title: Predictors of treatment retention for substance-dependent adults with co-occurring depression.
abstract: Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified as a pervasive challenge. We examine predictors of treatment retention in a sample of veterans (N = 253) participating in a clinical trial comparing two types of psychotherapy for co-occurring depression and substance use disorders. The study protocol included 24 weeks of outpatient group psychotherapy in either a newly developed Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation Therapy (TSF). Using a model of treatment utilization developed by Aday and Anderson, we analyzed predictors categorized into predisposing factors, enabling resources, need for treatment, and type of treatment received. Outcome included total number of sessions attended (maximum of 36 sessions). Treatment retention did not differ between the two study interventions. Bivariate analyses indicated that predisposing factors were most predictive, with older participants, Caucasians, and those using only alcohol in the month before treatment attending more sessions, and individuals who had recently experienced a health event remained in treatment longer. Importantly, several factors were not related to treatment retention: marital status, education, neuropsychological functioning, financial stress, chronic health problems, treatment motivation, and psychiatric severity. In the combined model of predisposing, enabling and need factors, age and ethnicity were the only significant predictors.
authors.affiliation: VA San Diego Healthcare System, California 92161, USA. srtate@ucsd.edu
authors.forename: Susan R
authors.initials: SR
authors.lastname: Tate
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mrnak-Meyer
authors.forename: Chris L
authors.initials: CL
authors.lastname: Shriver
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Atkinson
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Robinson
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D012720:Severity of Illness Index; D012944:Social Support; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D017211:Treatment Failure; D014728:Veterans / Q000523:psychology
chemical_list: D000928:Antidepressive Agents