Relationship of treatment orientation and continuing care to remission among substance abuse patients.
OBJECTIVE
The authors examined whether continuing outpatient mental health care, the orientation of the treatment program (12-step, cognitive-behavioral, or eclectic), and involvement in self-help groups were linked to substance abuse patients' remission status two years after discharge.


METHODS
The data were from a cohort of 2,805 male patients who were treated through one of 15 Department of Veterans Affairs substance abuse programs. Remission was defined as abstinence from illicit drug use and abstinence from or nonproblem use of alcohol during the previous three months. The relationships of the three variables to remission were tested with regression models that controlled for baseline characteristics.


RESULTS
About a quarter of the study participants (28 percent) were in remission two years after discharge. Intake characteristics that predicted remission at two years included less severe substance use and psychiatric problems, lower expected disadvantages and costs of discontinuing substance use, and having abstinence as a treatment goal. No significant relationship emerged between treatment orientation and remission status two years later. Involvement in outpatient mental health care during the first follow-up year and participation in self-help groups during the last three months of that year were associated with a greater likelihood of remission at the two-year follow-up.


CONCLUSIONS
The results extend previously published one-year outcome findings showing that cognitive-behavioral and 12-step treatment programs result in similar remission rates. Patients who enter intensive substance abuse treatment with polysubstance use, psychiatric symptoms, or significant emotional distress have more difficulty achieving remission. Routinely engaging patients in continuing outpatient care is likely to yield better outcomes. The duration of such care is probably more important than the number of sessions.
Ritsher
Jennifer Boyd
JB
Program Evaluation and Resource Center, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, California 94025, USA. jennifer.ritsher@med.va.gov
Moos
Rudolf H
RH
Finney
John W
JW
D000328:Adult; D000553:Ambulatory Care; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D000529:Complementary Therapies / Q000379:methods*; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D011369:Professional-Patient Relations; D015397:Program Evaluation; D012074:Remission Induction; D012657:Self-Help Groups; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D013287:Illicit Drugs