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Predictors of 4-year outcome of community residential treatment for patients with substance use disorders

Laffaye C, McKellar JD, Ilgen MA, Moos RH. Predictors of 4-year outcome of community residential treatment for patients with substance use disorders. Addiction. 2008 Apr 1; 103(4):671-80.

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AIMS: This study examined systematically how predictors of substance use disorder (SUD) treatment outcome worked together over time and identified mediators and moderators of outcome. DESIGN: The MacArthur model was applied in this naturalistic study to identify 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 were selected based on geographic representativeness, number of patient referrals and type of treatment orientation. PARTICIPANTS: Of 2796 male patients who completed intake assessments, 2324 were assessed at the 1-year follow-up and 2023 at the 4-year follow-up. 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 predicted improvement significantly in substance-related problems 4 years later. At the 1-year follow-up, being employed and greater use of AA-related coping predicted outcome significantly. AA-related coping at 1 year mediated the relationship partially between belief in AA philosophy at treatment entry and 4-year outcome. CONCLUSIONS: The findings highlight the unique and positive impact of AA involvement on long-term SUD treatment outcome and extend understanding of why AA is beneficial for patients.

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