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Response to inpatient substance use treatment in suicidal and non-suicidal patients

Ilgen M, Tiet Q, Moos R. Response to inpatient substance use treatment in suicidal and non-suicidal patients. Paper presented at: American Psychological Association Annual Convention; 2004 Jul 2; Honolulu, HI.

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Introduction: Suicide attempts are more common in patients with substance use disorders (SUDs) than in patients without SUDs. Elevated rates of psychopathology and substance-related problems have been consistently reported in SUD patients with a history of at least one suicide attempt when compared to non-suicidal SUD patients. Yet, little is known about the response to treatment of suicidal SUD patients. The present study was designed to investigate the impact of treatment on psychiatric symptoms and substance use at discharge and 1-year follow-up in male patients presenting for inpatient SUD treatment within the Veterans Administration Health Care System (VAHCS).Methods: Patients were recruited from fifteen inpatient treatment programs in the VAHCS that were selected at random out of 174 inpatient programs nationwide. Patients were recruited after medical detoxification and after admission to SUD treatment programs. Women were excluded due to low numbers of female participants. Of the 3,698 patients who completed the initial assessment at the start of treatment, 3,328 (90%) patients were re-interviewed at discharge from treatment and 3,018 (82%) were interviewed at 1-year follow-up. During the baseline, discharge and follow-up interviews, participants provided self-report ratings of their psychiatric symptomatology and information about their substance use. Approximately seven percent of this sample reported a suicide attempt within three months of the intake assessment. Results: Those patients with a suicide attempt within three months of the intake assessment reported significantly more psychiatric symptoms and more problematic patterns of substance use at baseline than did non-suicidal patients. At discharge and 1-year follow-up, both suicidal and non-suicidal patients improved significantly on all measures of psychiatric symptomatology and substance use. Suicidal patients were not significantly different from non-suicidal patients on measures of substance use at discharge or 1-year follow-up although they consistently reported significantly more psychiatric symptoms at all time points. Conclusions: Results indicate that despite a more severe pattern of substance use at baseline, suicidal SUD patients benefited substantially from inpatient SUD treatment. Similar to past work on SUD patients with comorbid psychiatric disorders, SUD treatment is associated with substantial improvements in measures of substance use but patients continue to struggle with psychiatric problems after treatment.

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