Gender Differences in Treatment Retention Among Individuals with Co-Occurring Substance Abuse and Mental Health Disorders

Choi, Sam; Adams, Susie; Morse, Siobhan; MacMaster, Sam

doi:10.3109/10826084.2014.997828

Cited by 57 publications

(45 citation statements)

References 47 publications

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“…Among patients diagnosed with AOD use disorder and comorbid psychiatric disorders, previous studies have identified several patient characteristics that may influence AOD treatment initiation and engagement, including age, 9 gender, [9][10][11][12][13] type and severity of comorbid psychiatric disorder, 4,10 and presence of multiple AOD use disorders. 5 In a sample of older adults, patients who initiated treatment had more severe symptoms of AOD abuse and depression, compared with patients who did not initiate treatment.…”

Section: Introductionmentioning

confidence: 99%

Psychiatric Comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) Measures of Alcohol and other Drug Treatment Initiation and Engagement across 7 Health Care Systems

et al. 2019

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Background: Psychiatric comorbidity is common among patients with alcohol and other drug (AOD) use disorders. To better understand how psychiatric comorbidity influences AOD treatment access in health care systems, the present study examined treatment initiation and engagement among a large, diverse sample of patients with comorbid psychiatric and AOD use disorders. Methods: This study utilized data from a multisite observational study examining Healthcare Effectiveness Data and Information Set (HEDIS) measures of initiation and engagement in treatment (IET) among patients with AOD use disorders from 7 health care systems. Participants were aged 18 or older with at least 1 AOD index diagnosis between October 1, 2014, and August 15, 2015. Data elements extracted from electronic health records and insurance claims data included patient demographic characteristics, ICD-9 (International Classification of Diseases, Ninth Revision) diagnostic codes, and procedure codes. Descriptive analyses and multivariate logistic regression models were used to examine the relationship between patient-level factors and IET measures. Results: Across health care systems, out of a total of 86,565 patients who had at least 1 AOD index diagnosis during the study period, 66.2% (n ¼ 57,335) patients also had a comorbid psychiatric disorder. Among patients with a comorbid psychiatric disorder, 34.9% (n ¼ 19,998) initiated AOD treatment, and of those, 10.3% (n ¼ 2,060) engaged in treatment. After adjusting for age, sex, and race/ethnicity, patients with comorbid psychiatric disorders were more likely to initiate (odds ratio [OR] ¼ 3.20, 95% confidence interval [CI] ¼ 3.08, 3.32) but no more likely to engage (OR ¼ 0.56, 95% CI ¼ 0.51, 0.61) in AOD treatment, compared with those without a comorbid psychiatric disorder. Conclusions: Findings suggest that identification of comorbid psychiatric disorders may increase initiation in AOD treatment. However, innovative efforts are needed to enhance treatment engagement both generally and especially for individuals without diagnosed psychiatric conditions.

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Section: Introductionmentioning

confidence: 99%

Psychiatric Comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) Measures of Alcohol and other Drug Treatment Initiation and Engagement across 7 Health Care Systems

et al. 2019

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“…Similar findings have been reported for substance using adolescents with comorbid psychiatric disorders (Tomlinson et al, 2004). Nevertheless, the impact of psychiatric comorbidity on substance use outcomes is not always consistent and may vary by sex, the type and severity of comorbidity, substance use type, and treatment setting (Choi et al, 2015; Compton et al, 2003; Mertens and Weisner, 2000; Polcin et al, 2015). Past research on the association of psychiatric comorbidities with substance use treatment outcomes has been mainly limited to small samples and select treatment programs.…”

Section: Introductionmentioning

confidence: 99%

The association of psychiatric comorbidity with treatment completion among clients admitted to substance use treatment programs in a U.S. national sample

Krawczyk

Feder

Saloner

et al. 2017

Drug and Alcohol Dependence

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Background Psychiatric disorders are highly comorbid with substance use disorders and play an important role in their course and recovery. However, the impact of comorbidity on treatment outcomes has not been examined in a U.S. national sample. This study explores the impact of psychiatric comorbidity on treatment completion among individuals admitted to publicly funded substance use treatment facilities across the United States. Methods Using data on first-time treatment episodes in the U.S. from the Treatment Episode Dataset-Discharges (TEDS-D) for the years 2009–2011, logistic regression was used to assess the association between psychiatric comorbidity and treatment non-completion, and Cox proportional hazards regression was used to assess the association between comorbidity and rate of attrition. Analyses were performed for all substances together and then stratified by primary substance of abuse (alcohol, cannabis, stimulants, or opioids). Results Of 856,385 client treatment episodes included in our analysis, 28% had a psychiatric comorbidity and 38% did not complete treatment. After adjusting for socio-demographic and treatment characteristics, clients with psychiatric comorbidity had higher odds of not completing treatment relative to those without comorbidity [OR = 1.28 (1.27–1.29)], and had an earlier time to attrition [HR = 1.14 (1.13–1.15)]. Psychiatric comorbidity was most strongly associated with treatment non-completion and rate of attrition in those admitted primarily for alcohol [OR = 1.37 (1.34–1.39); HR = 1.19 (1.17–1.21), respectively]. Conclusions Individuals with psychiatric comorbidities receiving treatment for substance use disorders face unique challenges that impact their ability to complete treatment. The findings call for further efforts to integrate treatment for psychiatric comorbidities in substance use treatment settings.

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“…Examination of variables associated with retention in residential treatment has confirmed the predictive utility of primary substance of abuse, with those reporting alcohol as their primary drug having a greater likelihood of remaining in treatment beyond three-months when compared to those with opiates or "other" drugs as their substance of chief concern (Deane, Wootton, Hsu & Kelly, 2012). Similarly, those presenting with cocaine use have been found to have shorter stays when compared to an alcohol control group (Choi, Adams, Morse & MacMaster, 2015;Simpson et al, 1997).Types of substances used appear related to length of stay and dropout in a range of alcohol and other drug treatment services and suggest the need to consider them as a potential factor for understanding differences in length of stay and outcome.…”

Section: Predictors Of Client Outcomementioning

confidence: 99%

Length of stay as a predictor of reliable change in psychological recovery and well being following residential substance abuse treatment

Turner

Deane

2016

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(2016). Length of stay as a predictor of reliable change in psychological recovery and well being following residential substance abuse treatment. Therapeutic Communities: the international journal for therapeutic communities, 37 (3).Length of stay as a predictor of reliable change in psychological recovery and well being following residential substance abuse treatment AbstractPurpose Longer length of stay (LOS) in residential drug and alcohol treatment has been associated with more favourable outcomes, but the optimal duration has yet to be determined for reliable change indices. Optimal durations are likely a function of participant and problem characteristics. The current study aims to determine whether LOS in a residential therapeutic drug and alcohol treatment community independently predicts reliable change across a range of psychological recovery and well being measures.. Design/ methodology/approach Three hundred and eighty clients from Australian Salvation Army residential drug and alcohol treatment facilities were assessed at intake and three months post-discharge using the Addiction Severity Index 5th ed., the Depression, Anxiety and Stress Scale, the Recovery Assessment Scale, the Mental Health Continuum-Short Form and the Life Engagement Test. Findings The findings confirm LOS as an independent predictor of reliable change on measures of well being and client perceived assessment of recovery. The mean LOS that differentiated reliable change from no improvement was 37.37 days. Originality/value The finding of LOS as a predictor of reliable change and the identification of an estimated time requirement may be useful for residential drug treatment providers in modifying treatment durations. AbstractObjective: Longer length of stay (LOS) in residential drug and alcohol treatment has been associated with more favourable outcomes, but the optimal duration has yet to be determined for reliable change indices. The current study aims to determine whether LOS in residential drug and alcohol treatment independently predicts reliable change across a range of psychological recovery and well-being measures.Method: Three hundred and eighty clients from Australian Salvation Army residential drug and alcohol treatment facilities were assessed at intake and three months post-discharge using the Addiction Severity Index, the Depression, Anxiety and Stress Scale, the Recovery Assessment Scale, the Mental Health Continuum-Short Form and the Life Engagement Test. Results:The findings confirm LOS as an independent predictor of reliable change on measures of well-being and client perceived assessment of recovery. The mean LOS that differentiated reliable change from no improvement was 37.37 days. Conclusions:The finding of LOS as a predictor of reliable change and the identification of an estimated time requirement may be useful for residential drug treatment providers in modifying treatment durations.

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Gender Differences in Treatment Retention Among Individuals with Co-Occurring Substance Abuse and Mental Health Disorders

Cited by 57 publications

References 47 publications

Psychiatric Comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) Measures of Alcohol and other Drug Treatment Initiation and Engagement across 7 Health Care Systems

Psychiatric Comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) Measures of Alcohol and other Drug Treatment Initiation and Engagement across 7 Health Care Systems

The association of psychiatric comorbidity with treatment completion among clients admitted to substance use treatment programs in a U.S. national sample

Length of stay as a predictor of reliable change in psychological recovery and well being following residential substance abuse treatment

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