Volume 102 Issue 3 Page 432 - March 2007RESEARCH REPORT
Treatment setting and baseline substance use severity interact to predict patients' outcomes
Treatment setting and baseline substance use severity interact to predict patients' outcomes
1Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA, 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA and Quyen Tiet, Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA. E-mail: quyen.tiet@va.gov; tietq2@yahoo.com ,
Mark A. Ilgen
1Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA, ,
Hilary F. Byrnes
3University of California, Berkeley, School of Public Health, and Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA ,
Alex H. S. Harris1
1Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA, &
John W. Finney
1Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA, 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA and
1Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA, 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA and 3University of California, Berkeley, School of Public Health, and Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
1Center for Health Care Evaluation, Department of Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA, 2Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA and 3University of California, Berkeley, School of Public Health, and Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
Quyen Tiet, Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025, USA. E-mail:
ABSTRACT
Aims This study tested the hypothesis that patients with more severe substance use disorders (SUDs) at intake respond better when treated in more structured and intensive settings (i.e. in-patient/residential versus out-patient), whereas patients with less severe SUD problems have similar outcomes regardless of treatment setting.
Design, setting and participants Up to 50 new patients were selected randomly from each of a random and representative sample of 50 Department of Veterans Affairs (VA) SUD treatment programs (total n = 1917 patients), and were followed-up an average of 6.7 months later (n = 1277).
Measures Patients completed a brief self-report version of the Addiction Severity Index (ASI) at baseline and at follow-up.
Findings In mixed-model regression analyses, baseline substance use severity predicted follow-up substance use severity and there were no main effects of treatment setting. However, interaction effects were found, such that more severe patients experienced better alcohol and drug outcomes following in-patient/residential treatment versus out-patient treatment; on the other hand, patients with lower baseline ASI drug severity had better drug outcomes following out-patient treatment than in-patient treatment. Treatment setting was unrelated to alcohol outcomes in patients with less severe ASI alcohol scores.
Conclusions Results provide some support to the matching hypothesis that for patients who have higher levels of substance use severity at intake, treatment in in-patient/residential treatment settings is associated with better outcomes than out-patient treatment. More research needs to be conducted before in-patient/residential settings are further reduced as a part of the SUD continuum of care in the United States.
