Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3079 — Patient and Program Characteristics Predicting Improved Outcomes among Individuals with Co-Occurring Psychiatric and Substance Use Disorders

Schutte KK (VA Palo Alto HCS COE) , Ilgen M (VA Palo Alto HCS COE), Tiet Q (VA Palo Alto HCS COE/Stanford University )

Objectives:
Treatment outcomes are generally worse among individuals with co-occurring psychiatric and substance use disorders (ICOPaS) than among individuals with a single disorder. However, predictors of improved outcomes among ICOPaS are largely unknown. This study identified patient and treatment program factors predicting improvement among ICOPaS.

Methods:
Patients (n = 411) initiating treatment at one of four VA psychiatric or substance use disorder (SUD) clinics completed a structured diagnostic interview and questionnaires assessing participants’ psychiatric symptomatology, substance use, treatment history, stage of change, medication adherence, and therapeutic alliance. From these, a sample of 310 ICOPaS who made at least two clinic visits was identified. Six months later, 261 of surviving participants (85%) completed follow-up questionnaires. Treatment program characteristics were assessed with surveys administered to program directors of participating programs and by aggregating responses of clinicians within each program.

Results:
Improved outcome was operationalized as a decline in depressive symptomatology between baseline and the six-month follow-up of at least one-half a standard deviation on scores of a validated depressive symptom questionnaire. “Improvers” experienced an average improvement of 18.10 points; “non-improvers” an average worsening of 4.83 points. Improvement in depressive symptoms was closely aligned with declines in PTSD symptomatology, alcohol consumption, and drug use. Improvers (n = 92) were more likely than non-improvers to be male, to have the recurrent type of Major Depressive Disorder (MDD), and to be suffering Generalized Anxiety Disorder (GAD). Improvers with COPaS were less likely to be alcohol dependent but were more likely to have recently experienced a DUI, job loss, and lost housing (p’s < .05). Treatment programs with a higher percentage of improvers had fewer restrictions on treatment entry and retention (e.g., no abstinence requirement) and employed clinicians who had more patient contact hours. Findings could not be accounted for by group differences on treatment history, baseline depressive or PTSD symptoms, data collection site, and other examined variables.

Implications:
ICOPaS are more likely to experience improved treatment outcomes if they are motivated by current generalized anxiety symptoms or recent major negative life events and if they encounter non-restrictive treatment programs.

Impacts:
Study results underscore the value of adopting less restrictive treatment entry and retention policies for ICOPaS.