title: Evaluation of full vs. partial continuum of care in the treatment of publicly funded substance abusers in Washington State.
abstract: This study evaluated the relative effectiveness of two forms of publicly funded substance abuse treatment provided in Washington State: The full continuum (FC), in which clients receive approximately three weeks of inpatient treatment prior to outpatient care, and the partial continuum (PC), in which clients are admitted directly to outpatient treatment. Data on treatment process/proximal outcomes, such as psychological distress and readiness to change, were assessed at 8 weeks post intake, and data on treatment services received were obtained at 2, 4, 8, and 12 weeks. Multidimensional outcomes, including alcohol and drug use as well as a number of psychosocial functioning outcomes, were assessed at 3 and 9 months post intake. Results indicated that clients in the FC had greater alcohol, drug, and legal problem severity at intake than those in the PC, whereas medical and employment problem severity was greater in the PC. Clients in the FC received more treatment services in the first 2 weeks than those in the PC, but there were no differences at subsequent points. Outcome analyses at 3 and 9 months indicated that clients in the FC had greater improvements in alcohol, drug, and psychiatric severity than those in the PC. Matching analyses indicated that clients with greater substance-use severity at baseline improved to a greater degree in the FC as compared to the PC. Matching effects were not obtained with medical or psychiatric severity, or readiness to change.
authors.affiliation: University of Pennsylvania, Philadelphia, USA. mckay_j@mail.trc.upenn.edu
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Donovan
authors.forename: Thomas
authors.initials: T
authors.lastname: McLellan
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krupski
authors.forename: Michelle
authors.initials: M
authors.lastname: Hansten
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Stark
authors.forename: Kathy
authors.initials: K
authors.lastname: Geary
authors.forename: Jarrod
authors.initials: J
authors.lastname: Cecere
mesh_terms: D000328:Adult; D000359:Aftercare / Q000191:economics; D000437:Alcoholism / Q000191:economics* / Q000534:rehabilitation; D000553:Ambulatory Care / Q000191:economics*; D003266:Continuity of Patient Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005380:Financing, Government / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000191:economics*; D016320:Substance Abuse Treatment Centers / Q000191:economics*; D019966:Substance-Related Disorders / Q000191:economics* / Q000534:rehabilitation; D014861:Washington