title: The effect of matching comprehensive services to patients' needs on drug use improvement in addiction treatment.
abstract: OBJECTIVE
  To examine whether need-service matching in addiction treatment leads to improvements in drug use, and whether treatment duration mediates those improvements.
  
  
  METHODS
  This analysis utilizes prospective data from a US cohort of addiction treatment patients who reported service needs beyond core rehabilitative services (n = 3103). 'Drug use improvement' is the difference between the patient's peak drug use frequency (in days per month) in the year before intake and in the year after treatment. Overall and primary use of the major illicit drugs (heroin, powder or crack cocaine and marijuana) are considered separately. 'Need-service match' means that a patient rated a service as important at intake and reported its receipt during treatment. 'Percentage of needs matched' indicates the proportion of five service domains (medical, mental health, family, vocational and housing) so matched.
  
  
  RESULTS
  In mixed regression models controlling for multiple factors, a greater percentage of needs matched tended to improve primary (beta = 0.028, P = 0.09) and overall (beta = 0.049, P = 0.05) drug use in the follow-up year. Exclusion of treatment duration as a covariate doubled the magnitude of these coefficients. The benefits of matching were concentrated among the half of patients reporting needs in four to five rather than one to three domains, and were strongest among patients in long-term residential facilities. Addressing vocational and housing needs exerted the greatest effects.
  
  
  CONCLUSIONS
  Matching comprehensive services to needs is a useful addiction treatment practice, especially for high-need patients. Treatment duration might partially mediate its effect.
authors.affiliation: Division of General Internal Medicine, Departments of Medicine and Community Health, Brown University School of Medicine and Rhode Island Hospital, Providence, RI 02903, USA. pfriedmann@lifespan.org
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
authors.forename: James C
authors.initials: JC
authors.lastname: Hendrickson
authors.forename: Dean R
authors.initials: DR
authors.lastname: Gerstein
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D015331:Cohort Studies; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D015999:Multivariate Analysis; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome; D014481:United States