Schaefer JA (Resource Center for Health Care Evaluation and Program Evaluation), Harris A
(Resource Center for Health Care Evaluation and Program Evaluation), Cronkite RC
(Center for Health Care Evaluation), Turrubiartes P
(Resource Center for Program Evaluation)
Helping patients maintain abstinence is an elusive goal that addictions staff struggle to achieve, with many patients returning to substance abuse following treatment. Our objective was to predict abstinence using factors drawn from the entire continuum of care, i.e., pre-treatment, treatment, discharge and post-treatment, including previously unexamined discharge factors (e.g., continuity of care practices, discharge plans) that may facilitate patients’ transition to and engagement in continuing care as well as their abstinence.
At treatment entry, staff from 18 VA intensive outpatient substance use disorder (SUD) treatment programs assessed drug and alcohol problems of 429 non-abstinent patients using the Addiction Severity Index (ASI). At discharge, staff provided data on each patient’s motivation, treatment intensity and completion, discharge plans, and staff’s continuity of care practices. At follow-up, patients’ abstinence was assessed with a self-report ASI. VA administrative data were used to assess continuing care engagement over a 6-month follow-up period. Mixed-effects logistic models were used to examine predictors of abstinence.
Abstinence occurred more often when discharge plans specified two or more continuing care appointments per month, when patients received continuing care appointments prior to discharge, and when staff secured drug-free or sober living arrangements for patients. Abstinence also was associated with use of VA substance abuse or psychiatric clinics in the year prior to treatment, treatment completion, more motivation at discharge to participate in continuing care, and longer engagement in continuing care.
The transition from intensive treatment to continuing care is a critical juncture in the continuum of care for SUD patients. Staff discharge practices are instrumental in facilitating abstinence. The more staff can do to create “momentum” for patients to participate in continuing care through discharge plans that prescribe two or more visits per month and by making their first continuing care appointment for them, the higher the abstinence rates. Staff efforts to provide drug-free and sober living arrangements for patients at discharge also enhance abstinence.
Findings point to concrete steps staff can take to improve abstinence rates through discharge planning. Directing program resources toward improved discharge planning and enhanced access to continuing care may help patients attain better abstinence outcomes.