Risk factors for symptom exacerbation among treated patients with substance use disorders.
OBJECTIVE
The purpose of this study was to develop an index of risk factors to identify patients prospectively with substance use disorders whose substance use symptoms exacerbate during or shortly after treatment, and to identify characteristics of care that may reduce the likelihood of exacerbation.


METHODS
On the basis of data obtained from a nation-wide outcomes monitoring system, a group of 2809 treated patients experienced an exacerbation of their substance use symptoms. These patients were matched on baseline substance abuse problems with 5618 patients who remained stable or improved.


RESULTS
Risk factors for substance use symptom exacerbation included younger age, non-married status and residential instability; long-term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence and more severe self-rated drug problems; and psychiatric problems. High-risk patients who obtained a longer episode of mental health care were less likely to experience an exacerbation of symptoms.


CONCLUSIONS
Clinicians can identify at treatment entry patients whose substance use symptoms are likely to exacerbate and, by providing these patients a longer duration of care, may reduce the likelihood of symptom exacerbation.
Moos
Rudolf H
RH
Center For Health Care Evaluation, VA Health Care System, Menlo Park, CA 94025, USA. bmoos@stanford.edu
Nichol
Aran C
AC
Moos
Bernice S
BS
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D003415:Crime; D004522:Educational Status; D017050:Episode of Care; D005260:Female; D006798:Housing; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D011379:Prognosis; D011594:Psychometrics; D012044:Regression Analysis; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000208:ethnology / Q000628:therapy*; D016896:Treatment Outcome