Thursday, January 28, 2016

Patient Characteristics & Predictors of Completion in Residential Treatment for Substance Use Disorders

Aims and method 
To identify the patient characteristics and rates of retention in a residential rehabilitation drug and alcohol service (Springhill) based on an eclectic model of care. Patients were assessed using the Alcohol and Drug Outcome Measure (ADOM), a brief tool designed for the New Zealand setting. We looked at correlations between demographic, social and drug use parameters. Logistic regression assessed the relative impact of each variable on completion. 

The 183 patients who completed the data collection did not differ from 47 non-completers by demographic data; 62.2% of patients completed the programme, with equal number of men and women. One in five participants was Maori, the indigenous minority. Alcohol (51.9%) was the commonest drug of misuse, with methamphetamine (16.4%) and cannabis (14.2%) also significant. Completers were more likely to be Maori, have conflict with family and housing problems, although the last became non-significant in logistic regression. 

Clinical implications 
Retention rates are higher in Springhill than in comparable programmes. Ethnicity and family conflict predict completion, although the reasons for this are unclear. ADOM is an effective tool that can be used in a clinical setting to enable analysis of service provision.

...Significant morbidity is reported in physical, psychological and social domains by the patients in this study. These problems are directly related to drug use and small changes in use are likely to be associated with significant benefits to health, relationships and well-being. Previous economic analysis indicates major benefits associated with effective addictions intervention also. The relative failure of community intervention for this cohort argues in favour of residential intervention, particularly if retention is high, and implies improved prognosis. This is the case for Springhill and may relate to positive longer-term outcomes., Follow-up studies will enable further examination of longer-term benefits and overcome the limitation of using completion as a proxy marker for improved prognosis.

Identifying who is likely to benefit most from residential treatment allows for a more targeted approach to management. Prior research has recommended a ‘non-discriminatory approach to referral’ and no clear indicators are apparent in the current literature base. Using regression analyses to consider the impact of several factors likely to alter treatment completion, we are able to show that Maori, the indigenous minority in New Zealand, and those with conflict in the home are more likely to complete the programme. The programme includes the capacity for patients to engage with a cultural assessment but does not include individual or group activities that are specifically culturally oriented. Previous research identifies greater social morbidity in Maori in an out-patient addictions setting and greater satisfaction with a culturally specific service. Cultural factors have been a point of focus in policy debate about the provision of services, with some advocating for a culturally appropriate approach research methodology frame, although support (and the application) of this is very limited. The current findings suggest Maori manage well in a generic eclectic setting. This does not indicate a generic service is likely to outperform a culturally specific service; rather, Maori are more likely than clients of other ethnicities to complete this programme. Ethnicity is not a proxy marker for social disadvantage as measured by social role difficulties, employment, housing problems and crime in this study as the linear regression of model D elucidates. Understanding the impact of homelessness in dependence is complex, although the parsimonious explanation of having basic needs met does not preclude the potential for recovery and may be an important component of successful recovery...

Full article at:

Correspondence to Giles Newton-Howes (
Dr Giles Newton-Howes BA, BSc, MBChB, MRCPsych, FRANZCP is senior lecturer at the Department of Psychological Medicine, Wellington School of Medicine, Otago University, Wellington, New Zealand, and honorary senior lecturer at Imperial College London, UK. Dr James Stanley PhD is a research fellow at Wellington School of Medicine, Otago University.
 2015 Oct;39(5):221-7. doi: 10.1192/pb.bp.114.047639.

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