title: Profiles of substance use disorders in patients of therapeutic communities: link to social, medical and psychiatric characteristics.
abstract: BACKGROUND
  Therapeutic community (TC) clients frequently display a pattern of multiple substance use disorders (SUDs) which is associated with poorer treatment outcomes. This study aimed to characterize multiple SUD profiles in patients enrolled in TCs, and examine the association of these profiles with social, medical and psychiatric outcomes.
  
  
  METHODS
  Observational study. We acquired substance use diagnoses and sociodemographic, medical and psychiatric comorbidity data for 4102 patients who had been admitted to six public TCs in Andalusia (Spain) from 2004 to 2012. Latent class analysis was applied to participants' substance use diagnoses, and the resulting classes were associated with social (i.e., education, employment, criminality), medical (i.e., infectious diseases) and psychiatric comorbidity.
  
  
  RESULTS
  We found four differentiated profiles of substance use diagnoses among TC patients: cocaine/opiates (Class 1: 37% of participants); cocaine/opiates/benzodiazepines (Class 2: 25.3%); alcohol (Class 3: 24.7%); and cocaine/cannabis/alcohol (Class 4: 12.9%). Classes 1 and 2 were associated with poorer social and medical characteristics. Class 2 was also associated with greater prevalence of impulsive spectrum mental disorders. Class 3 was associated with greater prevalence of mood and anxiety disorders and cognitive dysfunction, and Class 4 was associated with higher prevalence of psychotic illness.
  
  
  CONCLUSIONS
  Patients admitted to TCs have heterogeneous substance use diagnostic profiles. Profiles involving multiple use of heroin, cocaine, alcohol and benzodiazepines are associated with poorer social and medical function and impulse control disorders. Profiles involving alcohol use and cannabis/cocaine use are associated with cognitive dysfunction and psychotic illness respectively.
authors: Therapeutic Community of Cartaya, Agency of Social Services and Dependence of Ansalusia, Huelva, Spain.
authors: David
authors: D
authors: Fernández-Calderón
authors: Research and Information System Department, Agency of Social Services and Dependence of Ansalusia, Sevilla, Spain; Clinical, Experimental and Social Psychology Department, University of Huelva, Huelva, Spain.
authors: Fermín
authors: F
authors: Fernández
authors: Education and Social Psychology Department, University of Pablo de Olavide, Sevilla, Spain.
authors: Sofía
authors: S
authors: Ruiz-Curado
authors: Red de Trastornos Adictivos, University of Granada, Spain; School of Psychological Sciences, Monash University, Australia.
authors: Antonio
authors: A
authors: Verdejo-García
authors: Clinical, Experimental and Social Psychology Department, University of Huelva, Huelva, Spain; Red de Trastornos Adictivos, University of Granada, Spain. Electronic address: oscar.lozano@dpsi.uhu.es.
authors: Óscar M
authors: ÓM
authors: Lozano
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology; D015897:Comorbidity; D004194:Disease; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*; D015995:Prevalence; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*; D013808:Therapeutic Community; D016896:Treatment Outcome
keywords: Comorbidity; Latent class analysis; Multiple substance use disorders