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Biomedical subjects

J V Rachal

Publications and source records attributed to J V Rachal.

At least 19 recordsLinked to original sources
PubMed2001

Using social indicators to estimate county-level substance use intervention and treatment needs.

This study describes the development of a model for estimating county-level substance use intervention and treatment needs using social indicators. Forty-five indicators conceptually related to substance misuse were reduced through factor analysis. Logistic regression models were then developed using selected indicators to predict service needs. The following variables were significant predictors of substance use intervention and treatment needs: the percent of the population who is male aged 15 to 34, urbanicity, and population density. The results suggest that substance misuse may be successfully modeled by a few easy to obtain and reliably measured variables describing the population characteristics of local communities.

Adolescent↗
PubMed1996

Health care reforms and managed care for substance abuse services: findings from eleven case studies.

In 1992, the United States spent $820 billion on health care. For the same year, an estimated 15 percent of the U.S. population, approximately 43 million people, were uninsured. As health care costs continue to rise, the number of people able to afford coverage continues to decline. Given these statistics, it is not surprising that concern over health care reform is at the forefront of government policy. Over the past few years, policymakers have faced the challenge of creating a more cost-efficient, universal health care system. Many of the proposed reforms rely heavily on managed care practices and treatment limits to help control costs. The impact of managed care is already apparent in primary health care where private insurers have been using it for years (e.g., HMOs, PPOs). However, its full impact on substance abuse treatment services remains unknown. In this paper, we present the perceptions, opinions, and experiences of eleven drug treatment programs regarding the actual or anticipated effects of managed care and health care reforms on the delivery, financing, and costs of substance abuse treatment. We also present an analysis of these programs' current costs and financing. We believe that the information presented in this paper provides timely insights into the substance abuse treatment system; these insights should assist policymakers in developing optimal health care reform policies.

Cost-Benefit Analysis↗
PubMed1993

Dimensions of adolescent problem drinking.

Issues involved in defining and measuring adolescent problem drinking have occupied the attention of alcohol researchers since the mid-1970s. However, appropriate definitions and measures of problem drinking remain important and unanswered conceptual and research questions. The research reported in this study was designed to address these issues by identifying multiple dimensions of adolescent problem drinking and examining correlates of these dimensions using multivariate regression models. A longitudinal sample of 2,771 students who had tried alcohol was used in these analyses. The sample was followed over three waves of data collection, between 1985 and 1990, in middle and high schools located in a southeastern U.S. county. Data from the third wave were used to characterize problem-drinking behavior. Results of exploratory factor analyses supported the conclusion made by others that adolescent problem drinking is a multidimensional phenomenon. Three dimensions measuring (1) level or frequency of alcohol use, (2) problems related to drinking and (3) symptoms of dependency were identified and were only moderately intercorrelated. The independent measures used to model the three problem-drinking measures were the same for each model, and the significant predictors and proportions of variance explained by the predictors differed widely across models. Results of the regression models confirmed the uniqueness of the three measures and suggested that the potency of specific risk factors varies for different types of problem drinking. Prevention implications and recommendations for this area of research are discussed.

Adolescent↗
PubMed1993

The effects of time in drug abuse treatment and employment on posttreatment drug use and criminal activity.

The impact of length of stay in drug abuse treatment on follow-up drug use and criminal behavior has important clinical and policy implications. In this paper we use longitudinal data from the Treatment Outcome Prospective Study to estimate the simultaneous effects of time in treatment and employment outcomes--weeks worked and total earnings--on posttreatment drug use and criminal activity. The drug use/criminal activity variables include four indexes measuring the severity of use, drug-related problems, predatory illegal acts, and overall criminal behavior. The results show that time in treatment had a negative and statistically significant impact on these outcome variables for every modality with residential clients experiencing the largest relative impact. The time-in-treatment effect was robust even when employment outcomes were modeled jointly with drug use and criminal activity outcomes. These findings highlight the importance of length of stay in treatment in the recovery and rehabilitation of drug abusers.

Ambulatory Care↗
PubMed1992

The characterization of inconsistencies in self-reports of alcohol and marijuana use in a longitudinal study of adolescents.

The reliability of self-reported measures remains an important issue for research on adolescent alcohol and drug use. Many studies have concluded that adolescents' self-reports are valid and reliable, but few studies have excluded consistent nonusers from their reliability estimates, and no study has examined in detail the reliability of reported age at first use of substances. This study explores the consistency of self-reports of frequency of use and age of first use of alcohol and marijuana in a sample of 5,770 secondary school students in a southeastern U.S. county. Two waves of data were collected between 1985 and 1988 using state-of-the-art data collection procedures and self-administered instruments. Consistency of reports was examined by comparing reports at T1 and T2, approximately 1 year apart. Results showed that when consistent nonusers were dropped from the analysis, consistency rates of lifetime frequency of use dropped from 82.7% to 74.7% for alcohol and from 95.6% to 83.2% for marijuana. Reports were more consistent for lifetime marijuana use than for alcohol use, but these results must be interpreted with caution given differences in the measures for the two substances. Reliability of reported age of first use was very low for both substances. When consistent nonusers were dropped from the analysis, only 27.8% of respondents made consistent estimates of their age at first alcohol use and 34.4% for their age at first marijuana use. Implications and recommendations for this area of research are discussed.

Adolescent↗
PubMed1992

Predicting continued use of marijuana among adolescents: the relative influence of drug-specific and social context factors.

Most research on the determinants of adolescent drug use has focused on predictors of either initiation or current use. Little attention has been given to the determinants of continued use of drugs after initiation, even though some researchers have found that the consequences of continued use are more serious than those associated with experimental or occasional use. In this study, a longitudinal sample of 456 secondary and high school students who had already tried marijuana was used to examine the determinants of continued use of marijuana. Nearly 38 percent of those who had tried marijuana continued using, according to the definition operationalized in this study. Potential predictor measures were grouped in a drug-specific domain and a social context domain, and their effects on continued use, controlling for background characteristics, were examined in logistic regression models. Results showed that only the drug-specific domain had a statistically significant effect on the likelihood of continued use. Students who felt that the adverse physical and psychological effects of marijuana were not very important reasons for discontinuing use and those who had gotten stoned during their experimental stage of use were the most likely to continue use after initiation. The results suggest that the perceived physical and psychological effects of the drug are more important determinants of continued use than are social factors or benefits related to use. Any relationships between social factors and continued use are mediated by the perceived effects and risks of the drug.

Adolescent↗
PubMed1991

Cocaine use by clients in methadone programs: significance, scope, and behavioral interventions.

Widespread use of cocaine by methadone clients is undermining the effectiveness of methadone treatment programs in reducing illicit drug use, decreasing criminal behavior, and slowing the spread of the human immunodeficiency virus (HIV). In response, methadone programs are implementing a range of behavioral interventions to manage this growing problem. Many of these interventions, however, have yet to be evaluated for effectiveness for reducing cocaine use among methadone clients. Interventions that are effective for cocaine use in the general population may not be as effective with cocaine users in methadone programs because these clients differ from other cocaine users in ways that are likely to affect how they respond to the interventions. This paper reviews the literature on the significance and scope of the problem of cocaine use by methadone clients and on the behavioral interventions that have been evaluated for these clients.

Adolescent↗
PubMed1991

Conceptual framework for estimating the social cost of drug abuse.

Drug abuse imposes costs on individuals and society. Researchers have produced several studies on a subset of tangible costs of drug abuse and other illnesses, but key tangible costs sometimes have been overlooked and, even when recognized, rarely have been estimated. An assortment of intangible costs also have received very little research attention. This study outlines a comprehensive conceptual framework for estimating the social cost of drug abuse. We address both the tangible and intangible costs for the drug-abusing and non-drug-abusing population. Our conceptual framework is based on critical reviews of new and traditional methods for estimating the costs of illness and disease including cost-of-illness methods, averting behavior methods, and utility valuation techniques. We show how the proposed methods can be combined with existing data to estimate the total social cost of drug abuse. Using social cost estimates will enable policymakers to more accurately assess the total burden of drug abuse and related problems on society.

Costs and Cost Analysis↗
PubMed1991

The impact of time in treatment on the employment and earnings of drug abusers.

We use data from a longitudinal survey to estimate the effects of time in drug abuse treatment on post-treatment weeks worked and earnings for 2,420 clients in three treatment modalities. The regression analysis shows that time in treatment had a positive and statistically significant impact on these labor market outcomes, but the effects were small for all modalities. Although residential clients experienced the largest relative changes in weeks worked and real earnings, a benefit-cost calculation suggests that additional residential treatment cannot be justified from earnings improvements alone. These results may indicate a need for more employment services while in treatment.

Cost-Benefit Analysis↗
PubMed1986

Patterns of alcohol and drug abuse in drug treatment clients from different ethnic backgrounds.

In this paper we have sought to identify differences in alcohol consumption patterns and problems among young adult males from white, black, and Hispanic ethnic groups entering drug treatment programs. In overall consumption patterns we found results similar to those obtained in general population studies. However, about one-third of the clients in all ethnic groups could be classified as heavier drinkers (drinking at least once a week and 4 or more drinks per drinking occasion) in the period immediately prior to treatment. About one-fourth of the clients in each ethnic group consumed a daily average of 2.5 ounces of absolute alcohol. Compared with the other ethnic groups, blacks were the most likely to be abstainers and reported regular alcohol use and drunkenness at later ages. Regardless of the pattern of development, similar proportions of the clients in all ethnic groups reported heavier drinking levels by age 21-30. Consistent with the current hypotheses in the literature, whites reported much higher levels of alcohol-related problems and prior treatment. Despite having similar levels of drinking, black and Hispanic ethnic groups did not appear to recognize alcohol as a problem or to report alcohol-related problems to the extent that whites did. Examination of drug-use patterns showed great variation in the nature and extent of drug use among the three ethnic groups. Whites were distributed among the seven patterns of use. Heroin use with cocaine, marijuana, and alcohol was the predominant pattern for blacks and Hispanics. Although the patterns of drug use differed greatly, these patterns were not differentially related to alcohol consumption or alcohol-related problems within ethnic groups. On the contrary, the drug-use patterns appeared to be a stronger predictor than ethnicity of use and problems. Multiple-nonnarcotic-users reported the highest levels of alcohol consumption and the greatest numbers of alcohol-related problems. This group typically reported the highest number of alcohol-related problems. Expression of a current need for treatment and a history of prior alcohol treatment were highest for black multiple-nonnarcotic-users. Our examination of the influences of family and friends was based on a limited number of questions available in the data. Heavier drinking was reported by clients who lived with friends, had family or friends who drank regularly, or had extensive involvement in the drug-use network, including drug sales. No ethnic differences were found.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗