Pilot Program of Research to Integrate Substance Abuse Issues into Mainstream Medicine (PRISM)

An RWJF National Program

Field of Work: Encouraging physicians and health care researchers to address the effects of alcohol and drug abuse on serious chronic illnesses.

Problem Synopsis: Chronic diseases such as diabetes, hypertension and sleep disorders are involved in more than 70 percent of all health care received by adults. Between 25 and 35 percent of adults receiving care for medical problems abuse alcohol or drugs. An additional 15 percent are addicted to alcohol or drugs. Medically harmful alcohol or drug use by patients with chronic diseases leads to misdiagnoses, poor adherence to prescribed care, unexpected side effects from prescribed medications, poorer outcomes and greater cost. Nonetheless, many clinicians and researchers who treat chronic diseases know little about the effects of substance use on management of these diseases and are unaware of ways to address substance use in their patients.

Synopsis of the Work: The Pilot Program of Research to Integration Substance Abuse Issues into Mainstream Medicine (PRISM) (January 2004 through September 2007) commissioned 10 systematic reviews of studies that analyzed the relationship between alcohol or drug use and chronic illnesses and conditions and selected five research projects for funding that analyzed the relationship between alcohol and drug use and sleep disorders, hypertension, breast cancer, type II diabetes and coronary artery risk.

Key Findings

  • According to the researchers associated with the various projects:

    • Among men, level of alcohol consumption was associated with mild or worse sleep-disordered breathing. There was no significant association between alcohol use and sleep-disordered breathing or other sleep problems among women.
    • People who drink three or more drinks per day were more likely to suffer from hypertension than people who do not drink.
    • Among people with normal blood pressure at baseline, former drinkers (who had not consumed alcohol for at least one year) were significantly more likely to have hypertension after five years than moderate drinkers.
    • Light or moderate drinking is associated with decreased hypertension among European Americans but not among African Americans.
    • Among sisters who either had breast cancer themselves or did not have breast cancer but had a sister who did, there was a 30 percent increased risk of breast cancer from drinking about one drink per day. Among unrelated women, there was no apparent overall effect of alcohol drinking on breast cancer.

Key Communications

  • The systematic reviews yielded 10 papers published in peer-reviewed journals, while funded research projects yielded one book chapter, 13 articles and presentations at two national meetings.

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