title: Predictors of engagement in continuing care following residential substance use disorder treatment.
abstract: BACKGROUND
  Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment.
  
  
  METHODS
  Patients (n=3032) at 15 geographically diverse SUD residential treatment programs provided data on demographics, symptom patterns, recovery resources, and perceptions of treatment environment. We identified patient characteristics associated with the number of consecutive months of engagement in continuing care. We then consolidated and classified risk factors into an integrated model.
  
  
  RESULTS
  Being African American, having more SUD and psychiatric symptoms, more resources for recovery, and perceiving the treatment staff as being supportive were associated with longer engagement in continuing care. African Americans' engagement in continuing care was 17% longer than Caucasians'. The positive effect of being African American was partially mediated by having taken actions toward changing use, and by the presence of psychotic symptoms.
  
  
  CONCLUSIONS
  These results extend previous research on the predictors of continuing care engagement after residential SUD programs. Clinicians can use information about characteristics that put patients at risk for shorter engagement in continuing care to target patients who might benefit from interventions to increase engagement in continuing care.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System, CA, USA. Alexander.HarrisZ@va.gov
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: John D
authors.initials: JD
authors.lastname: McKellar
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Schaefer
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Cronkite
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003710:Demography; D005006:Ethnicity / Q000706:statistics & numerical data; D015438:Health Behavior; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D009042:Motivation; D009483:Neuropsychological Tests; D015995:Prevalence; D012054:Reinforcement, Psychology; D012067:Religion; D012114:Residential Treatment; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors