The association of psychiatric comorbidity with treatment completion among clients admitted to substance use treatment programs in a U.S. national sample

Noa Krawczyk, Kenneth A. Feder, Brendan Saloner, Rosa M Crum, Marc Kealhofer, Ramin Mojtabai

Research output: Contribution to journalArticle

Abstract

Background Psychiatric disorders are highly comorbid with substance use disorders and play an important role in their course and recovery. However, the impact of comorbidity on treatment outcomes has not been examined in a U.S. national sample. This study explores the impact of psychiatric comorbidity on treatment completion among individuals admitted to publicly funded substance use treatment facilities across the United States. Methods Using data on first-time treatment episodes in the U.S. from the Treatment Episode Dataset-Discharges (TEDS-D) for the years 2009–2011, logistic regression was used to assess the association between psychiatric comorbidity and treatment non-completion, and Cox proportional hazards regression was used to assess the association between comorbidity and rate of attrition. Analyses were performed for all substances together and then stratified by primary substance of abuse (alcohol, cannabis, stimulants, or opioids). Results Of 856,385 client treatment episodes included in our analysis, 28% had a psychiatric comorbidity and 38% did not complete treatment. After adjusting for socio-demographic and treatment characteristics, clients with psychiatric comorbidity had higher odds of not completing treatment relative to those without comorbidity [OR = 1.28 (1.27–1.29)], and had an earlier time to attrition [HR = 1.14 (1.13–1.15)]. Psychiatric comorbidity was most strongly associated with treatment non-completion and rate of attrition in those admitted primarily for alcohol [OR = 1.37 (1.34–1.39); HR = 1.19 (1.17–1.21), respectively]. Conclusions Individuals with psychiatric comorbidities receiving treatment for substance use disorders face unique challenges that impact their ability to complete treatment. The findings call for further efforts to integrate treatment for psychiatric comorbidities in substance use treatment settings.

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalDrug and Alcohol Dependence
Volume175
DOIs
StatePublished - Jun 1 2017

Fingerprint

Psychiatry
Comorbidity
Substance-Related Disorders
Alcohols
Cannabis
Aptitude
Opioid Analgesics
Logistics
Hazards
Recovery
Logistic Models
Demography

Keywords

  • Alcohol treatment
  • Comorbidity
  • Drug treatment
  • Mental health integration
  • Substance use treatment
  • Treatment retention

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

@article{18878a8ca97f4e8bad2e88e9305d3b8f,
title = "The association of psychiatric comorbidity with treatment completion among clients admitted to substance use treatment programs in a U.S. national sample",
abstract = "Background Psychiatric disorders are highly comorbid with substance use disorders and play an important role in their course and recovery. However, the impact of comorbidity on treatment outcomes has not been examined in a U.S. national sample. This study explores the impact of psychiatric comorbidity on treatment completion among individuals admitted to publicly funded substance use treatment facilities across the United States. Methods Using data on first-time treatment episodes in the U.S. from the Treatment Episode Dataset-Discharges (TEDS-D) for the years 2009–2011, logistic regression was used to assess the association between psychiatric comorbidity and treatment non-completion, and Cox proportional hazards regression was used to assess the association between comorbidity and rate of attrition. Analyses were performed for all substances together and then stratified by primary substance of abuse (alcohol, cannabis, stimulants, or opioids). Results Of 856,385 client treatment episodes included in our analysis, 28{\%} had a psychiatric comorbidity and 38{\%} did not complete treatment. After adjusting for socio-demographic and treatment characteristics, clients with psychiatric comorbidity had higher odds of not completing treatment relative to those without comorbidity [OR = 1.28 (1.27–1.29)], and had an earlier time to attrition [HR = 1.14 (1.13–1.15)]. Psychiatric comorbidity was most strongly associated with treatment non-completion and rate of attrition in those admitted primarily for alcohol [OR = 1.37 (1.34–1.39); HR = 1.19 (1.17–1.21), respectively]. Conclusions Individuals with psychiatric comorbidities receiving treatment for substance use disorders face unique challenges that impact their ability to complete treatment. The findings call for further efforts to integrate treatment for psychiatric comorbidities in substance use treatment settings.",
keywords = "Alcohol treatment, Comorbidity, Drug treatment, Mental health integration, Substance use treatment, Treatment retention",
author = "Noa Krawczyk and Feder, {Kenneth A.} and Brendan Saloner and Crum, {Rosa M} and Marc Kealhofer and Ramin Mojtabai",
year = "2017",
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day = "1",
doi = "10.1016/j.drugalcdep.2017.02.006",
language = "English (US)",
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pages = "157--163",
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T1 - The association of psychiatric comorbidity with treatment completion among clients admitted to substance use treatment programs in a U.S. national sample

AU - Krawczyk, Noa

AU - Feder, Kenneth A.

AU - Saloner, Brendan

AU - Crum, Rosa M

AU - Kealhofer, Marc

AU - Mojtabai, Ramin

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background Psychiatric disorders are highly comorbid with substance use disorders and play an important role in their course and recovery. However, the impact of comorbidity on treatment outcomes has not been examined in a U.S. national sample. This study explores the impact of psychiatric comorbidity on treatment completion among individuals admitted to publicly funded substance use treatment facilities across the United States. Methods Using data on first-time treatment episodes in the U.S. from the Treatment Episode Dataset-Discharges (TEDS-D) for the years 2009–2011, logistic regression was used to assess the association between psychiatric comorbidity and treatment non-completion, and Cox proportional hazards regression was used to assess the association between comorbidity and rate of attrition. Analyses were performed for all substances together and then stratified by primary substance of abuse (alcohol, cannabis, stimulants, or opioids). Results Of 856,385 client treatment episodes included in our analysis, 28% had a psychiatric comorbidity and 38% did not complete treatment. After adjusting for socio-demographic and treatment characteristics, clients with psychiatric comorbidity had higher odds of not completing treatment relative to those without comorbidity [OR = 1.28 (1.27–1.29)], and had an earlier time to attrition [HR = 1.14 (1.13–1.15)]. Psychiatric comorbidity was most strongly associated with treatment non-completion and rate of attrition in those admitted primarily for alcohol [OR = 1.37 (1.34–1.39); HR = 1.19 (1.17–1.21), respectively]. Conclusions Individuals with psychiatric comorbidities receiving treatment for substance use disorders face unique challenges that impact their ability to complete treatment. The findings call for further efforts to integrate treatment for psychiatric comorbidities in substance use treatment settings.

AB - Background Psychiatric disorders are highly comorbid with substance use disorders and play an important role in their course and recovery. However, the impact of comorbidity on treatment outcomes has not been examined in a U.S. national sample. This study explores the impact of psychiatric comorbidity on treatment completion among individuals admitted to publicly funded substance use treatment facilities across the United States. Methods Using data on first-time treatment episodes in the U.S. from the Treatment Episode Dataset-Discharges (TEDS-D) for the years 2009–2011, logistic regression was used to assess the association between psychiatric comorbidity and treatment non-completion, and Cox proportional hazards regression was used to assess the association between comorbidity and rate of attrition. Analyses were performed for all substances together and then stratified by primary substance of abuse (alcohol, cannabis, stimulants, or opioids). Results Of 856,385 client treatment episodes included in our analysis, 28% had a psychiatric comorbidity and 38% did not complete treatment. After adjusting for socio-demographic and treatment characteristics, clients with psychiatric comorbidity had higher odds of not completing treatment relative to those without comorbidity [OR = 1.28 (1.27–1.29)], and had an earlier time to attrition [HR = 1.14 (1.13–1.15)]. Psychiatric comorbidity was most strongly associated with treatment non-completion and rate of attrition in those admitted primarily for alcohol [OR = 1.37 (1.34–1.39); HR = 1.19 (1.17–1.21), respectively]. Conclusions Individuals with psychiatric comorbidities receiving treatment for substance use disorders face unique challenges that impact their ability to complete treatment. The findings call for further efforts to integrate treatment for psychiatric comorbidities in substance use treatment settings.

KW - Alcohol treatment

KW - Comorbidity

KW - Drug treatment

KW - Mental health integration

KW - Substance use treatment

KW - Treatment retention

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U2 - 10.1016/j.drugalcdep.2017.02.006

DO - 10.1016/j.drugalcdep.2017.02.006

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JO - Drug and Alcohol Dependence

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