Health Services Research & Development

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2006 HSR&D National Meeting Abstract

1044 — Treatment Intensity and Symptom Severity in Patients with Substance Use Disorders

Author List:
Ilgen MA (VA Palo Alto Healthcare System)
Tiet Q (VA Palo Alto Healthcare System)
McKellar J (VA Palo Alto Healthcare System)
Barnett P (VA Palo Alto Healthcare System)
Luna Y (VA Palo Alto Healthcare System)
Finney JW (VA Palo Alto Healthcare System)

Several empirical reviews indicate that less-intensive interventions for patients with substance use disorders are as effective as more intensive treatments. However, the majority of this research was conducted in alcohol dependent patients treated in residential or inpatient settings. Consequently, less is known about the impact of amount of treatment in more representative samples of veterans with a combination of alcohol- and drug-related problems treated in outpatient settings. Additionally, it is unclear whether or not amount of treatment is particularly important for patients with more severe substance-related problems. The present study was designed to test if: (1) the amount of outpatient treatment is related to substance use disorder treatment outcomes and (2) the association between amount of treatment and treatment outcomes is stronger in veterans with more severe substance use at treatment entry than in those with lower baseline severity.

A national sample of patients presenting for outpatient treatment of SUDs in the VA health care system was selected to participate in an evaluation of a pilot outcomes monitoring system. A total of 691 outpatients were assessed for substance-related problems at baseline and 6-month follow-up. Additionally, VA patient treatment records were used to measure the number of outpatient substance use disorder treatment visits for each patient. Mixed model regression analyses were used to examine the relationship of baseline severity, number of visits and the interaction between severity and number of visits to substance-use related outcomes.

Amount of treatment did not predict substance-related outcomes. However, a significant interaction was found between baseline drug-use severity and amount of treatment predicting follow-up drug use (t = 2.8; p < .01) indicating that the association between amount of treatment and lower follow-up drug use became stronger as the level of baseline severity increased.

Although less intensive treatments appear to be generally effective for the average VA substance use disorder patient, patients with more severe substance-related problems respond better to more-intensive treatments.

Treatments of varying intensity should be available to deal with the full spectrum of veterans with substance use disorders. However, for those patients with greater drug severity, greater intensity treatments should be considered.