Introduction

1. Substance Use, Psychiatric, and Service Characteristics of Clients with Co-Occurring Disorders Completing Substance Abuse Treatment Laurel Mangrum, Ph.D. University of Texas at Austin, Addiction Research Institute Introduction Client Characteristics Results and Conclusions The co-occurrence of psychiatric and substance use disorders (COD) and the effects of comorbidity on the clinical presentation and outcomes of substance abuse treatment are growing areas of study. As research progresses, studies are focusing on identifying client and service characteristics that may be associated with treatment response and recovery. Research to date indicates considerable heterogeneity in the COD population in relation to both diagnoses and symptom severity; continuing studies are needed examining client characteristics that are associated with outcomes. Further, research also suggests that COD clients often present to treatment with multifaceted social support needs that may hinder response to treatment and maintenance of recovery if left unattended. Thus, the addition of recovery support services during treatment is a potential intervention that may enhance client engagement and sustain recovery following discharge. The extant literature examining the effect of recovery support services for COD clients is limited and generally confined to studies of wrap-around service provision in mental health treatment settings. Further, research regarding the effects of peer mentoring on client engagement and recovery is particularly lacking. One component of the Texas Co-Occurring State Incentive Grant (COSIG) project is designed to address these complex service needs of COD clients. Clients who qualify for the COSIG program are provided an $1,800 voucher during treatment to procure recovery support services in ten categories: housing, transportation, food assistance, peer mentoring, education, clothing, medical, prescriptions, vocational, and childcare. The current study examines client and recovery support service characteristics in a sample of COD clients who participated in the Texas COSIG project. The purpose of the study is to compare substance abuse treatment completers with non-completers to explore client and service features that may be associated with successful outcomes. • Analyses of demographic and social variables revealed that completers were more likely to be male and homeless. No group differences were found in age, race/ethnicity, marital status, education, employment, or past year substance related arrests. In the psychiatric domain, a greater proportion of completers received diagnoses of depression and generalized anxiety disorder using the M.I.N.I interview. Non-completers were more often diagnosed with bipolar and posttraumatic stress disorders. No group differences were found in client-reported symptom severity on the BSI; however, non-completers were rated more severely by clinicians in the areas of interpersonal sensitivity, depression, and hostility on the BDPRS. In the area of substance use patterns, no differences were found in primary substance of abuse, with alcohol being the most frequently identified primary substance for both groups. Completers reported more days of use during the month prior to treatment, whereas non-completers were more likely to report daily substance use over the past six months. Completers also had a greater history of both prior detox and non-detox treatment. By contrast, a greater percentage of the non-completer group reported attending AA/NA during the 30 days prior to admission. At discharge, completers achieved higher rates of past month abstinence (89% vs.61%; X2(1) = 32.53, p < .0001)and AA/NA attendance (94% vs.78%; X2(1) = 21.86, p < .0001), but no differences were found in length of stay in treatment (106 vs. 99 days). Examination of recovery support services utilization revealed that completers more often received peer mentoring services. Approximately 62% of completers received peer mentoring services compared to 44% of non-completers, representing the greatest proportional difference among the recovery support categories. Greater proportions of the non-completer group received education, clothing, food assistance, medical care, and vocational services. Analyses of recovery support service combinations indicated that completers were more likely to receive a combination of peer mentoring and social support services, whereas non-completers were more likely to receive social support services only. • The results of this study have significant clinical implications regarding the treatment of COD clients in substance abuse service settings. Higher treatment completion for males indicates that women may need specialized interventions during substance abuse treatment. A previous study analyzing gender differences using a subset of these data revealed that women demonstrated a higher awareness of psychiatric issues relative to substance use problems, suggesting that substance abuse treatment interventions may need a greater focus on the interaction of the two disorders (Mangrum, Spence, & Steinley-Bumgarner, 2006). Further, lower completion rates for clients with bipolar and posttraumatic stress disorder suggests that these syndromes may be more difficult to treat in substance abuse treatment settings and that addiction counselors may benefit from training on specialized interventions for these two disorders. Analyses of recovery support service utilization revealed that peer mentoring had the strongest association with treatment completion among the ten voucher categories. Social support services, particularly in the absence of peer mentoring, were associated with non-completion. Similar trends have been found in the Texas Access to Recovery (ATR) grant voucher data, indicating that direct recovery support services are associated with greater completion rates, whereas the provision of social support services only is more highly associated with non-completion. These patterns of findings across the two grant projects suggest that peer mentoring may play a pivotal role in the recovery support process that enhances the effect of other social support services on improving client outcomes. Diagnostic Impressions from M.I.N.I. Demographic and Social Characteristics Recovery Support Services Received Treatment History and Substance Use Sample and Method The sample consisted of 424 COSIG clients who entered and were discharged from substance abuse treatment during the period of February 2005 through October 2006. Clients qualified for the COSIG program based on the presence of a comorbid non-substance use disorder determined though the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was recruited from eleven state-funded substance abuse treatment programs participating in the COSIG project. The total sample was 53% female, 47% White, 42% Hispanic, and 10% Black. Seventy-six percent of the total sample was rated by counselors as completing treatment using state agency guidelines defining completion. Treatment completers (n = 323) and non-completers (n = 101) were compared on demographic variables, M.I.N.I. psychiatric diagnoses, substance use characteristics, psychiatric severity, and recovery support service utilization. Psychiatric severity measures included the Brief Symptom Inventory (BSI; client report) and the Brief Derogatis Psychiatric Rating Scale (BDPRS; clinician rating). Demographic, substance use, and treatment history data were obtained from the Behavioral Health Integrated Provider System (BHIPS), which is the mandatory data collection and outcomes monitoring system for state-funded substance abuse treatment providers in the state of Texas. Data regarding COSIG voucher service utilization were also available from BHIPS. Psychiatric Severity Recovery Support Service Combinations Acknowledgements The author acknowledges the Texas Department of State Health Services (TDSHS), Mental Health and Substance Abuse Services Division for their assistance in providing data for this study. The author also acknowledges the treatment providers participating in the COSIG project for contributing client data and recognizes their continuing efforts to enhance services for clients with co-occurring disorders. The author has no financial relationships associated with the topic of this presentation. The findings and conclusions of this in this presentation are the opinions of the author and do not necessarily reflect the official position of TDSHS. Presented at the College on Problems of Drug Dependence Conference, Quebec City, Canada, June 19, 2007