No abstract

No abstract

No abstract

Introduction: Treatment completion is associated with a better outcome in substance use disorders. We examined the rates of treatment completion and its predictors in patients admitted to specialized addiction treatment settings over a 13-year period. Methods: Ours was a retrospective cohort study. We included consecutive 2850 patients admitted to the inpatient treatment between January 2007 and December 2019. We divided the patients into 2 groups: completed versus premature discontinuation of treatment. The predictor variables were based on previous research, clinical experience, and availability of the digital record. Results: The number of patients who completed and discontinued treatments was 1873 (72.6%) and 707 (27.4%), respectively. The inpatient treatment discontinuation rate varied widely during the study period (18% in 2007 and 41% in 2012). The average rate of treatment discontinuation was 27%. The change-point analysis showed 5 statistically significant change points in the years 2008, 2010, 2012, 2014, and 2016. Patients who were prescribed medications for alcohol and opioid dependence and those who were on opioid agonist treatment had 4.7 and 6.3 higher odds of completing inpatient treatment than those who were not on medication. Patients with physical and psychiatric comorbidities had higher odds of treatment completion. Patients with a primary diagnosis of opioid dependence had lower odds of treatment completion than those with alcohol dependence. Conclusions: The rates of discontinuation may vary with concurrent changes in the treatment policies. Awareness of the risk factors and policy measures that may improve treatment completion must aid in informed decision making.

BPD) at 12 weeks in subsamples of people who were adherent with medication during this period, those without coexisting substance misuse, and those who had a recent history of deliberate self-harm. While conducting this analysis, we identified a typographical error that appeared in our article (1) but not in the monograph that has subsequently been published that provides additional information about the trial (2). The number of participants in the placebo arm of the trial who reported deliberate self-harm in the 6 months prior to randomization was 87 (63%), not 51 (37%) as erroneously stated in our article. Among 98 participants who did not report substance misuse at baseline, the difference in the mean ZAN-BPD score at 12 weeks between those prescribed lamotrigine and those prescribed placebo was 0.90 (95% CI521.56 to 3.37). Among 181 participants who adhered to study medication during the first 12 weeks, the difference in the mean ZAN-BPD score between those prescribed lamotrigine and those prescribed placebo was 0.52 (95% CI5 22.41 to 1.36), and among the 143 participants who reported deliberate self-harm at baseline, the difference in the mean ZAN-BPD score at 12 weeks between those prescribed lamotrigine and those prescribed placebo was 20.60 (95% CI522.73 to 1.54).Since the publication of the results of the LABILE trial, many people have told us of their surprise that the study generated negative findings and have asked us whether there was something about the group we recruited or the design of the trial that led to this result. In keeping with findings from previous research examining the views of psychiatrists (3), some clinicians have told us that they have seen firsthand how people with borderline personality disorder make a good response when prescribed medication. However, we would argue that this experience is entirely in keeping with the results of the LABILE trial that demonstrate that, when people are offered clear information by staff who provide structured follow-up, there are likely to be clinically important reductions in symptoms of emotional distress.