Relational Discord at Conclusion of Treatment Predicts Future Substance Use for Partnered Patients

1. Relational Discord at Conclusion of Treatment Predicts Future Substance Use for Partnered Patients Wayne H. Denton, MD, PhD; Paul A. Nakonezny, PhD; Bryon H. Adinoff, MD; & Kathleen M. Carroll, PhD University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care Center, Yale University School of Medicine INTRODUCTION RESULTS STUDY ONE Relational discord has many associations with substance use disorders. No studies, however, have specifically examined the association of relational functioning at the conclusion of community treatment with substance-use following treatment. In the present analyses, we evaluated the association of relational discord at the conclusion of community treatment with days of substance use during the follow-up period in two independent samples. Our hypothesis was that patients experiencing relational discord would have more days of substance use during follow-up than those without relational discord. A secondary aim was to examine changes in relational discord over the course of the 28-day treatment period. • Substance use during the 12 weeks after the termination assessment was significantly higher for those who had relational discord at the termination assessment [4.23 days (95% CI: 1.72 to 10.37 days) vs. 0.59 days (95% CI: 0.19 to 1.79 days); p = 0.01; Cohen’s d = 0.67] (see figure). • The average ASI Family/Social Composite score was 0.20 (SD=0.25) at baseline and 0.14 (SD=0.20) at the 28-day termination assessment. This difference was not significant [-0.06, S (54) = -117.5, p = .09]. • 35 participants (59.3%) had relational discord at baseline and 32 (54.2%) had relational discord at the 28-day termination assessment. This difference was not significant [QM = 0.47 (1), p = .49]. METHOD STUDY TWO • Participants in Study 1 were drawn from NIDA-CTN-0004; MET [Motivational Enhancement Treatment] to improve treatment engagement and outcome in subjects seeking treatment for substance abuse (N=461) (Ball et. al, 2007) • Participants in Study 2 were drawn from NIDA-CTN-0005; MI [Motivational Interviewing] to improve treatment engagement and outcome in subjects seeking treatment for substance abuse (N=423) (Carroll et al., 2006) • For inclusion in the present analyses, it was required that the participant: • Was married or cohabiting by self-report • Completed both the 28-day termination assessment and the follow-up assessment (12 weeks for Study 1 and 8 weeks for Study 2) • Of the original participants, these criteria were met by 59 subjects from Study 1 and 66 subjects from Study 2. Demographic characteristics are in Table 1. • Substance use during the 8 weeks after the termination assessment was significantly higher for those who had relational discord at the termination assessment [8.16 days (95% CI: 3.34 to 20.01 days) vs. 1.66 days (95% CI: 0.64 to 4.34 days); p = 0.02; Cohen’s d = 0.60] (see figure). • The average ASI Family/Social Composite score was 0.22 (SD=0.26) at baseline and 0.12 (SD=0.20) at the 28-day assessment. This difference was significant [ -0.10, S (58) = -166, p = .007] • 36 participants (54.5%) had relational discord at baseline while, at the 28-day termination assessment, 29 (43.9%) had family/social discord. This difference was not significant [QM = 2.33 (1), p = .12]. SUMMARY & CONCLUSIONS • Patients experiencing relational discord at the end of a 28 day treatment program had more days of substance use in the immediate period following discharge than partnered patients without dyadic discord. This finding was confirmed in two independent samples.. • The severity of relational discord did not improve in one sample (Study 1) during the 28-day treatment period but did improve in the second sample (Study 2) • The proportion of patients who could be classified as experiencing relational discord did not change during the 28-day treatment for either study • Relational discord at the end of substance abuse treatment is a risk factor for substance use after discharge and may warrant a referral to relational (couple) therapy. Dependent Variable: Substance Use Calendar (Carroll et al., 2004; Sobell & Sobell, 1992) The primary outcome was total number of days of drug use during the first follow-up period after the 28-day termination assessment. Substance use was assessed using the substance use calendar. Independent Variable: Family/Social Composite Score of the Addiction Severity Index (McLellan et al., 1980) Relational discord was assessed by the Family/Social composite score of the Addiction Severity Index. Higher scores indicate higher levels of discord. The composite score was utilized both continuously and categorically. For the categorical usage, a score of 0 was defined as “no discord” while and a score greater than 0 was defined as “relational discord..” Data Analysis p=.01 p=.02 • Primary outcome was total number of days of drug use during the time period after the termination assessment using a negative binomial loglinear model in a Generalized Estimating Equation (GEE). The main effect of relational discord at the termination assessment was examined. • The secondary aim was to examine change in relational discord over the course of the initial 28-day treatment period. The Wilcoxon Signed Rank test (two-tailed) was used. The McNemar's test was used to compare the proportion of participants with relational discord at study entry and termination assessment. • The level of significance for all tests was set at p < .05. Supported by the NIDA Clinical Trials Network and the VA North Texas Health Care System