Treatment Attendance Among Veterans With Depression, Substance Use Disorder, and Trauma

Abstract

Objective Low attendance in psychotherapy, particularly among individuals with comorbid disorders, is a pervasive challenge. The present study examined predictors of treatment attendance in a sample of veterans with depression, substance use disorder, and trauma. Methods This is an analysis of data collected as part of a larger clinical trial involving outpatients at a Veterans Administration dual diagnosis clinic. Individuals were excluded if they had significant memory deficits, schizophrenia, bipolar disorder, or substantial travel constraints. Participants (N = 146) received 12 weeks of group-delivered Integrated Cognitive Behavioral Therapy for depression and substance use, followed by randomization to 12 additional weeks of individually-delivered Cognitive Behavioral Therapy (n = 62) or Cognitive Processing Therapy (n = 61) modified to address substance use and trauma. Participants, therapists, and researchers were not blinded to group assignment. For this study, we included only the 123 participants who were randomized into the second phase, analyzing predictors of treatment attendance categorized into predisposing factors, enabling factors, and need factors. Results Participants were primarily male (89%), Caucasian (76%), and averaged 47 years old (SD = 12). Forty-four percent had alcohol use disorder, 16% had drug use disorder, and 40% had polysubstance use disorder. Most met criteria for PTSD (82%), with 44% having combat-related trauma, 33% sexual trauma, and 28% other trauma. Treatment attendance did not differ between groups. More education was associated with increased group (r = .19, p = .04) and individual session attendance (r = .28, p = .002). Individuals with chronic housing problems attended fewer group sessions (r = -.19, p = .04), while individuals with sexual trauma, compared to those with other traumas, attended more individual sessions (r = .23, p = .01). Number of group sessions attended was positively associated with individual session attendance. Conclusions Few variables were significantly predictive of treatment attendance, possibly due to the complex nature of comorbid disorders. Including a focus on trauma was not associated with lower attendance. Special consideration may need to be given to education level, homelessness, and trauma when trying to engage and retain patients with comorbid disorders in treatment. This clinical trial is registered at www.ClinicalTrials.gov as NCT00958217.

Associations between violence, criminality, and cognitive control deficits among young men living in low resource communities in South Africa

“…Regardless of potential causal links between the observed cognitive control deficits and the deviant behavior our participants reported, we know from other longitudinal studies that individuals with a history of deviant behavior and individuals with cognitive control deficits are at increased risk of engaging in future acts of violence and lawlessness (Caspi & Moffitt, ; Cui et al, ; de Ridder et al, ; Giancola, ; Hawkins & Trobst, ; Moffitt, ; Moffitt et al, ; Morgan & Lilienfeld, ; Paschall & Fishbein, ; Vazsonyi et al, ). The cognitive control deficits we observed among young men with a history of deviant behavior thus point to a high risk of recidivism in our sample, and suggest that young men in this community may benefit from interventions to improve their cognitive control as a means of protecting them from future engagement in violence and criminal behavior.…”

Trauma, Technology, and Routine Outcome Measures

“…The results did not support the hypothesized mediation role of general tension reduction, but other pathways were significant. Cui, Haller, Skidmore, Goldsteinholm, Norman, and Tate (2016) studied treatment attendance among veterans with co-occurring depression, substance dependence, and posttraumatic stress disorder who were randomly assigned to two forms of psychotherapy. Group assignment and most other variables did not predict attendance.…”

Predictors of Treatment Attendance and Adherence among Individuals Receiving Cognitive Behavioral Therapy for Insomnia

“…Researchers have utilized the Anderson (1995) model to predict utilization of a number of different types of treatment. These include complementary and alternative medicine treatment (Brown, Barner, Bohman, & Richards, 2009), Human Immunodeficiency Virus treatment (Anthony et al, 2007), anxiety disorder treatment (Keyes et al, 2008), panic disorder treatment (Goodwin & Andersen, 2002), mood disorder treatment (Keyes et al, 2008), alcohol use disorder treatment (Zemore, Mulia, Ye, Borges, & Greenfield, 2009), substance use disorder treatment (Keyes et al, 2008), depression and substance use disorder treatment (Tate et al, 2011), and substance use and PTSD treatment (Cui et al, 2016).…”