Predictors of dropout from group therapy among patients with bipolar and substance use disorders

Abstract

Objective-Bipolar and substance use disorders frequently co-occur. Integrated treatment for these disorders has been shown to be effective at reducing substance use, but no study has examined attrition from dual diagnosis group therapy. The current study identified baseline demographic and clinical characteristics that predict treatment dropout among patients with co-occurring bipolar and substance use disorders.Method-Using binary and multivariate analyses, baseline data were analyzed as part of a randomized controlled trial of integrated group therapy for bipolar and substance use disorders.Results-Cigarette smoking, recent mood episode, and lack of a college education were strong predictors of dropout after controlling for demographic and substance use variables.Conclusions-Given the strength of smoking as a predictor of dropout as well as the high rate of smoking among this population, a greater focus on the relationship between smoking and bipolar disorder is warranted.

Feasibility and Acceptability of the ‘HABIT’ Group Programme for Comorbid Bipolar and Alcohol and Substance use Disorders

“…Several individuals initially agreed to referral and/or discussed attendance at the group, only to fail to attend any of the sessions offered. Our data agree with other studies that showed that those who refused to participate or who dropped out were younger than those who did attend, including IGT studies (Graff et al , ). In a study of an Internet‐based psychoeducation programme (Nicholas et al , ), about 27% participants, especially younger males, did not complete the intervention offered.…”

“…Attendance rates are a useful proxy measure of engagement, and it was encouraging that all six individuals who began the group programme attended at least five M1 sessions, and four out of the six also attended five or more sessions of M2; only one individual dropped out. This attrition in group membership is similar to the 19–21% reported in studies of integrated therapy (Graff et al , ; Wenze et al , ). Intermittent absenteeism from planned sessions has been partly resolved in other studies through the use of automatic text‐messaging (Graff et al , ).…”

Predictors of clinical trial dropout in individuals with co-occurring bipolar disorder and alcohol dependence

“…However, despite the small sample size, our final model afforded strong and reliable prediction of clinical trial dropout. Furthermore, as noted by Graff and colleagues (2008), those who did drop out of the study may represent an especially difficult to retain population. Our preliminary results suggest that it may be possible to identify patients at high risk of clinical trial dropout who could benefit from new and/or intensified retention strategies.…”

“…Following the method used previously in a similar sample (Graff et al 2008), dropout was defined as missing at least the last 4 weekly study visits. Group differences on baseline characteristics were evaluated using chi-square and independent sample t-tests.…”

“…However, when the missingness depends on observed outcomes ("missing at random") or unobserved outcomes ("missing not at random"), the consequences of missing data are reduced statistical power and biased parameter estimates (Little and Rubin, 2002). Determinants of attrition in individuals with comorbid bipolar and substance use disorders are not well understood, but recent analyses have found that factors such as cigarette smoking, low education, recent mood episodes (Graff et al, 2008), comorbid panic disorder (Nomamiukor and Brown, 2009), and impulsivity (Akingbala et al, 2006) have predicted dropout from group therapy and medication trials.…”