Integrating Substance Abuse Care With Community Diabetes Care: Implications for Research and Clinical Practice.

Integrating substance abuse care with community diabetes care: implications for research and clinical practice.

Filed under: Addiction Rehab

Subst Abuse Rehabil. 2013 Jan 1; 4: 3-10
Ghitza UE, Wu LT, Tai B

Cigarette smoking and alcohol use are prevalent among individuals with diabetes in the US, but little is known about screening and treatment for substance use disorders in the diabetic population. This commentary discusses the scope and clinical implications of the public health problem of coexisting substance use and diabetes, including suggestions for future research. Diabetes is the seventh leading cause of death in the US, and is associated with many severe health complications like cardiovascular disease, stroke, kidney damage, and limb amputations. There are an estimated 24 million adults in the US with type 2 diabetes. Approximately 20% of adults aged 18 years or older with diabetes report current cigarette smoking. The prevalence of current alcohol use in the diabetic population is estimated to be around 50%-60% in epidemiological surveys and treatment-seeking populations. Cigarette smoking is associated with an increased risk of type 2 diabetes in a dose-dependent manner and is an independent modifiable risk factor for development of type 2 diabetes. Diabetic patients with an alcohol or other drug use disorder show a higher rate of adverse health outcomes. For example, these patients experience more frequent and severe health complications as well as an increased risk of hospitalization, and require longer hospital stays. They are also less likely to seek routine care for diabetes or adhere to diabetes treatment than those without an alcohol or other drug use disorder. The Affordable Care Act of 2010 and the Mental Health Parity Act and Addiction Equity Act of 2008 provide opportunities for facilitating integration of preventive services and evidence-based treatments for substance use disorders with diabetes care in community-based medical settings. These laws also offer emerging areas for research.
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Risk Factors for Problem Gambling Among Indigenous Australians: An Empirical Study.

Filed under: Addiction Rehab

J Gambl Stud. 2013 Feb 2;
Hing N, Breen H, Gordon A, Russell A

Despite a long history of gambling amongst many Indigenous peoples, knowledge about contemporary Indigenous gambling is sparse. In Australia, previous studies of Indigenous gambling have been severely limited in number, scope and rigour. The research reported in this paper is based on the first Indigenous-specific quantitative gambling research undertaken in Australia since 1996 and draws on the largest sample to date. This study examined numerous aspects of gambling among Indigenous Australians. After appropriate consultations and permission, the study collected surveys from 1,259 self-selected Indigenous adults in 2011 at three Indigenous festivals, online and in several Indigenous communities. This paper draws on these data to identify problem gambling risk factors by comparing selected socio-demographic characteristics, early exposure to gambling, gambling motivations, gambling behaviour, gambling cognitions, and substance use while gambling, amongst non-problem, low risk, moderate risk and problem gamblers. A logistic regression investigated the difference between problem gamblers and all other PGSI groups. Risk factors associated with being a problem gambler were: being older, commencing gambling when under 10 years old, always being exposed to adults gambling as a child, using alcohol and/or drugs while gambling, having family and friends who gamble, having an addiction to gambling and not gambling to socialise, having a high expenditure on commercial gambling, and living in a state or territory other than NSW or QLD. Public health measures to address these risk factors are identified.
HubMed – addiction


The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders.

Filed under: Addiction Rehab

Am J Psychiatry. 2013 Feb 1; 170(2): 180-7
Busch AB, Yoon F, Barry CL, Azzone V, Normand SL, Goldman HH, Huskamp HA

OBJECTIVE The Mental Health Parity and Addiction Equity Act requires insurance parity for mental health/substance use disorder and general medical services. Previous research found that parity did not increase mental health/substance use disorder spending and lowered out-of-pocket spending. Whether parity’s effects differ by diagnosis is unknown. The authors examined this question in the context of parity implementation in the Federal Employees Health Benefits (FEHB) Program. METHOD The authors compared mental health/substance use disorder treatment use and spending before and after parity (2000 and 2002, respectively) for two groups: FEHB enrollees diagnosed in 1999 with bipolar disorder, major depression, or adjustment disorder (N=19,094) and privately insured enrollees unaffected by the policy in a comparison national sample (N=10,521). Separate models were fitted for each diagnostic group. A difference-in-difference design was used to control for secular time trends and to better reflect the specific impact of parity on spending and utilization. RESULTS Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder (-$ 62, 99.2% CI=-$ 133, -$ 11). Out-of-pocket spending decreased for all three groups (bipolar disorder: -$ 148, 99.2% CI=-$ 217, -$ 85; major depression: -$ 100, 99.2% CI=-$ 123, -$ 77; adjustment disorder: -$ 68, 99.2% CI=-$ 84, -$ 54). Total annual utilization (e.g., medication management visits, psychotropic prescriptions, and mental health/substance use disorder hospitalization bed days) remained unchanged across all diagnoses. Annual psychotherapy visits decreased significantly only for individuals with adjustment disorders (-12%, 99.2% CI=-19%, -4%). CONCLUSIONS Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more severe or chronic and reduced for diagnoses expected to be less so.
HubMed – addiction


Development of a gambling addictive behavior scale for adolescents in Korea.

Filed under: Addiction Rehab

J Korean Acad Nurs. 2012 Dec; 42(7): 957-64
Park HS, Jung SY

This study was conducted to develop a gambling addictive behavior scale for adolescents.The process involved construction of a conceptual framework, initial item search, verification of content validity, selection of secondary items, and extraction of final items. The participants were 299 adolescents from two middle schools and four high schools. Item analysis, factor analysis, criterion validity, internal consistency, and ROC curve were used to analyze the data.For the final scale, 25 items were selected, and categorized into 4 factors which accounted for 54.9% of the total variance. The factors were labeled as loss of control, life dysfunction from gambling addiction, gambling experience, and social dysfunction from problem gambling. The scores for the scale were significantly correlated with addictive personality, irrational gambling belief, and adolescent’s gambling addictive behavior. Cronbach’s alpha coefficient for the 25 items was .94. Scale scores identified adolescents as being in a problem gambling group, a non-problem gambling group, and a non-gambling group by the ROC curve.The above findings indicate that the gambling addictive behavior scale has good validity and reliability and can be used with adolescents in Korea.
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