Introduction

1. Characteristics of Substance Abuse Treatment Completion of Clients with Co-Occurring Psychiatric and Substance Use Disorders Laurel Mangrum & Richard Spence University of Texas at Austin, Addiction Research Institute Client and Treatment Characteristics Introduction Demographics Results and Conclusions Co-Occurring Psychiatric Diagnoses • Numerous demographic variables were found to be associated with treatment completion. Completers were more likely to be male, White and non-Hispanic, over the age of 36, unemployed at admission, and to have college-level education. In the area of substance abuse treatment history, completers had a greater incidence of prior detox and had attended AA more frequently in the 30 days prior to admission. Rates of previous non-detox substance abuse treatment did not differ between the groups. Completers were more likely to have alcohol as their primary substance of abuse and had slightly higher average days of use the past 30 days. Primary marijuana users were less likely to complete treatment and polysubstance use did not differ between the two groups. Analyses of psychiatric diagnostic categories indicated that individuals with affective disorders were more likely to complete treatment relative to clients with schizophrenia (X2 = 8.42; p < .04). • A number of treatment characteristics were found to be significantly different between completers and non-completers. COPSD clients placed in residential treatment were more likely to complete treatment compared to outpatient, home-based, and other settings (X2 = 83.70; p < .0001). Reasons for discharge, as expected, were highly associated with completion status. Completers were more likely to be discharged due to no need for further services or were referred or transferred to another level of service. Non-completers were more often discharged due to being deemed inappropriate for the treatment program, program decisions related to non-compliance, or for leaving against medical advice (X2 = 273.78; p < .0001). Length of stay in treatment was significantly longer for completers at 121.8 days relative to 87.2 days for non-completers. Completers also attended AA meetings more frequently and were more likely to be abstinent during the 30 days prior to discharge. In the area of social functioning, completers were more likely to be employed at discharge, be living in a non-institutional environment, have close people involved in their treatment and recovery, and less likely to be exposed to alcohol and drugs in their living environment. • Findings of this study indicate that, in this sample of COPSD clients, the majority of characteristics found to be associated with completion are similar to those identified in prior studies of general substance abuse treatment clients. The demographic factors of male gender, White racial status, age, and higher education level were found to be associated with successful completion as previously reported. In this analysis, unemployment at admission was associated with completion; however, employment at discharge was higher in the completer group. Other features associated with completion in this COPSD sample were comparable to the general substance abuse treatment population. Previous participation in AA or other self-help groups, retention in treatment, and greater social resources were also identified as being positively related to completion for COPSD clients. A few differences were found in this COPSD group; polysubstance use and detox were not identified as negative indicators for completion as had been reported in previous studies. Overall, the results of this study suggest that characteristics of treatment completion are analogous in clients with COPSD to those in the general treatment population. The findings further suggest the need to target clients with more severe psychiatric disorders, such as schizophrenia, to identify needs unique to these individuals that will enhance retention and treatment completion. Numerous studies have examined characteristics of successful completion in the general substance abuse treatment population. In this line of research, demographic, substance use severity, psychiatric status, and treatment characteristics have been studied in relation to completion. In the general treatment population, increased age, higher levels of education, employment, male gender, White racial status, psychological distress, prior self-help involvement, greater social resources, and retention in treatment were found to be positively associated with completion. Negative indicators for completion that have been identified include greater substance use severity, polysubstance use, and prior detox. The present study explored characteristics of treatment completion of clients in substance abuse treatment with co-occurring psychiatric and substance use disorders (COPSD). Research has indicated that clients with COPSD, particularly those with severe mental illness, present with complex treatment needs that often hinder response to substance abuse treatment. The purpose of these analyses was to identify features associated with successful completion in a sample of COPSD clients and to compare the identified characteristics to those previously found for the general substance abuse treatment population. Substance Abuse Treatment Environment Treatment History and Substance Use Patterns Sample and Method The sample consisted of 3,851 COPSD clients who received treatment services in state-funded substance abuse treatment programs during the Texas 2004 fiscal year. These clients were identified as having co-occurring disorders and received adjunct treatment from counselors who specialize in treatment of COPSD in addition to standard substance abuse treatment. The study examined data from BHIPS, the mandatory data collection and outcomes monitoring system for state-funded substance abuse treatment programs in Texas. Treatment completers (57%; n = 2,200) were compared to non-completers (43%; n = 1,651) on demographic, admission, treatment, and discharge characteristics to determine factors associated with successful completion. Continuous variables were analyzed using between-groups t-tests and Chi-square analyses were used to examine categorical variables. Reasons for Discharge Discharge Features Acknowledgements The authors acknowledge the Texas Department of State Health Services (TDSHS), Mental Health and Substance Abuse Treatment Division for their assistance in providing data for this study. The findings and conclusions of this in this presentation are the opinions of the authors and do not necessarily reflect the official position of TDSHS. Presented at the College on Problems of Drug Dependence, Orlando, Florida, June 20, 2005