Schutte KK (VA Palo Alto Health Care System), Tiet Q
(California School of Professional Psychology at the Alliant International University)
Guidelines for treating patients with co-occurring psychiatric and substance use disorders (SUD) indicate that treatment should address both disorders. We examined the role of patient preferences and readiness for change in predicting receipt of dual-diagnosis treatment (DDx) and treatment outcomes.
Patients (n = 249) initiating treatment at one of four VA psychiatric or SUD clinics were identified as having co-occurring disorders using the computerized DIS for DSM-IV. Of these, 207 (83%) completed baseline and six-month follow-up questionnaires assessing treatment preferences, treatment received, and stage of change (SOCRATES) for addressing psychiatric and SUD-related behavior. Also assessed were general psychiatric (SCL), PTSD (PCL), and depressive (HDL) symptoms, recent life events, substance use and problems, medication adherence (MARS), and working alliance (WAI). Based on patient report and medical record review, among patients receiving a minimum of three treatment sessions, 66% (n = 136) were identified as having received DDx, i.e., treatment addressing both their psychiatric disorder and SUD. Baseline patient characteristics and treatment outcomes of patients who did versus did not receive DDx were compared using multivariate ANOVA, logistic and multiple regression.
Patients who did versus did not receive DDx were similar on age, gender, income, marital and homeless status; however, patients receiving DDx were more likely to be Black, less likely to be employed, had more health problems and more intensive psychiatric treatment histories. In analyses controlling for these differences, patients who received DDx were more likely to indicate a baseline preference for DDx, had greater readiness to change, and had more SUD problems, but did not differ from those not receiving DDx on substance use, psychiatric symptoms, or life events. DDx and readiness to change predicted better SUD outcomes, even when controlling for demographics, treatment history, MARS, and WAI.
Two-thirds of patients with co-occurring disorders received DDx. Patients with greater baseline readiness to change were more likely to receive DDx and experienced better SUD outcomes.
Results underscore the necessity of addressing unmet needs for DDx, as well as the potential utility of doing so by attending to patients’ readiness to change.