Predicting Dropout from Inpatient Substance Use Disorder Treatment: A Prospective Validation Study of the OQ-Analyst

Abstract

Background and Aims: There is an urgent need for tools allowing therapists to identify patients at risk of dropout. The OQ-Analyst, an increasingly popular computer-based system, is used to track patient progress and predict dropout. However, we have been unable to find empirical documentation regarding the ability of OQ-Analyst to predict dropout. The aim of the present study was to perform the first direct test of the ability of the OQ-Analyst to predict dropout. Design: Patients were consecutively enlisted in a naturalistic, prospective, longitudinal clinical trial. As interventions based on feedback from the OQ-Analyst could alter the outcome and potentially render the prediction wrong, feedback was withheld from patients and therapists. Setting: The study was carried out during 2011–2013 in an inpatient substance use disorder clinic in Oslo, Norway. Participants: Patients aged 18 to 28 years who met criteria for a principal diagnosis of mental or behavioural disorder due to psychoactive substance use (ICD 10; F10.2–F19.2). Measurements: Red signal (predictions of high risk) from the Norwegian version of the OQ-Analyst were compared with dropouts identified using patient medical records as the standard for predictive accuracy. Findings: A total of 40 patients completed 647 OQ assessments resulting in 46 red signals. There were 27 observed dropouts, only one of which followed after a red signal. Patients indicated by the OQ-Analyst as being at high risk of dropping out were no more likely to do so than those indicated as being at low risk. Random intercept logistic regression predicting dropout from a red signal was statistically nonsignificant. Bayes factor supports no association. Conclusions: The study does not support the predictive ability of the OQ-Analyst for the present patient population. In the absence of empirical evidence of predictive ability, it may be better not to assume such ability.

The impact of poly-traumatization on treatment outcomes in young people with substance use disorders

“…Indeed, one study that examined motivational factors in treatment found that individuals who experienced slow or no progression towards their treatment goals more often had a perception of low competence which in turn led to less motivation for treatment [ 76 ]. In treatment, lack of motivation often leads to drop-out [ 77 ]. However, we did not find support for a higher drop-out rate among the poly-traumatized youth in the present study.…”

Pretreatment social network characteristics relate to increased risk of dropout and unfavorable outcomes among women in a residential treatment setting for substance use

“…1 Other studies have shown that dropout is common in this time frame. For example, participants with SUD dropped out after 8.4 weeks in residential treatment in Norway (Brorson, Arnevik, & Rand, 2019) and participants with methamphetamine SUD dropped out after 8.5 weeks in randomized control trials of psychopharmacological interventions (Cook, Quinn, Heinzerling, & Shoptaw, 2017). Clinicians discharged participants from the residential facility either voluntarily, by clinical recommendation, or upon incarceration.…”

Exercise as Medicine for People with a Substance Use Disorder: An ACSM Call to Action Statement

“…Prohibitive costs and inconsistent social-environmental support of services encouraging exercise as medicine in treatment for people with SUD presents additional challenges (49)(50)(51). Low drug treatment completion rates among people with SUD raises concerns with sustaining exercise programs adjunctive to substance use treatment, with drop-out rates of 30% to 60% common (52,53) and notable disparities in treatment completion by race (54). In a large study using national data, African Americans were less than 70% as likely to complete treatment (residential and outpatient) compared with Whites (53).…”