Impact of Program Services on Treatment Outcomes of Patients With Comorbid Mental and Substance Use Disorders

Department of Psychology, UCLA, Los Angeles, CA 90025, USA.
Psychiatric Services (Impact Factor: 2.41). 08/2006; 57(7):1007-15. DOI: 10.1176/
Source: PubMed


This study examined the outcomes of individuals with co-occurring disorders who received drug treatment in programs that varied in their integration of mental health services. Patients treated in programs that provided more on-site mental health services and had staff with specialized training were expected to report less substance use and better psychological outcomes at follow-up.
Participants with co-occurring disorders were sampled from 11 residential drug abuse treatment programs for adults in Los Angeles County. In-depth assessments of 351 patients were conducted at treatment entry and at follow-up six months later. Surveys conducted with program administrators provided information on program characteristics. Latent variable structural equation models revealed relationships of patient characteristics and program services with drug use and psychological functioning at follow-up.
Individuals treated in programs that provided specific dual diagnosis services subsequently had higher rates of utilizing mental health services over six months and, in turn, showed significantly greater improvements in psychological functioning (as measured by the Brief Symptom Inventory and the RAND Health Survey 36-item short form) at follow-up. More use of psychological services was also associated with less heroin use at follow-up. African Americans reported poorer levels of psychological functioning than others at both time points and were less likely to be treated in programs that provided mental health services.
Study findings support continued efforts to provide specialized services for individuals with co-occurring disorders within substance abuse treatment programs as well as the need to address additional barriers to obtaining these services among African Americans.

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    • "The presence of drug or alcohol craving [10,14,17] also is associated with a lower completion rate. Programs that encourage treatment of dual disorders improve outcomes in patients with dual diagnosis [18,19]. "
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    ABSTRACT: Background A person-centered substance use treatment component, the Natural Recovery Program, was developed. The Natural Recovery Program is comprised of small group therapy combined with pursuit of hobbies. Methods This was a pilot study of the program and was not randomized. A retrospective record review of 643 veterans in an inpatient mental health recovery and rehabilitation program was analyzed to determine if participants of Natural Recovery had a different rate of treatment completion than those who elected to participate in the core program alone. Univariate and multivariate analyses were conducted on: participation in the Natural Recovery Program; co-morbid psychiatric disorders; and legal, medical, and psychiatric issues. Results Participation in Natural Recovery was significantly associated with successful treatment completion when analyzed by univariate analysis (p = 0.01). Other significant variables associated with successful completion included: no co-morbid psychiatric diagnosis, fewer prior suicide attempts, and no homelessness prior to admission. Binary logistic regression demonstrated that participation in Natural Recovery was associated with improved treatment completion, even when other variables were considered (p = 0.01). Treatment retention was longer for patients who participated in Natural Recovery, even if they did not complete treatment. Conclusions The Natural Recovery Program was associated with improved outcomes, as measured by treatment retention in the first 60 days and by treatment completion. Participants of Natural Recovery with co-morbid psychiatric disorders completed treatment at a higher rate than those with co-morbid psychiatric disorders who participated in the core program. Patients reported high satisfaction with the program. This program may be a valuable adjunct to residential treatment.
    Addiction science & clinical practice 05/2014; 9(1):7. DOI:10.1186/1940-0640-9-7
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    • "Furthermore, among patients who were referred to substance abuse treatment, a delay in the referral process after SUDs were identified and was associated with a decreased likelihood of depression improvement. The observed associations between substance abuse treatment referral and depression improvement lend support to prior research suggesting that patients with co-occurring disorders would benefit from concurrent treatment for these disorders and that sequential treatment may result in suboptimal outcomes for either disorder (Baker et al., 2010; Burnam & Watkins, 2006; Cucciare, Boden, & Weingardt, 2013; Grella & Stein, 2006; Jaffee et al., 2009; Pettinati et al., 2010). When treatment of depression is supplemented with substance abuse treatment, better treatment outcomes were achieved. "
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    ABSTRACT: This study examined the relationship between substance treatment referrals and depression improvement among 2,373 participants with concurrent substance use and depressive disorders enrolled in an integrated behavioral health program. Three groups of substance treatment referral status were identified: accessed treatment (n=780), declined treatment (n=315), and no referral for treatment (n=1278). The primary outcome is improvement in depressive symptoms (PHQ-9<10 or≥50% reduction). Using propensity score adjustments, patients accessing substance treatment were significantly more likely to achieve depression improvement than those who declined receiving treatment services (hazard ratio (HR)=1.82, 95% confidence interval (CI): 1.50-2.20, p<0.001) and those without a referral for treatment (HR=1.13, 95% CI: 1.03-1.25, p=0.014). Each 1week delay in initiating a referral was associated with a decreased likelihood of depression improvement (HR=0.97, 95% CI: 0.96-0.98, p<0.001). Study findings highlight the need of enhancing early treatment contact for co-occurring substance use disorders in primary care.
    Journal of substance abuse treatment 10/2013; 46(2). DOI:10.1016/j.jsat.2013.08.016 · 2.90 Impact Factor
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    • "As such, these findings can inform policy for large systems of care that seek to use current program utilization and evaluation data to determine treatment effectiveness among publicly funded substance abuse treatment programs. Overall, study findings highlight the need for the application of evidence-based engagement treatment practices (e.g., motivational interviewing, assertive community case management, housing first approaches) for specific racial and ethnic groups during the early stages of their treatment careers (Grella & Stein, 2006). By understanding the unique services needs of racial and ethnic minority clients with different treatment careers, we can develop tailored pathways to recovery with the goal of eliminating health disparities. "
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    ABSTRACT: Women and racial and ethnic minorities face significant challenges to successfully completing substance abuse treatment. There is limited knowledge about factors that affect women and minorities' treatment careers over several treatment episodes. Survival Cox regression was used to model time and episodes to treatment completion. Using multiyear (2006–2009) data, the sample consisted of 52,799 clients from 276 treatment programs in Los Angeles County, California. Findings supported the role of homelessness and mental health status and their association with more episodes to complete treatment. Results also showed that the rate of completion was 41% lower among African Americans and 17% lower among Latinos compared to Whites. With each additional treatment episode, the rate of treatment completion increased by 73% for all groups. Compared to minorities, Whites and men were more likely to complete treatment throughout their treatment career trajectories. Implications for social work interventions to enhance treatment adherence and reduce disparities are discussed.
    Journal of Social Work Practice in the Addictions 07/2013; 13(3):227-243. DOI:10.1080/1533256X.2013.812011
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