A comparative, process-effectiveness evaluation of VA substance abuse treatment.
Over 3,000 patients from 15 VA inpatient, substance abuse treatment programs showed considerable improvement from intake to a one-year follow-up. Patients in 12-step programs, as opposed to cognitive-behavioral (CB) or eclectic programs, and those with more extended continuing outpatient mental health care and 12-step self-help group involvement, were more likely to be abstinent and free of substance use problems at follow-up. Consistent with their better one-year outcomes, patients in 12-step programs improved more between intake and discharge than CB patients on proximal outcomes assumed to be specific to 12-step treatment (e.g., disease model beliefs) and as much or more on CB proximal outcomes. Proximal outcomes assessed at treatment discharge and follow-up were, at best, modestly related to one-year substance use and other outcomes. No evidence was found that CB or 12-step treatment is more beneficial for certain types of patients.
Finney
J W
JW
Program Evaluation and Resource Center, VA Palo Alto Health Care System, Palo Alto, California 94025, USA.
Ouimette
P C
PC
Humphreys
K
K
Moos
R H
RH
D000328:Adult; D000436:Alcoholics Anonymous / Q000191:economics; D000437:Alcoholism / Q000191:economics* / Q000534:rehabilitation; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019966:Substance-Related Disorders / Q000191:economics* / Q000534:rehabilitation; D014728:Veterans / Q000523:psychology*