming involved in alliances addressing alternatives to incarceration, creating programs that address the needs of women in correctional facilities, and identifying the pathways by which correctional policies damage health.
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Affiliation(s)
- Nicholas Freudenberg
- Program in Urban Public Health, Hunter College, City University of New York, USA.
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15
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Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need. Public Health Rep 2002. [PMID: 12042608 DOI: 10.1016/s0033-3549(04)50072-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.
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Winkelman M. Alternative and traditional medicine approaches for substance abuse programs: a shamanic perspective. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2001. [DOI: 10.1016/s0955-3959(01)00100-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Guydish J, Woods WJ, Davis T, Bostrom A, Frazier Y. Does centralized intake improve drug abuse treatment outcomes? J Subst Abuse Treat 2001; 20:265-73; discussion 275-6. [PMID: 11672641 DOI: 10.1016/s0740-5472(01)00170-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study was designed to assess whether centralized intake and assessment in a drug abuse treatment system would lead to improved outcomes. Clients entering treatment through a centralized intake unit (CIU) or through individual programs (non-CIU) were interviewed at admission, and at 1 month and 1 year postadmission. Interviews included measures of treatment access and satisfaction, psychiatric symptoms, social support, and Addiction Severity Index composite scores. At treatment entry, CIU participants had more employment and psychological problems and lower social support, were more often required to be in treatment, and were more often placed on a waiting list. In analyses controlling for baseline differences between groups, there were main effects of time, but no CIU status effects or CIU status by time interactions. The CIU may have improved access to treatment for a more disabled population; however, clients entering treatment through the CIU did not have better outcomes than those entering treatment directly.
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Affiliation(s)
- J Guydish
- Institute for Health Policy Studies, University of California-San Francisco, San Francisco, CA 94118, USA.
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Amaro H, Raj A, Vega RR, Mangione TW, Perez LN. Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need. Public Health Rep 2001; 116:434-48. [PMID: 12042608 PMCID: PMC1497361 DOI: 10.1093/phr/116.5.434] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.
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Affiliation(s)
- H Amaro
- Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA.
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Conklin TJ, Lincoln T, Tuthill RW. Self-reported health and prior health behaviors of newly admitted correctional inmates. Am J Public Health 2000; 90:1939-41. [PMID: 11111273 PMCID: PMC1446449 DOI: 10.2105/ajph.90.12.1939] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study obtained comprehensive health information from newly admitted correctional inmates. METHODS Interviews were conducted with 1198 inmates on day 3 of their incarceration. RESULTS Interviewers found a high prevalence of chronic medical and mental health issues, limited access to health care, high rates of infections and sexually transmitted diseases, substantial substance abuse, other unhealthy behaviors and violence, and a strong desire for help with health-related problems. CONCLUSIONS The data document the need to apply the public health approach to correctional health care, including detection and early treatment of disease, education and prevention to facilitate health and behavior change, and continuity of care into the community.
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Affiliation(s)
- T J Conklin
- Hampden County Correctional Center, Ludlow, Mass. 01056, USA.
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Shah NG, Celentano DD, Vlahov D, Stambolis V, Johnson L, Nelson KE, Strathdee SA. Correlates of enrollment in methadone maintenance treatment programs differ by HIV-serostatus. AIDS 2000; 14:2035-43. [PMID: 10997409 DOI: 10.1097/00002030-200009080-00020] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify correlates of enrollment in methadone maintenance treatment programs (MMTP) among a prospective cohort of injection drug users (IDUs) in Baltimore, Maryland. METHODS A total of 1480 IDUs undergoing semi-annual HIV tests and interviews were studied between 1994 and 1998, during which time a needle exchange program was introduced. Longitudinal analysis using generalized estimating equations was used to identify correlates of MMTP participation over time. RESULTS Although similar proportions of HIV-seropositive and -seronegative IDUs enrolled in MMTP during follow-up (26 versus 22%, respectively), correlates of enrollment differed by HIV-serostatus. Among HIV-seropositive participants, older age [adjusted odds ratio (AOR, 1.37)] was associated with enrollment in MMTP. Among HIV-seronegative IDUs, factors associated with not enrolling in MMTP were being African American (AOR, 0.22) and having been recently incarcerated (AOR, 0.62) or homeless (AOR, 0.72). In both groups, females were twice as likely to be enrolled in MMTP, and those with Medicaid were 1.5 times more likely to be enrolled. When behavioral factors were lagged one visit, needle exchange program attendance was positively associated with MMTP enrollment among HIV-negative IDUs (AOR, 2.10); however, this association diminished significantly over time as dedicated treatment slots for needle exchange program participants became saturated. CONCLUSIONS These findings underscore the need to improve access to MMTP, especially to certain subgroups such as African-Americans, the homeless, incarcerated and uninsured. Our data suggest that health care providers and needle exchange programs can facilitate enrollment into MMTP provided that adequate treatment slots are consistently available to this particularly vulnerable population.
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Affiliation(s)
- N G Shah
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore 21205, Maryland, USA
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Abstract
The cost to society of alcohol, tobacco, and illicit drug dependence is enormous. Although the importance of treatment for substance abuse to public health is increasingly acknowledged, pharmacotherapy is generally underutilized. However, the selection of medications for clinical testing is increasingly guided by the rapidly evolving science of addictive drugs and behavior. The benefit of medication for smoking cessation is firmly established, particularly for nicotine replacement and antidepressant therapy. Naltrexone is an important addition to the pharmacopoeia, and acamprosate may soon be approved as well. Although no new medications are approved for cocaine and amphetamine abuse, a variety of candidate treatments have shown promise in ongoing studies. Opiate substitution therapy is highly effective for rehabilitation of heroin addiction, and several alternative forms will soon be available; alternative forms of opiate detoxification have also received attention. Overall, there is increasing recognition that physicians have an obligation to identify and treat all forms of substance dependence, although knowledge of the efficacy of the available treatments is steadily increasing.
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Affiliation(s)
- P C Gottschalk
- Veteran's Affairs Medical Center 116-A, 950 Campbell Avenue, West Haven, CT 06516, USA
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