Predictors of engagement in continuing care following residential substance use disorder treatment

Center for Health Care Evaluation, VA Palo Alto Health Care System, CA, USA.
Drug and Alcohol Dependence (Impact Factor: 3.42). 10/2006; 84(1):93-101. DOI: 10.1016/j.drugalcdep.2005.12.010
Source: PubMed


Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment.
Patients (n=3032) at 15 geographically diverse SUD residential treatment programs provided data on demographics, symptom patterns, recovery resources, and perceptions of treatment environment. We identified patient characteristics associated with the number of consecutive months of engagement in continuing care. We then consolidated and classified risk factors into an integrated model.
Being African American, having more SUD and psychiatric symptoms, more resources for recovery, and perceiving the treatment staff as being supportive were associated with longer engagement in continuing care. African Americans' engagement in continuing care was 17% longer than Caucasians'. The positive effect of being African American was partially mediated by having taken actions toward changing use, and by the presence of psychotic symptoms.
These results extend previous research on the predictors of continuing care engagement after residential SUD programs. Clinicians can use information about characteristics that put patients at risk for shorter engagement in continuing care to target patients who might benefit from interventions to increase engagement in continuing care.

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    • "Although it has been operationalized differently, continuity has been adopted as a quality measure by the Department of Veterans Affairs (Harris et al. 2006; Schaefer et al. 2004; Schaefer et al. 2008), the American Society on Addiction Medicine (ASAM) and the American Psychological Association. In addition, rapid re-admissions into acute care services are also considered problematic because they signify lack of clinical progress, consume expensive resources and can be a marker of inadequate or insufficiently effective community services (Barnett and Swindle 1997; Mattick and Hall 1996; Mertens et al. 2005; Thakur et al. 1998). "
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    • "Several studies have developed and investigated methods to increase both patient involvement/participation and treatment retention. A number of correlational and quasi-experimental studies 5 (e.g., Harris et al. 2006; Schaefer et al. 2005; Hitchcock et al. 1995; Schmitt et al. 2003) have investigated factors that predict involvement and retention in continuing care. These analyses identified a wide range of variables that may have an influence. "
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