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HSR&D 2004 National Meeting Abstracts


2011. Patient-Treatment Setting Interaction Effects on SUD Patientsí Outcomes
Quyen Q Tiet, PhD, VA Palo Alto Heathcare System and Stanford University of Medicine, J Finney, VA Palo Alto Heathcare System and Stanford University of Medicine, H Byrnes, VA Palo Alto Heathcare System and Stanford University of Medicine, G Tregor, VA Palo Alto Heathcare System and Stanford University of Medicine, L Liu, VA Palo Alto Heathcare System and Stanford University of Medicine, S Kuang, VA Palo Alto Heathcare System and Stanford University of Medicine, A Strubolo, VA Palo Alto Heathcare System and Stanford University of Medicine

Objectives: This study tested the hypothesis that patients with more severe substance use disorder (SUD) problems respond better to more intensive treatment settings (e.g., inpatient), whereas patients with less severe SUD problems have similar outcomes regardless of treatment setting.

Methods: Up to 50 new patients were randomly selected from each program of a random sample of 52 VA SUD treatment programs (low intensity: 17 outpatient and 15 intensive outpatient programs; high intensity: five domiciliary, 10 residential, and five inpatient programs). Patients completed a self-report version of the Addiction Severity Index (ASI) at baseline and at a 6-12-month follow-up (N=1,290).

Results: Mixed model regression found an interaction effect between treatment setting and baseline alcohol composite scores in relation to follow-up alcohol composite scores, while psychiatric and drug problems were controlled. Drug composite scores at follow-up were predicted by the interaction between treatment setting and baseline drug composite scores, while psychiatric and alcohol problems were controlled.

Conclusions: Results support the hypothesis that treatment setting is unrelated to alcohol or drug use outcomes for patients with low levels of alcohol or drug problems; however, for patients who have higher levels of alcohol or drug problems prior to treatment, more intensive treatment settings are associated with better outcomes.

Impact: These preliminary results suggest that intensive treatment settings are differentially beneficial for VA patients who have higher levels of substance use problems prior to treatment initiation and should continue to be part of the SUD continuum of care.