Study Assesses Effectiveness of Residential Substance Use Disorder Programs in Treating Veterans with SUDs and Mental Illness
The prevalence of psychiatric disorders among individuals with substance use disorders (SUDs) is high, with estimates ranging from 18% to 70%. Moreover, psychiatric comorbidity is associated with more severe functional impairment, a more chronic course of illness, and less likelihood of completing and benefiting from treatment. Few studies have assessed whether patients dually-diagnosed (DD) with co-occurring substance use and psychiatric disorders respond as well to SUD treatment as patients diagnosed with substance use disorders alone. This study compared processes and outcomes for alcohol-dependent Veterans with (n=691) and without (n=1805) comorbid psychiatric illness at one and five years following treatment in 15 residential SUD treatment programs affiliated with VA.
Findings show that dually-diagnosed Veterans did not perceive SUD programs as positively as Veterans with SUD alone, and DD Veterans had worse proximal outcomes at discharge from treatment. For example, DD patients saw fewer benefits to quitting and had less self-efficacy in regard to staying abstinent. Results also showed that dually-diagnosed Veterans did as well as SUD patients on 1-year and 5-year substance use outcomes but had worse psychiatric outcomes. Veterans from both groups who perceived treatment more positively and had better outcomes at discharge had better longer-term outcomes; however, dually-diagnosed patients perceived the programs to be less supportive and clear, and were less satisfied with treatment. The authors suggest that SUD programs either need to add resources directed toward treating psychiatric problems, or that dually-diagnosed Veterans need to be treated in sequential or integrated programs. They note, however, that standard SUD programs may offer more components of integrated treatment than standard psychiatric programs do.
Boden M and Moos R. Dually Diagnosed Patients’ Responses to Substance Use Disorder Treatment. Journal of Substance Abuse Treatment December 2009;37(4):335-345.
This study was funded through HSR&D. Drs. Boden and Moos are part of HSR&D's Center for Health Care Evaluation in Palo Alto, CA.