Schaefer JA (Center for Health Care Evaluation), Cronkite RC
(Center for Health Care Evaluation), Hu K
(Center for Health Care Evaluation)
Our aim was to identify predictors of engagement in continuing care and abstinence for initially non-abstinent patients treated in inpatient/residential substance use disorder (SUD) treatment programs. Predictors included pre-treatment, treatment, and discharge factors, including previously unexamined continuity of care practices which may promote engagement and abstinence.
Staff from 10 VA intensive inpatient/residential SUD programs used the Addiction Severity Index (ASI) to assess drug and alcohol problems at treatment entry for N = 249 non-abstinent patients (N = 212 alcohol non-abstinent; N = 144 drug non-abstinent). At discharge, staff provided data on patients’ treatment amount, continuity of care services received, treatment completion, discharge plans, and motivation for continuing care. A 6-month follow-up self-report ASI assessed abstinence. VA administrative data assessed continuing care engagement during the follow-up period. We examined predictors of engagement and abstinence using mixed effects regression models. We conducted separate analyses for alcohol- and drug-non-abstinent patients.
Continuity of care practices to maintain contact with patients (e.g. appointment reminders, missed appointment follow-ups) predicted greater engagement for patients who were drug-non-abstinent at intake, but not for alcohol-non-abstinent patients. Staff efforts to connect patients to community resources (e.g., 12-step groups, drug-free and sober living) and coordinate with continuing care counselors predicted greater engagement for both patient groups and also predicted alcohol abstinence for patients who were alcohol-non-abstinent at intake, but not for patients who were drug-non-abstinent at intake. Motivation to attend continuing care predicted more engagement in continuing care for both alcohol-and drug-non-abstinent patients. However, engagement only predicted a higher likelihood of alcohol abstinence for alcohol-non-abstinent patients.
Continuity of care practices’ impact on engagement in continuing care and abstinence varies for alcohol- and drug-non-abstinent patient groups. Various continuity of care practices result in more engagement for both patient groups, but higher abstinence rates only for patients who are alcohol-non-abstinent at intake.
It’s important to examine alcohol- and drug-non-abstinent patients separately when studying the impact of continuity of care practices on SUD treatment outcomes. We have identified specific practices that are linked to better treatment outcomes which staff can use to tailor the types of continuity of care services they provide to these two groups of patients.