Residential & Outpatient Treatment Completion for Substance Use Disorders In the U.S.

BACKGROUND:

This study investigates the impact of residential versus outpatient treatment setting on treatment completion, and how this impact might vary by demographic characteristics and drug of choice, using a national sample of publicly funded substance abuse programs in the United States.

METHODS:

This is a retrospective analysis using data extracted from the 2011 Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set (TEDS-D). A total of 318,924 cases were analyzed using logistic regression, fixed-effects logistic regression, and moderated fixed-effects logistic regression.

RESULTS:

Residential programs reported a 65% completion rate compared to 52% for outpatient settings. After controlling for other confounding factors, clients in residential treatment were nearly three times as likely as clients in outpatient treatment to complete treatment. The effect of residential treatment on treatment completion was not significantly moderated by gender, but it was for age, drug of choice, and race/ethnicity. Residential compared to outpatient treatment increased the likelihood of completion to a greater degree for older clients, Whites, and opioid abusers, as compared to younger clients, non-Whites, and alcohol and other substance users, respectively.

CONCLUSION:

We speculate that for opioid abusers, as compared to abusers of other drugs, residential treatment settings provide greater protection from environmental and social triggers that may lead to relapse and non-completion of treatment. Greater use of residential treatment should be explored for opioid users in particular.

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By:  Stahler GJ¹, Mennis J², DuCette JP³.

¹Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States. Electronic address: jstahler@temple.edu.

²Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, United States. Electronic address: jmennis@temple.edu.

³Department of Psychological Studies in Education, Temple University, Philadelphia, PA 19122, United States. Electronic address: jducette@temple.edu.

Addict Behav. 2016 Jul;58:129-35. doi: 10.1016/j.addbeh.2016.02.030. Epub 2016 Feb 17.

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Substance Use Outcomes Following Treatment: Findings from the Australian Patient Pathways Study

OBJECTIVE:

Adolescent substance use is an area of concern because early substance use is associated with a higher risk of adverse outcomes. Parenting style, defined as the general style of parenting, as well as substance-specific parenting practices may influence children's substance use behaviour. The present study aims to probe the impact of parenting style on adolescent substance use.

METHOD:

A cohort of 1268 adolescents (48% girls), aged 12-13 years at baseline, from 21 junior high schools was assessed in the first semester of junior high school, and then again in the last semester of the 9th grade, 32 months later. Parenting style, operationalised as a fourfold classification of parenting styles, including established risk factors for adolescent substance use, were measured at baseline.

RESULTS:

Neglectful parenting style was associated with worse substance use outcomes across all substances. After adjusting for other proximal risk factors in multivariate analyses, parenting style was found to be unrelated to substance use outcomes with one exception: authoritative parenting style was associated with less frequent drinking. Association with deviant peers, delinquent behaviour, provision of alcohol by parents, and previous use of other substances were associated with substance use outcomes at follow-up.

CONCLUSIONS:

The results of the present study indicate that parenting style may be less important for adolescent substance use outcomes than what has previously been assumed, and that association with deviant peers and delinquent behaviour may be more important for adolescent substance use outcomes than general parenting style.

Below:  Non-linear association between the deviant peers scale and illicit drug use at follow-up. Values on the y-axis denote log odds ratio (solid line) and 95% confidence intervals (dotted lines).

Full article at:  http://goo.gl/KaouP5

By:  Berge J1, Sundell K2, Öjehagen A1, Håkansson A1.

• 1Lund University, Lund, Sweden.
• 2Medical Management Center Department of Learning, Informatics, Management & Ethics Karolinska Institutet, Stockholm, Sweden. 
• BMJ Open. 2016 Jan 14;6(1):e008979. doi: 10.1136/bmjopen-2015-008979.

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Epidemiology of DSM-5 Drug Use Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

IMPORTANCE:

Current information on the prevalence and sociodemographic and clinical profiles of individuals in the general population with DSM-5 drug use disorder (DUD) is limited. Given the present societal and economic context in the United States and the new diagnostic system, up-to-date national information is needed from a single uniform data source.

OBJECTIVE:

To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, disability, and treatment of DSM-5 DUD diagnoses overall and by severity level.

DESIGN, SETTING, AND PARTICIPANTS:

In-person interviews were conducted with 36 309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional representative survey of the United States. The household response rate was 72%; person-level response rate, 84%; and overall response rate, 60.1%. Data were collected April 2012 through June 2013 and analyzed from February through March 2015.

MAIN OUTCOMES AND MEASURES:

Twelve-month and lifetime DUD, based on amphetamine, cannabis, club drug, cocaine, hallucinogen, heroin, nonheroin opioid, sedative/tranquilizer, and/or solvent/inhalant use disorders.

RESULTS:

Prevalences of 12-month and lifetime DUD were 3.9% and 9.9%, respectively. Drug use disorder was generally greater among men, white and Native American individuals, younger and previously or never married adults, those with lower education and income, and those residing in the West. Significant associations were found between 12-month and lifetime DUD and other substance use disorders. Significant associations were also found between any 12-month DUD and major depressive disorder, dysthymia, bipolar I, posttraumatic stress disorder, and antisocial, borderline, and schizotypal personality disorders. Similar associations were found for any lifetime DUD with the exception that lifetime DUD was also associated with generalized anxiety disorder, panic disorder, and social phobia. Twelve-month DUD was associated with significant disability, increasing with DUD severity. Among respondents with 12-month and lifetime DUD, only 13.5% and 24.6% received treatment, respectively.

CONCLUSIONS AND RELEVANCE:

DSM-5 DUD is a common, highly comorbid, and disabling disorder that largely goes untreated in the United States. These findings indicate the need for additional studies to understand the broad relationships in more detail; estimate present-day economic costs of DUDs; investigate hypotheses regarding etiology, chronicity, and treatment use; and provide information to policy makers about allocation of resources for service delivery and research. Findings also indicate an urgent need to destigmatize DUD and educate the public, clinicians, and policy makers about its treatment to encourage affected individuals to obtain help.

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By: Grant BF1, Saha TD1, Ruan WJ1, Goldstein RB1, Chou SP1, Jung J1, Zhang H1, Smith SM1, Pickering RP1, Huang B1, Hasin DS2.

• 1Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland.
• 2Department of Psychiatry, College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York3New York State Psychiatric Institute, New York. 

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