title: Impact of sexual orientation and co-occurring disorders on chemical dependency treatment outcomes.
abstract: OBJECTIVE
  The aims of this study were to compare client characteristics at admission to chemical dependency (CD) treatment by sexual orientation, examine sexual orientation as a predictor of co-occurring CD and mental health problems (hereafter referred to as co-occurring disorders [COD]), and to examine the effect of sexual orientation and COD on 1-year CD treatment outcomes (treatment completion, treatment reentry, and arrest) among men and women.
  
  
  METHODS
  This retrospective cohort study used 2004-2008 data from publicly funded CD treatment programs in Washington State (n = 69,525 clients). Bivariate comparisons were made using chi-square tests; logistic and Cox regressions were to estimate risk in multivariate analyses.
  
  
  RESULTS
  Risk factors associated with sexual minority status (lesbian/gay/bisexual) included COD, primary drug (vs. alcohol) use, and greater substance use. In multivariate analyses, sexual minority clients were more than twice as likely as their heterosexual counterparts to have COD. COD, but not sexual orientation, negatively predicted treatment completion and arrest overall in the year following treatment among male and female clients and positively predicted treatment reentry and intimate partner violence-related arrest among women. COD moderated the effect of sexual orientation on arrest; gay men with COD were less likely to be arrested, particularly for substance use and other violence-related crimes.
  
  
  CONCLUSIONS
  These findings highlight the importance of assessing mental health among sexual minority clients in treatment settings and addressing issues specific to both female and male sexual minorities.
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations, Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA 98104-2499, USA. Lipsky@u.washington.edu
authors.forename: Sherry
authors.initials: S
authors.lastname: Lipsky
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krupski
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.forename: Alice
authors.initials: A
authors.lastname: Huber
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Lucenko
authors.forename: David
authors.initials: D
authors.lastname: Mancuso
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003415:Crime / Q000706:statistics & numerical data; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011329:Prisoners / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D019529:Sexuality / Q000706:statistics & numerical data*; D013179:Spouse Abuse / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014754:Violence / Q000706:statistics & numerical data; D055815:Young Adult