Substance Abuse Treatment Modalities and Outcomes in a Naturalistic Setting

Outcome studies are gaining importance in all areas of medical, social services and education practices due to a growing emphasis on evidence-based interventions. Evidence-based programs and practices combine research evidence with clinical expertise; the ultimate goal is to optimize clinical outcomes and improve patient quality of life. The need to implement programs that have track records of effectiveness has never been greater. The specific research questions addressed by this study were: 1. Among patients who completed treatment, what are the abstinence rates at up to 3 months, 3-6 months, and 6-12 months post-discharge? 2. What are the effects of the various treatment modalities on inpatient treatment completion status? 3. How do demographic characteristics (age, gender, and diagnosis) affect treatment completion status? 4. Among patients who completed treatment, what are the effects of the various treatment modalities on abstinence at various points in time? 5. Among patients who completed treatment, how do demographic characteristics (age, gender, and diagnosis) affect abstinence? 6. By incorporating the significant results from questions 2-5, which factors remain significant in a final logistic regression model? A retrospective case series study based on chart review was conducted in a private residential substance abuse treatment facility. During the 18-month time period of the study, 775 patients entered treatment and 677 completed treatment (87.4%). For those who completed treatment, follow-up data were collected by telephone calls. The abstinence rate at one year, including non-respondents to follow-up, was approximately 11%. Women were less likely to be abstinent than men, even though they were more likely to complete treatment. Those aged 65+ and ≤ 30 were more likely to be abstinent than those aged 31-64, yet an incremental increase by age category was found to be associated with treatment completion. Two intervention modalities, relapse prevention and spirituality, significantly differentiated patients by treatment completion in a univariate analysis. In a multiple imputation logistic regression analysis of abstinence, social support was the only interventive modality found to be positively related to abstinence, OR=2.31 and 95% CI=(1.44, 3.68), while substance abuse counseling was the only modality found to be negatively associated with abstinence, OR=0.41 and 95% CI=(0.21, 0.82. Implications for treatment improvement are discussed.