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Substance dependence (SD) is a chronic disease that requires specialty drug and alcohol treatment, primary care (PC), and management of related problems. Although patients with SD may be linked with specialty care and PC, their health care often remains episodic and fragmented, rather than longitudinal, comprehensive, integrated, and coordinated. As a result, adults with SD often enter addiction treatment later and require acute medical care, rather than entering the system earlier when interventions of lower intensity but longer duration might prevent catastrophes. Chronic disease management (CDM) is a collaborative, longitudinal approach to treatment of certain chronic medical illnesses proven to be more effective than routine care. CDM addresses individual patient and health systems barriers to receipt of needed treatment. However, the effectiveness of CDM for SD has not been tested. The objective of this Addiction Health Evaluation and Disease management (AHEAD) study, was to test the effectiveness of CDM for SD in PC.

Subject identification and recruitment occurred primarily at a local detoxification center, as well as by self and physician referral from the Boston Medical Center primary and ambulatory care clinics, emergency department, urgent care center, inpatient settings, and the community. The study enrolled 320 adults with drug dependence and 320 adults with alcohol dependence who were not in SD treatment, and randomized them to a SD CDM program (the AHEAD Clinic) integrated into a real-world PC clinic or to referral to standard PC. All subjects were assessed regarding SD diagnosis, substance use and problems, readiness to change, health-related quality of life, and medical and drug treatment utilization. Subjects were evaluated 3, 6, and 12 months later, and health services utilization data were collected for 2 years from a statewide database. Additionally, in order to better understand and explain the implementation and fidelity of the AHEAD Clinic, the primary care providers (PCPs) of AHEAD Clinic patients were surveyed. Each PCP was presented with a letter from the Principal Investigator explaining the purpose of the survey, the reason why s/he was being asked to complete the survey, compensation for completing the survey, and details about confidentiality and anonymity. The survey itself consisted of questions asking providers about their satisfaction and their attitudes towards caring for patients with alcohol and drug problems, their knowledge of services that the AHEAD Clinic provides, and their experience working with the AHEAD Clinic.

Primary outcomes were illicit drug use, alcohol use, substance-related problems, emergency department visits, and hospitalizations. The proposal's hypothesis was that compared with standard care, a health services delivery intervention (CDM for SD integrated in PC) would decrease alcohol and illicit drug use and related problems, and improve health care utilization patterns. Improved outcomes using the AHEAD approach would support the adoption of a health services delivery strategy, CDM, to better care for patients with SD.

• Dataset 1: 844 variables; 563 cases
• Dataset 2: 607 variables; 500 cases
• Dataset 3: 607 variables; 487 cases
• Dataset 4: 713 variables; 532 cases
• Dataset 5: 80 variables; 549 cases
• Dataset 6: 59 variables; 1,435 cases
• Dataset 7: 25 variables; 87 cases
• Dataset 8: 25 variables; 87 cases
• Dataset 9: 41 variables; 73 cases
• Dataset 10: 9 variables; 11,018 cases
• Dataset 11: 5 variables; 511 cases

The Biomarker study is Project 4 of the Midlife in the United States (MIDUS) longitudinal study, a national survey of more than 7,000 Americans (aged 25 to 74) begun in 1994. The purpose of the larger study was to investigate the role of behavioral, psychological, and social factors in understanding age-related differences in physical and mental health. With support from the National Institute on Aging (NIA), a longitudinal follow-up of the original MIDUS samples [core sample (N = 3,487), metropolitan over-samples (N = 757), twins (N = 957 pairs), and siblings (N = 950)] was conducted in 2004-2006. Guiding hypotheses, at the most general level, were that behavioral and psychosocial factors are consequential for health (physical and mental). A description of the study and findings from it are available on the MIDUS website.

The Biomarker Project (Project 4) of MIDUS 2 contains data from 1,255 respondents. These respondents include two distinct subsamples, all of whom completed the Project 1 Survey: (1) longitudinal survey sample (n = 1,054) and (2) Milwaukee sample (n = 201). The Milwaukee group contained individuals who participated in the baseline MIDUS Milwaukee study, initiated in 2005. The purpose of the Biomarker Project (Project 4) was to add comprehensive biological assessments on a subsample of MIDUS respondents, thus facilitating analyses that integrate behavioral and psychosocial factors with biology. The broad aim is to identify biopsychosocial pathways that contribute to diverse health outcomes. A further theme is to investigate protective roles that behavioral and psychosocial factors have in delaying morbidity and mortality, or in fostering resilience and recovery from health challenges once they occur. The research was not disease-specific, given that psychosocial factors have relevance across multiple health endpoints.

Biomarker data collection was carried out at three General Clinical Research Centers (at UCLA, University of Wisconsin, and Georgetown University). The biomarkers reflect functioning of the hypothalamic-pituitary-adrenal axis, the autonomic nervous system, the immune system, cardiovascular system, musculoskeletal system, antioxidants, and metabolic processes. Our specimens (fasting blood draw, 12-hour urine, saliva) allow for assessment of multiple indicators within these major systems. The protocol also included assessments by clinicians or trained staff, including vital signs, morphology, functional capacities, bone densitometry, medication usage, and a physical exam. Project staff obtained indicators of heart-rate variability, beat to beat blood pressure, respiration, and salivary cortisol assessments during an experimental protocol that included both a cognitive and orthostatic challenge. Finally, to augment the self-reported data collected in Project 1, participants completed a medical history, self-administered questionnaire, and self-reported sleep assessments. For respondents at one site (UW-Madison), objective sleep assessments were also obtained with an Actiwatch(R) activity monitor.

The MIDUS Refresher study Survey (2011-2014 ICPSR 36532) recruited a national probability sample of 3,577 adults, aged 25 to 74, designed to replenish the original MIDUS 1 baseline cohort and paralleling the five decadal age groups of the MIDUS 1 baseline survey (ICPSR 2760). The MIDUS Refresher survey employed the same comprehensive assessments as those assembled on the core longitudinal MIDUS sample, but with additional questions about impacts of the economic recession of 2008-09. The MIDUS Refresher Biomarker study (2012-2016) obtained data from 863 respondents (n=746 Main sample, n=117 African Americans from Milwaukee) who completed the MIDUS Refresher Survey.

The purpose of the Refresher Biomarker Project (Project 4) parallels that of the MIDUS 2 Biomarker project (ICPSR 29282), which collected comprehensive biological assessments on a subsample of MIDUS respondents, thus facilitating analyses that integrate behavioral and psychosocial factors with biological regulation/dysregulation, broadly defined. The aim was to use such data to explicate biopsychosocial pathways that contributed to diverse health outcomes. A further theme was to examine period effects on health (mental and physical) related to the economic recession by comparing the pre-recession MIDUS sample with the post-recession MIDUS Refresher sample. A further objective of the MIDUS Refresher sample was to strengthen cross-project analyses by increasing the sample sizes available for testing hypotheses regarding the interplay of key factors (e.g., socioeconomic status, gender, psychosocial factors, biological factors) in mid- and later-life health.

Biomarker data collection was carried out at hypothalamic-pituitary-adrenal axis, the autonomic nervous system, the immune system, cardiovascular system, musculoskeletal system, antioxidants, and three General Clinical Research Centers (at UCLA, University of Wisconsin, and Georgetown University). The biomarkers reflect functioning of the metabolic processes. Our specimens (fasting blood draw, 12-hour urine, saliva) allowed for assessment of multiple indicators within these major systems. The protocol also included assessments by clinicians or trained staff, including vital signs, morphology, functional capacities including 3 dimensional gait analysis, bone densitometry, body composition, ankle brachial index, medication usage, and a physical exam. Project staff obtained indicators of heart-rate variability, beat to beat blood pressure, respiration, and salivary cortisol assessments during an experimental protocol that included both a cognitive and orthostatic challenge. Finally, to augment the self-reported data collected in Survey (Project 1), participants completed a medical history, self-administered questionnaire, and self-reported sleep assessments. For respondents at one site (UW-Madison), objective sleep assessments were also obtained with an Actiwatch(R) activity monitor.

The Study of Women's Health Across the Nation (SWAN), is a multi-site longitudinal, epidemiologic study designed to examine the health of women during their middle years. The study examines the physical, biological, psychological, and social changes during this transitional period. The goal of SWAN's research is to help scientists, health care providers, and women learn how mid-life experiences affect health and quality of life during aging. The data include questions about doctor visits, medical conditions, medications, treatments, medical procedures, relationships, smoking, and menopause related information such as age at pre-, peri- and post-menopause, self-attitudes, feelings, and common physical problems associated with menopause.

The study is co-sponsored by the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), the National Institutes of Health (NIH), and the NIH Office of Research on Women's Health. The study began in 1994. Between 1996 and 1997, 3,302 participants joined SWAN through 7 designated research centers. The research centers are located in the following communities: Detroit, MI; Boston, MA; Chicago, IL; Oakland and Los Angeles, CA; Newark, NJ; and Pittsburgh, PA. SWAN participants represent five racial/ethnic groups and a variety of backgrounds and cultures. This is the next phase of data collection after the original collection of the screening data (ICPSR 4368).

The Study of Women's Health Across the Nation (SWAN) is a multi-site longitudinal, epidemiologic study designed to examine the health of women during their middle years. The study examines the physical, biological, psychological, and social changes during this transitional period. The goal of SWAN's research is to help scientists, health care providers and women learn how mid-life experiences affect health and quality of life during aging. The data include questions about doctor visits, medical conditions, medications, treatments, medical procedures, relationships, smoking, and menopause related information such as age at pre-, peri- and post-menopause, self-attitudes, feelings, and common physical problems associated with menopause.

The study is co-sponsored by the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), the National Institutes of Health (NIH), and the NIH Office of Research on Women's Health. The study began in 1994. Between 1997 and 1999, 2,881 of the 3,302 women that joined SWAN were seen for their first follow-up visit. The research centers are located in the following communities: Detroit, MI; Boston, MA; Chicago, IL; Oakland and Los Angeles, CA; Newark, NJ; and Pittsburgh, PA. SWAN participants represent five racial/ethnic groups and a variety of backgrounds and cultures.