Prediction of treatment outcomes: lifetime depression versus the continuum of care.

We sought to determine the impact of a lifetime diagnosis of major depression on addiction treatment outcome. Structured interviews were conducted upon admission, and consecutive structured interviews were conducted prospectively for treatment outcome at 6 and 12 month follow-up periods. A multisite evaluation study of patients undergoing addiction treatment for alcohol and drug dependence was conducted in private outpatient facilities. Two thousand twenty-nine subjects from 33 independent programs were enrolled in a national registry for addiction treatment outcomes. The patients received abstinence-based addiction treatment with referral to a 12-step recovery program, often Alcoholics Anonymous, and continuing care in the treatment programs. The outcome areas measured were treatment completion, posttreatment substance use, exposure to psychosocial relapse risk factors, involvement with continuing care (formal aftercare and peer support groups), and posttreatment vocational functioning, health care utilization, and legal involvement. The prevalence rate of depressive symptoms over at least a 2-week period (major depression) in our sample was 28%. Multivariate analysis with stepwise multiple regression indicated that the most powerful predictors (relatively) of posttreatment alcohol/drug use were peer support group attendance and program continuing care involvement. Lifetime depression by itself and in interaction with each of these factors accounted for less than 2% of the variance in outcome. Logistic regression yielded similar results in the prediction of abstinence versus relapse. Posttreatment more than pretreatment factors appear to be more decisive in predicting risk for relapse.

Lifetime diagnosis of major depression as a multivariate predictor of treatment outcome for inpatients with substance use disorders from abstinence-based programs.

A multisite, longitudinal study of patients undergoing inpatient alcohol and drug dependence treatment was conducted in private inpatient facilities, consisting of 4339 subjects from 38 independent programs enrolled in a national addiction treatment outcomes registry. Structured interviews were conducted upon admission, including documentation of current alcohol/drug disorder (DSM-III-R) and lifetime diagnosis of major depressive syndrome; structured interviews were conducted prospectively at 6- and 12-month follow-up periods. The prevalence rate of lifetime diagnosis of major depression in the sample was 39%. Comorbidity varied according to gender and substance of choice. Lifetime depressive symptoms did not correlate with differential length-of-stay, treatment completion, or follow-up consent and, at best, were very weakly associated with follow-up contact. Patients diagnosed with lifetime depression showed the same frequency of participation in posttreatment continuing care: they also showed statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates pre- vs. posttreatment comparable to those of patients without lifetime depression diagnosis. Lifetime major depressive syndrome was not a predictor of outcome in response to abstinence-based treatment. Involvement in posttreatment continuing care accounted for far greater outcome variance. Posttreatment vs. pretreatment factors may be more decisive in influencing risk for relapse.

Integration of treatment and posttreatment variables in predicting results of abstinence-based outpatient treatment after one year.

A multi-site, longitudinal study of patients undergoing outpatient alcohol and drug dependence treatment was conducted in private outpatient facilities, consisting of 2,029 subjects from 33 independent programs enrolled in a national addiction treatment outcomes registry. Pretreatment demographic and substance variables, treatment utilization variables, and post-treatment continuum of care variables were examined simultaneously in a multivariate prediction context for association with outcome. Upon admission patients provided history information to treatment staff trained in the collection of data for the evaluation efforts. Trained interviewers conducted consecutive structured interviews prospectively for treatment outcome at six- and 12-month follow-up periods. Multivariate analysis with stepwise multiple regression indicated that, relatively speaking, the most powerful predictors of treatment outcome were posttreatment variables: namely, support group attendance and involvement in a continuing care program. Pretreatment and treatment variables contributed proportionately little to the prediction of outcome. Additional sequential-stage analysis showed that the incremental contribution to prediction by posttreatment attendance at Alcoholics Anonymous and involvement in a treatment program following discharge far exceeded the initial predictive validity of the 14 pretreatment and treatment variables examined. Participation in posttreatment continuing care correlated with statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates. Posttreatment more than pretreatment factors may be decisive in influencing risk for relapse.

Concurrent validation of substance abusers self-reports against collateral information: percentage agreement vs. kappa vs. Yule's Y.

The ability for chemical users to give an accurate self-report of substance use vs. abstinence has been questioned. This study investigated its concurrent validity, against collateral ratings. The results indicated that validity of reports of chemical use must be evaluated in the context of the validity of other types of information. Chemical use items were corroborated about as often as such nonchemical use items as reports of emergency room visits, arrests, and hospitalizations, thus arguing against the presence of a specific denial syndrome or overarching tendency toward self-misrepresentation. Relative concurrent validities seemed more a function of such factors as item salience and specificity. No consistent trend in patient over- or underreporting of chemical use was found. The choice of concurrent validation statistic is important and can influence interpretation of results. Current standards such as percentage agreement and kappa were seen as flawed; comparisons of results based on these two measures, as well as Yule's Y led to the conclusion that Yule's Y is the statistic of choice.

Screening for alcoholism in general medical patients.

Medical patients (N = 108) were administered a brief screening instrument (LAMSI) and a structured diagnostic interview (SUDDS). Twenty-five patients met DSM-III criteria for an alcohol use disorder, 20 current, five in remission. The four-item scale embedded in the screen identified the alcoholics with 88% sensitivity and 96% specificity.

Comparison of court-referred DWI arrestees with other outpatients in substance abuse treatment.

Outpatient treatment based on the "Minnesota Model" as one alternative for alcoholics arrested for driving while intoxicated (DWI) was examined. DWI arrestees (N = 543) who were court referred for chemical abuse treatment were compared with 827 non-DWI and non-court-referred patients in the same outpatient treatment programs. Results indicate that DWI arrestees tended to be younger and unmarried but were more likely to complete treatment. Their drinking was characterized more as an episode use in a social context with less solitary use, continuous use or use as a response to negative feelings. Although the DWI patients in this study were all alcoholics, as a group they appear to represent a generally less advanced stage of alcoholism than the non-DWI sample. Posttreatment follow-up measures at 6 months on subsamples of the patients demonstrated improvement for both DWI and non-DWI patients in virtually all areas assessed. Few outcome differences between DWI and non-DWI groups were found. The results indicate that outpatient substance abuse treatment may be a viable and vital component in any integrated policy on drunken driving.