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...on policy issues
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www.ProjectCork.org
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Summer 2007
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A prospective examination of high-cost health services utilization among drug using prisoners re-entering the community.
Leukefeld CG; Hiller ML; Webster JM; Tindall MS; Martin SS; Duvall J et al. Journal of Behavioral Health Services & Research 33(1): 73-85, 2006. (50 refs.)
The use of health services by prisoners during their incarceration and after their return to the community impacts the U.S. health care system and health care costs associated with this system. These health care costs are expected to increase over the next decade as more prisoners return to their communities. The current study prospectively examines the use of high-cost health care services emergency room visits and hospitalizations-among 565 male drug-abusing prisoners about 1 year after prison release. A series of structural equation models were used to examine predisposing factors, including health status and drug use, and to estimate the frequency of high-cost health service utilization. As expected, health status was the most robust predictor of high-cost health services. However, the finding that drug abuse had nonsignificant relationships with high-cost health services utilization was not expected. Discussion focuses on health care service issues and health problems as prisoners' transition from prison to the community. Copyright 2006, Springer.
Alcohol tax cuts and increase in alcohol-positive sudden deaths: A time-series intervention analysis.
Koski A; Siren R; Vuori E; Poikolainen K. Addiction 102(3): 362-368, 2007. (20 refs.)
Aim: The impact of alcohol regulation changes in Finland during 2004 on alcohol-positive sudden deaths was analysed, focusing on: (1) removal of traveller's allowance quotas on alcohol imports from other European Union (EU) countries, (2) lowering of Finnish alcohol excise duty rates and (3) Estonia joining the EU. Design: The impact of these changes was estimated using an autoregressive integrated moving average (ARIMA) analytical technique. Post-mortem forensic toxicology data were analysed over a 15-year period to account for seasonal and long-term variation. In all, the data comprised a weekly series of 33 782 alcohol-positive cases (at least 0.20 mg/g alcohol in blood) and a control series of 37 617 alcohol-negative cases. Setting: Finland in 1990-2004. Findings: The liberation of traveller's allowances had no material impact on alcohol-positive sudden deaths, but the impact of alcohol tax cuts in March 2004 was significant, resulting in an estimated eight additional alcohol-positive deaths per week, which is a 17% increase compared with the weekly average of 2003. The impact associated with Estonia joining the EU was not statistically significant. In the models applied to the control series of alcohol-negative deaths, none of the impact coefficients was statistically significant. Conclusions: Alcohol tax cuts were associated with an increase in the number of sudden deaths involving alcohol. This parallels the reported increases in alcohol consumption and alcohol-related causes of death in 2004 in Finland. Copyright 2007, Society for the Study of Addiction to Alcohol and Other Drugs.
Costs and outcomes of treatments for excessive alcohol consumption: Making policy decisions with the available data.
Gibson A; Shanahan M. Drugs: Education, Prevention and Policy 14(1): 1-17, 2007. (75 refs.)
AIM: To determine which treatments for risky or dependent alcohol consumption provide the best health outcomes for a given expenditure. Methods: Economic evaluation expressing results in cost per unit outcome, from the perspective of the Australian healthcare system. Interventions considered include brief interventions; psychosocial interventions (motivational approaches, cognitive-behavioural approaches and self-guided materials); and pharmacotherapies (acamprosate and naltrexone). Treatment outcomes and standard treatment costs were measured for selected studies, and costs per unit outcome were calculated. Findings: Twenty-nine studies were selected for the analysis. As treatment outcomes were not consistently expressed in a single unit across interventions, two outcomes were used in the analysis: percentage change in alcohol consumption and percentage change in the proportion of abstinent days. Brief interventions provided the best cost per unit outcome, followed by psychosocial interventions, then pharmacotherapies. Conclusions: By using two treatment outcomes instead of one we demonstrated that some treatments for alcohol dependence provide better value for money, but as a result we were unable to complete a formal health economic evaluation. Consistent measurement of alcohol consumption outcomes in research studies would facilitate similar economic evaluations in the future. This work illustrates the difficulties of using research studies with non-comparable outcomes to inform policy on the cost-effectiveness of different treatments. Copyright 2007, Taylor and Francis.
Does substance abuse treatment make a difference for child welfare case outcomes? A statewide longitudinal analysis.
Green BL; Rockhill A; Furrer C. Children and Youth Services Review 29(4): 460-473, 2007. (30 refs.)
Although substance abuse is one of the primary reasons that parents become involved with the child welfare system, there is surprisingly little empirical research that examines the relationship of substance abuse treatment to child welfare outcomes. In this statewide longitudinal study of 1911 women who had children placed in substitute care, we examined the influence of three key factors in the treatment process on child welfare outcomes. Results indicated that when these women entered treatment more quickly, spent more time in treatment, or completed at least one treatment episode, their children spent fewer days in foster care and were more likely to be reunified with their parents. These findings were significant even controlling for families' levels of risk including treatment and child welfare history, substance abuse frequency and chronicity, and demographic risks. Implications of these findings for improvements in the way that treatment services are provided to women in the child welfare system are discussed. Copyright 2007, Elsevier Science.
Harm minimization among teenage drinkers: Findings from an ethnographic study on teenage alcohol use in a rural Danish community.
Jorgensen MH; Curtis T; Christensen PH; Gronbaek M. Addiction 102(4): 554-559, 2007. (20 refs.)
Aim To examine strategies of harm minimization employed by teenage drinkers. Design, setting and participants Two periods of ethnographic fieldwork were conducted in a rural Danish community of approximately 2000 inhabitants. The fieldwork included 50 days of participant observation among 13-16-year-olds (n = 93) as well as 26 semistructured interviews with small self-selected friendship groups of 15-16-year-olds (n = 32). Findings The teenagers participating in the present study were more concerned about social than health risks. The informants monitored their own level of intoxication, but in order to reduce alcohol consumption they depended upon support from their peers. The informants preferred drinking in the company of well-known and trusted peers, and during drinking episodes they supervised and intervened in each others' drinking to the extent that they deemed it necessary and possible. In regulating the social context of drinking they relied on their personal experiences more than on formalized knowledge about alcohol and harm, which they had learned from prevention campaigns and educational programmes. Conclusions: In this study we found that teenagers may help each other to minimize alcohol-related harm, and teenage peer groups should thus be considered a resource for health promotion. Copyright 2007, Society for the Study of Addiction to Alcohol and Other Drugs.
Counselor turnover in substance abuse treatment centers: An organizational-level analysis.
McNulty TL; Oser CB; Johnson JA; Knudsen HK; Roman PM. Sociological Inquiry 77(2): 166-193, 2007. (85 refs.)
This article draws on institutional and ecological perspectives on work and organizations to develop a workplace level model of variation in voluntary counselor turnover rates across privately funded substance abuse treatment centers in the United States. Results show that participatory management structures reduce turnover rates principally by promoting organizational commitment. The analysis also tests hypotheses regarding the effects on turnover rates of other relevant theoretic domains of treatment center structure and organization. We discuss theoretical implications of the findings and suggest directions for future research. Copyright 2007, Blackwell Publishing.
Magazine alcohol advertising compliance with the Australian Alcoholic Beverages Advertising Code.
Donovan K; Donovan R; Howat P; Weller N. Drug and Alcohol Review 26(1): 73-81, 2007. (38 refs.)
The purpose of this study was to assess the frequency and content of alcoholic beverage advertisements and sales promotions in magazines popular with adolescents and young people in Australia, and assess the extent to which the ads complied with Australia's self-regulatory Alcoholic Beverages Advertising Code (ABAC). Alcohol advertisements and promotions were identified in a sample of 93 magazines popular with young people. The identified items were coded against 28 measures constructed to assess the content of the items against the five sections of the ABAC. Two thirds of the magazines contained at least one alcohol advertisement or promotion with a total of 142 unique items identified: 80 were brand advertisements and 62 were other types of promotional items (i.e. sales promotions, event sponsorships, cross promotions with other marketers and advertorials). It was found that 52% of items appeared to contravene at least one section of the ABAC. The two major apparent breaches related to section B-the items having a strong appeal to adolescents (34%) and to section C-promoting positive social, sexual and psychological expectancies of consumption (28%). It was also found that promotional items appeared to breach the ABAC as often as did advertisements. It is concluded that the self-regulating system appears not to be working for the alcoholic beverages industry in Australia and that increased government surveillance and regulation should be considered, giving particular emphasis to the inclusion of promotional items other than brand advertising. Copyright 2007, Taylor and Francis.
Five in a row -- reactions of smokers to tobacco tax increases: Population-based cross-sectional studies in Germany 2001-2006.
Hanewinkel R; Isensee B. Tobacco Control 16(1): 34-37, 2007. (21 refs.)
Objective: To assess reactions of smokers to five waves of tobacco tax increases in Germany. Design: A 10-wave cross-sectional study, with assessments before and after the tax increases. Setting: General population of Germany. Participants and methods: 10 representative samples from the general population with a total number of 27 608 people aged >= 14 years, including 8548 smokers ( 31% of the total sample), were interviewed. Outcome measures: Reflection on smoking behaviour, and smoking behaviour ( quitting, reducing, switching to a cheaper brand or no change) before and after tobacco tax increases. Results: Before the tax increases, one third to more than half of the smokers reflected on their smoking behaviour, 9.7 - 13.9% intended to quit, 23.4 - 34.7% intended to reduce smoking and 10.8 - 16.4% intended to switch to cheaper tobacco products, whereas 36.1 - 52.1% did not intend any change at all. After the tax increases, one fourth to more than one third reported to have reflected on their smoking behaviour, 4.0 - 7.9% quit smoking owing to the increase, 11.5 - 16.6% reduced consumption and 11.0 - 19.9% switched to cheaper products. Significant associations were found between the height of the price increase and the intentions and reactions of smokers. Conclusions: Price increases lead to a substantial reflection on smoking and intended and realised behaviour changes such as reduced consumption and switching to cheaper tobacco products. These effects are more pronounced the more the price rises. Therefore, taxation policy will lead to quitting and reducing smoking. However, complementary measures should also be taken to prevent smokers switching to cheaper tobacco products, which would reduce the effectiveness of taxation policy. Copyright 2007, British Medical Journal Publ.
'Mr Police Officer, I thought cannabis was legal' - Introducing new policy regarding cannabis in Belgium: A story of good intentions and Babel.
Gelders D; Laenen FV. Drugs: Education, Prevention and Policy 14(2): 103-116, 2007. (18 refs.)
Over the last five years, the announced new policy on drugs, cannabis in particular, has been the subject of much debate within the Belgian Federal Government and between the government and the opposition parties. Unclear policies and poor public communication from the Federal Government, the competent minister and the other parties caused immense confusion about whether and when the possession of cannabis would be legal and what the criteria would be for prosecution when found possessing cannabis. This confusion has been illustrated by a survey by Gelders and Van Mierlo (2004) Legalized or not? Poor public communication causes confusion over the new cannabis policy in Belgium. Drugs: Education, Prevention and Policy, 2, 167-177. Aims: (1) to present the most relevant policy developments specifically from the last two years, and (2) to determine whether there is still confusion and to assess the knowledge of young people about current prosecution practices. Methods: (1) an analysis of policy documents and legal texts, and (2) a more up-to-date survey among 748 Belgian youngsters. Findings: only 35.1% answered the basic-knowledge questions correctly while 59.2% assessed the prosecution practice in an appropriate manner. Conclusion: there is still a lot of confusion regarding the current cannabis legislation and prosecution. Copyright 2007, Taylor & Francis.
Program use of effective drug abuse treatment practices for juvenile offenders.
Henderson CE; Young DW; Jainchill N; Hawke J; Farkas S; Davis RM. Journal of Substance Abuse Treatment 32(3): 279-290, 2007. (89 refs.)
This study examined the extent to which organizational context predicted use of consensus-based elements of effective substance abuse treatment practices with juvenile offenders. Participants were either directors of substance abuse treatment programs located in residential facilities (institutional sample) or directors of community-based treatment agencies providing services to adolescents in their home communities (community sample). The two settings differed significantly in the number and types of effective practices they were using. Community programs were more likely to have staff qualified to deliver substance abuse treatment, involve families in treatment, and assess their treatment outcomes. In contrast, institutional programs were more likely to provide comprehensive services. Resources dedicated to training, internal support for new programming, and network connectedness with non-criminal-justice facilities were associated with greater use of effective practices. This highlights the need to establish corrections-community partnerships. Copyright 2007, Elsevier Science.
What do we get for our money? Cost-effectiveness of adding contingency management.
Sindelar, J.; Elbel, B.; Petry, NM. Addiction 102(2): 309-316, 2007. (33 refs.)
To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse. Design Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial. Setting Two community-based treatment centers. Participants Patients (n = 120) enrolled in out-patient treatment for cocaine abuse. Intervention Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won. Measurements Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure werederived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence: (2) percentage completing treatment; and (3) percentage of samples drug-free. Findings : The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis. Conclusions Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness. Copyright 2007, Society for the Study of Addiction to Alcohol and Other Drugs
The effect of the threat of legal sanction on program retention and completion: Is that why they stay in drug court?
Hepburn JR; Harvey AN. Crime & Delinquency 53(2): 255-280, 2007. (82 refs.)
Drug courts routinely rely on the threat of legal sanction to motivate drug-using criminal offenders to enter and complete community-based treatment programs. In light of the high failure rates among drug court participants, what is the effect of the threat of legal sanction on program retention and completion? A quasiexperimental research design was used to study program retention and completion within two adult drug courts that employed the same staff to administer identical treatment and supervision programs in the same jurisdiction. One court relied on a 120-day suspended sentence to coerce program participation, whereas the other court was prohibited by law from imposing a jail sentence on its participants. Using alternative measures of program retention, a single measure of program completion, and controls for salient sociodemographic and criminal history factors, the analysis found no differences in program retention or completion between the two courts. Copyright 2007, Sage Publications.
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