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HSR&D 2004 National Meeting Abstracts

2032. A Functional SUD Recovery Model Predicts Two-Year SUD Treatment Outcomes
Elizabeth Gifford, PhD, Palo Alto VA Healthcare System and Stanford University, JB Ritsher, San Francisco VAMC and University of California, JD McKellar, Palo Alto VA Healthcare System and Stanford University, RH Moos, Palo Alto VA Healthcare System and Stanford University

Objectives: A pragmatic approach to clinical science is based on identifying what can be altered, rather than black box theories without practical implications. This study tested a model of functional factors contributing to successful Substance Use Disorder (SUD) treatment in male veterans.

Methods: Participants were 2,593 veterans participating in a large scale effectiveness study of Department of Veterans Affairs (VA) 12-step, cognitive behavioral and eclectic substance abuse treatment programs. Structural Equation Modeling (SEM) was employed to evaluate the model for outcomes. Relationship context described the quality of relationships in (a) the treatment setting and (b) the patientís post-treatment social support network. Acceptance-based action described the patientís behavioral commitment to coping in a flexible non-avoidant manner, even in the presence of negative affect.

Results: Controlling for baseline latent variables, the model accounted for 41% of the variance in substance use impairment at two-year post treatment outcomes: an unusually large amount. Patients who learn and apply skills to cope with negative affect show markedly better outcomes. Supportive programs with involved staff and abstinence-supportive social networks contribute to the development and maintenance of these skills.

Conclusions: The findings show that a supportive treatment environment contributes to better posttreatment patient coping and support, which, in turn, contribute to better substance abuse outcomes.

Impact: SUD treatment providers should use quality improvement procedures to enhance program supportiveness and staff involvement. Regardless of treatment orientation, treatment programs should help patients develop and apply approach coping skills in the presence of negative affect.