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Needs-service matching in substance use disorder treatment programs

Byrnes H, Finney J, Tiet Q, Tregor G, Liu L, Kuang S, Strumolo A. Needs-service matching in substance use disorder treatment programs. Paper presented at: Research Society on Alcoholism Annual Scientific Meeting; 2004 Jun 2; Vancouver, Canada.


Objectives: We examined the effects of providing ancillary services (i.e., legal, employment, and psychological counseling) in substance use disorder (SUD) treatment programs on functioning in the targeted ancillary problem area, as well as on post-treatment substance use. In addition, we investigated whether additional services are especially beneficial for patients with more severe problems in each area, and whether effects varied by treatment setting (inpatient/residential vs. outpatient). Methods: Up to 50 new patients were randomly selected from each of 46 Department of Veterans Affairs SUD treatment programs and administered a brief, self-report version of the Addiction Severity Index at baseline and at a follow-up an average of 6.7 months later (N = 1,155). Average number of hours in each supplemental area provided to patients were determined from program directors' survey responses. Results: Mixed model regression indicated that increased employment services were linked to positive employment outcomes, but only for patients in inpatient/residential SUD programs. Higher levels of psychological services were related to reduced rates of drug use and problem drinking for patients with greater baseline psychological problems, but only in outpatient SUD programs. All analyses controlled for both baseline substance use and functioning in each respective service area, and time to follow-up. No effects were found for legal services. Conclusions: Results suggest that compared to outpatients, those in inpatient/residential treatment benefited more from vocational services. It may be that, compared to those in outpatient programs, such patients are able to concentrate on new job skills while removed from the workforce. Outpatients with high levels of psychological problems at intake in programs emphasizing psychological services had improved drug and alcohol outcomes. It is possible we do not see the benefits of additional psychological services for inpatients because inpatient programs provide higher levels of services than outpatient programs; it may be only when service levels are low that additional hours of psychological services make a difference. Overall, our findings provide some, but by no means consistent evidence that additional ancillary services improve substance use outcomes.

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