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Predictors of improvement in substance abuse problems four years following community residential treatment
Laffaye C, Ilgen M, McKellar J, Moos R. Predictors of improvement in substance abuse problems four years following community residential treatment. Paper presented at: Research Society on Alcoholism Annual Scientific Meeting; 2007 Jul 7; Chicago, IL.
Aims: The purpose of this study is to systematically examine how predictors of substance use disorder (SUD) treatment outcome work together over time, and to identify mediators and moderators of outcome.
Design: The MacArthur method of analyses was applied in this naturalistic study to create a model of how baseline, discharge, and 1-year follow-up factors worked together to predict 4-year improvement in substance-related problems.
Setting: Eighty-eight community residential facilities (CRFs) were selected based on geographic representativeness, number of patient referrals, and type of treatment orientation.
Participants: Of 2,796 male patients who completed intake assessments, 85% were assessed at the 1-year follow-up and 79% at the 4-year follow-up (N = 2,023).
Measurements: Self-report measures of symptom severity, functioning, social resources and coping, treatment, and involvement in Alcoholics Anonymous (AA) were collected at baseline, and at 1- and 4- year follow-ups. Provider-rated treatment participation measures were obtained at discharge.
Findings: Greater substance use severity, more psychiatric symptoms, more prior arrests, and stronger belief in AA-related philosophy at treatment entry, significantly predicted improvement in substance-related problems four years later. At the 1-year follow-up, being employed and greater use of AA-related coping significantly predicted outcome. AA-related coping at 1-year partially mediated the relationship between belief in AA philosophy at treatment entry and 4-year outcome.
Conclusions: The current study highlights the unique and positive impact of AA involvement on long term SUD treatment outcome and extends understanding of why AA is beneficial for patients.