Background: The impact of dual pathology on treatment outcomes is unclear, with the literature reporting both favorable and unfavorable evidence. The main aim of this study was to determine how dual pathology affects treatment outcomes using real world data obtained from inpatients that began treatment in therapeutic communities. Method: The data of 2458 inpatients were used. Clinical information was obtained from electronic medical records. Reliability of diagnosis was checked and revealed a mean kappa value of 0.88. Results: Of the sample, 41.8% were discharged after achieving the therapeutic objectives. Patients diagnosed with Cluster B personality disorders were found to have a higher risk of dropping out of treatment (HR = 1.320; z = 2.61; p = 0.009). Conclusions: Personality traits exhibited by Cluster B patients can interfere with treatment in therapeutic communities. There is a need to develop specific interventions for these inpatient groups, which could be implemented in therapeutic communities.
BackgroundSome authors have pointed out the usefulness of the levels of substance use disorder (SUD) as a treatment outcome. However, in order to use this variable as an outcome measure, its impact needs to be addressed within a clinical context. The aim of this study was to analyze the sensitivity of SUD levels as a measure for detecting reliable changes and to make a comparison between the changes in SUD levels detected when using the number of criteria fulfilled and when using the reliable change index (RCI).MethodsThe sample consisted of 206 (106 in follow‐up) patients diagnosed with abuse/dependence on alcohol and cocaine, according to DSM‐IV criteria. The Substance Dependence Severity Scale for DSM‐5 was used to determine current alcohol use disorder (AUD) and cocaine use disorder (CUD). Number of DSM‐5 criteria fulfilled and RCI were used to determine the change in SUD levels.ResultsNo association was found between adherence to/abandonment of treatment and AUD severity levels (χ2 = 7.029, p = 0.071) or CUD severity levels (χ2 = 2.044, p = 0.413). Statistical significant differences for levels of AUD (z = −3.870, p = 0.000) and CUD (z = −5.382, p = 0.000) were found between baseline assessment and follow‐up. According to the number of DSM‐5 criteria and RCI, the Kappa coefficient for the change in patient status (improved, worsened, or no change) was k = 0.61 for alcohol patients and k = 0.64 for cocaine patients. The “mild” category showed the greatest inconsistency between both procedures.ConclusionsLevels of SUD are sensitive to the impact of treatment as measured by the difference between the baseline assessment and 3‐month follow‐up. However, conclusions differ according to whether the DSM‐5 criteria or the RCI is applied.
Introduction:Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success.Methods: Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use.Results: Moderate effect size relations were found between the different type of clinical discharge and months in retention (η 2 = 0.12) and proportion of attendance (η 2 = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge. Discussions/Conclusion: Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.
Background: Patients readmitted for Cocaine Use Disorders are, along with Opiates Use Disorder, one of the group of patients with highest demand of treatment in specialized centers of addiction and with greater therapeutic failure. Objective: Our aim is to apply the Texas Christian University Process Model to modeling the relationships between patient's attributes at intake of treatment, treatment progress indicators and outcomes, including treatment success and readmissions. Method: A retrospective observational design was used with 10,298 Cocaine Use Disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n= 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) to modeling variables relations. Results: Patients attributes at intake have limited relevance in explaining the treatment progress indicators and outcomes. Time on treatment and patient's adherence are relevant to explain treatment success. Readmissions are mainly explained by time in treatment and therapeutic success. Been referred to addiction centers by health of services also appear to be relevant. Discussion and conclusion: Our study reflects that the therapeutic process is important in order to have and adequate therapeutic adherence and to stay longer in treatment. Patients with a successful treatment and longer stay in treatment are less likely to have future readmissions. Through this study we highlight, therefore, the value of an adequate therapeutic adherence to obtain successful short- and medium-term results. This would make the treatment of these patients more efficient, and alleviate suffering for the patients and their families.
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