Session number: 1145
Abstract title: Psychiatric Comorbidity, Continuing Care, and Self-Help as Predictors of Substance Abuse Remission
Author(s):
JB Ritsher - Center for Health Care Evaluation
J McKellar - Center for Health Care Evaluation
JW Finney - Center for Health Care Evaluation
PG Otilingam - Center for Health Care Evaluation
RH Moos - Center for Health Care Evaluation
Objectives: To examine whether psychiatric comorbidity, continuing outpatient mental health care, and involvement in self-help groups are associated with substance abuse patients' remission at a 5-year follow-up.
Methods: Data are from a cohort of 2595 male patients treated at one of 15 VA intensive substance abuse treatment programs. Remission was defined as abstinence from illicit drug use and either abstinence from, or non-problem use of alcohol. The relationships of psychiatric comorbidity, outpatient care, and self-help involvement to 5-year remission were tested using regression models, controlling for baseline characteristics, including age, education, marital status, motivation, inpatient substance abuse treatment in past year, number of substances used, number of substance abuse-related problems, and frequency of substance use.
Results: After controlling for covariates, patients with only substance use disorders were more likely to be in remission at Year 5 than dual diagnosis patients. The level of psychiatric symptoms at intake significantly predicted remission at Year 5. There was no significant relationship between the amount of continuing care in Year 1 or Year 2 and 5-year remission status, whereas the duration of continuing care at Year 1 was predictive of 5-year remission. Involvement in self-help groups during Year 1 or Year 2 was associated with an increased likelihood of remission at the 5-year follow-up. In an omnibus model, psychiatric comorbidity and self-help involvement were significant predictors of substance use remission at Year 5, but continuing care was not.
Conclusions: Results extend previously published 2-year outcome findings indicating that patients who attend continuing mental health outpatient treatment or self-help sessions following intensive substance abuse treatment are more likely to be remitted. Though demographically similar to patients with only substance use disorders (SUD), dual diagnosis patients are in more distress at intake. Self-help involvement for dual-diagnosis patients substantially improved the chances of substance use remission at Year 5 for both SUD-only and dual diagnosis patients.
Impact statement: Further research is recommended to investigate whether self-help specifically targeted to dual diagnosis patients further improves their likelihood of long-term remission. This could include self-help for dual diagnosis and/or self-help for severe mental illnesses, both of which are less common than self-help for addiction.