Comparison of clients completing inpatient alcoholism treatment with clients who left prematurely

Treatment refusal/attrition among adults randomly assigned to programs at a drug treatment campus: The New Jersey Substance Abuse Treatment Campus, Seacaucus, NJ

The New Jersey Substance Abuse Treatment Campus was funded to assess the feasibility of establishing a new model for delivering substance abuse treatment services and to serve as a research laboratory for conducting comparative evaluations of those services. The 350-bed campus was designed to improve treatment effectiveness by providing special services needed by underserved populations, and reduce treatment costs by serving large numbers of clients, centralizing services, and sharing facilities. First-time clients who met preliminary eligibility requirements during phone screening were randomly assigned to therapeutic community and chemical dependency programs. We used data collected on 1,573 adults who were ultimately accepted for admission to analyze treatment refusals and attrition during the 25 days after admission. Only 6.4% of the clients refused admission when informed of their treatment assignment. Planned duration of the residential phase of treatment, gender, and language spoken (English/Spanish) interacted with one another and differentially predicted treatment refusal/attrition. These findings may be useful for understanding treatment refusal and attrition in substance abuse treatment programs.

Irregular discharges from a dual diagnosis unit

Irregular discharges, previously studied on psychiatric or substance abuse treatment units, are a particular problem for dual diagnosis units. We examined demographic and clinical variables for their association with irregular discharge from an acute dual diagnosis inpatient unit, retrospectively reviewing 316 consecutive admissions. One hundred and nineteen patients (37.7%) were irregularly discharged (61 AMA, 31 administrative, 27 elopements), staying an average of 18.8 days compared with 51.4 days for those regularly discharged (p < .001). Younger age (p = .007) and discharge diagnosis of antisocial personality disorder (p < .001) were associated with irregular discharge; the attending psychiatrist was also significant (p = .016). Demographic variables (sex, ethnicity, marital status, religion, employment, education, living circumstances), Axis I diagnosis, and type and number of substances abused were not predictive of discharge type. Patients irregularly discharged within the first week (40% of irregular discharges) were significantly less likely to have known legal involvement (p = .006). No significant temporal clustering of irregular discharges was found on a daily, weekly, or monthly basis, nor was a seasonal pattern detected. These findings are generally consistent with several pre-DSM-III studies on nondual diagnosis units, but more specifically highlight the diagnosis of antisocial personality. Regarding program completion, they suggest that risk factors for irregular discharge (substance abuse, antisocial personality, characteristics of the doctor-patient relationship, problems of younger patients) have not been adequately addressed simply by creating dual diagnosis units. Further programming study appears warranted to address the problem of patient retention on dual diagnosis units.

Evidence of the construct validity and potential application of a multivariate approach to alcoholism diagnosis

To investigate the construct validity of a proposed 10-factor alcoholism diagnostic profile, a principal components analysis was performed on the responses of 1,535 alcoholic inpatients to a questionnaire designed to assess functioning in a number of life areas. A total of 16 components, explaining 50% of the total variance, were retained for rotation and interpretation. On this basis it is recommended that consideration be given to additional factor areas in the proposed profile. It is suggested that factor profiles from the proposed model might be of use in formulating predictions regarding treatment completion. To evaluate the likelihood of this suggestion, a stepwise discriminant analysis was performed using scale scores for the 16 components and the additional variable of age in an attempt to differentiate between treatment completers and premature discharges in the sample. The discriminant function which resulted contained 12 of the 17 variables available and served to correctly identify 62.5% of the premature discharges. Cautions are expressed regarding generalizations from the results of both analyses. It is concluded that evidence was obtained for both the construct validity of the factors in the proposed model and of the potential clinical use of the resultant profiles. Although substantial research and development is required, the proposed model seems to offer numerous advantages over the diagnostic approaches currently available.

Predicting treatment outcome after ten years among American Indian alcoholics

Forty-five American Indian alcoholics were intensively studied in 1970-1971. In addition to the usual demographic characteristics, research scales included Alcoholism History Scale, Alcohol Withdrawal Scale, Indian Culture Affiliation Scale, Social Competence Scale, Legal Problems Scale, Psychiatric Problems Scale, Liver Dysfunction Scale, Malnutrition Scale, and Abnormal Laboratory Screening Scale. These findings in 1970-1971 were then correlated with a four-item outcome rating obtained in 1980-1981. Better outcome was associated with less parental loss, ever having been married, compliance with treatment recommendations, and having predominantly Indian rather than non-Indian friends. Women alcoholics were unlikely to deteriorate and still survive, although this was the most frequent pattern among the men. Higher Indian Culture Affiliation and more severe Liver Dysfunction in 1970-1971 were correlated with better outcome in 1980-1981. Possible explanations for these findings are considered.