Presents

1
Presents Predictors of Alcohol and Drug Treatment
Outcomes A 6-month Follow-Up of Clients
Attending a Residential Treatment Program June
13, 2007
Janice Hambley, PhD, C. Psych Vice
President, Health and Clinical Services Bellwood
Health Services Inc.
Simone Arbour, MA Research CoordinatorBellwood
Health Services Inc.
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Bellwood Health Services Inc.Toronto, Ontario

• Treatment Programs
• Alcohol
• Drugs
• Gambling
• Concurrent PTSD/SUD
• Sexual Addiction
• Eating Disorders
• Compulsive Behaviours

• Inpatient/Outpatient
• Family Program
• 5 Year Aftercare

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Measurements and Variables

• Selecting a Yardstick of Success
• Quantity-frequency methods, estimates of average
  or usual consumption (Sobell, et al 2003)
• Follow-up Period 6 months post discharge
• (McLellan et al 1993, Gossop et al 2003)
• Aftercare, 12 step attendance
• (Gossop et al, 2003)
• Client Satisfaction
• (Carlson Gabriel, 2001)
• Motivation for Treatment
• Marlow et al, 2001, Staines et al, 2003, Miller
  Flaherty, 2000)
• Quality of Life BASIS-32
• Doerfler et al 2002, Sederer et al 1997

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Research Design

• Pre-Treatment

Discharge
6m Post-Treatment

• Treatment History
• Psychiatric History
• Motivation
• Treatment Entry Questionnaire

• Client Satisfaction
• Client Satisfaction Questionnaire

• Continuing Care
• Collateral Confirmation
• Client family, friends, etc.

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Method

• All clients invited to participate
• Signed consents
• Psychometric measures at admission, discharge,
  and 6 months follow-up
• Follow-up contact
• Telephone to clients
• Collateral reports
• family/friend
• clinician

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Response Rate

• 969 clients invited to participate from June 2004
  April 2007
• Participation rate 81 (n785)
• Present study 6 month follow-up
• Attempted contact with 680 clients
• 504 (74) participated 6 months data

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Addiction Groups Used in Analyses (N504)
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Collateral Report Ratefor 504 clients who were
followed-up
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Participant Demographics
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Demographics (Contd)
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Demographics (Contd)
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Addiction Groups and Substance Use History
Note differences between groups are not
statistically significant.
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Treatment Entry Motivation

• Scores reflect
• Strong internal positive motivation
• Moderate sense of shame
• Some feelings of external coercion

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Correlates of Treatment Entry Motivation

• Significant relationship between internal
  positive motivation scores and 6m Quality of Life
  (BASIS-32 plt.05).
• As external coercion motivation increases, the
  number of days spent in treatment decreases
  (plt.05).
• Significant relationship between external
  coercion and history of drug problem the longer
  the drug problem, less reported external coercion
  motivation (plt.01)
• Only one significant relationship between
  treatment entry motivation and substance use at
  outcome as internal negative motivation
  increases, total number of drug-free days at 6m
  follow-up decreases (plt.01)
• Motivation not impacted by EAP referral

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Client Satisfaction Questionnaire(N432)

• Clients were highly satisfied with treatment
• Treatment satisfaction was significantly
  correlated with Quality of Life (Bellwood
  Wellbeing Scale) at baseline (plt.05) and at 6m
  follow-up (plt.01).
• Client satisfaction was not significantly related
  to any substance use outcomes.

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Alcohol Clients (N206)Quality of Life -
BASIS-32
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Alcohol Clients Quality of LifeBellwood
Well-Being Survey
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Pre and Post Alcohol Consumption
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Alcohol Outcome Categories

• Measured as percent reduction in alcohol use
  (pre-admission quantity-frequency minus 6 month
  follow-up quantity-frequency)
• Categorized into 3 groups
• Abstinent 100 reduction (n110)
• High Improvement 80-99 reduction (n69)
• Moderate/Unimproved 0-79 reduction (n29)

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Alcohol Outcomes 6m Post-treatment
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Alcohol Clients Quality of Life Basis 32 Pre
and Post Scoresby Substance Use Outcome
n206
Note Significant effect for time plt.001 and
improvement category plt.05 (sig. difference
between abstinent and moderately/unimproved
categories)
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Marijuana/Prescription Drug Clients (N57)
Quality of Life - BASIS-32
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M/P Clients Quality of LifeBellwood Well-Being
Survey
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Pre Post Alcohol Consumption for M/P Clients
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Pre Post Drug Consumption for M/P Clients
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M/P Clients Marijuana and Prescription Drug Use
6m Post-treatment

• 80 of all M/P clients were abstinent from
  marijuana and prescription drugs at 6m
  post-treatment
• Over half of M/P clients (n31) 56.4 were
  totally abstinent from alcohol and drugs

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Substance Use Outcome Categories for M/P Clients

• Measured as percent reduction in alcohol use
  (pre-admission quantity-frequency minus 6 month
  follow-up quantity-frequency) and number of
  drug-free days in the last 6 months (out of 180)
• Categorized into 3 groups
• Abstinent 180 drug-free days and 100
• from both alcohol and drugs alcohol reduction
  (n31)
• High Improvement 175-180 cannabis and Rx
  drug-free days,
• with or without alcohol consumption (n19)
• Moderate/Unimproved fewer than 174 cannabis and
  RX drug-free days and any amount of alcohol
  use (n5)

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6m Post-treatment Substance Use Outcomes for M/P
Clients
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M/P Clients Quality of Life Basis 32 Pre and
Post Scoresby Substance Use Outcome
n55
Note Significant effect for time p001 and
improvement category p.001 (sig. diff. between
moderately/unimproved and remaining two groups)
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Cocaine Clients (N101)Quality of Life -
BASIS-32
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Cocaine Clients Quality of LifeBellwood
Well-Being Survey
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Pre Post Alcohol Consumption for Cocaine Clients
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Pre Post Drug Consumption for Cocaine Clients
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Cocaine Clients Cocaine Use6m Post-treatment

• 59 of all cocaine clients were abstinent from
  cocaine at 6m post-treatment
• Of all cocaine clients (n100) over one third
  (34) were totally abstinent from alcohol and
  drugs

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Substance Use Outcome Categories for Cocaine
Clients

• Measured as percent reduction in alcohol use
  (pre-admission quantity-frequency minus 6 month
  follow-up quantity-frequency) and number of
  drug-free days in the last 6 months (out of 180)
• Categorized into 3 groups
• Abstinent from alcohol 180 drug-free days, 100
  alcohol reduction
• And drugs (n34)
• High Improvement 170-180 cocaine-free days
• and at least 160 total drug-free days (n42)
• Moderate/Unimproved fewer than 170 cocaine-free
  days or fewer than 160 total drug-free days
  (n24)

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6m Post-treatment Substance Use Outcomes for
Cocaine Clients
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Cocaine Clients Quality of Life Basis 32 Pre
and Post Scoresby Substance Use Outcome
n100
Note Significant effect for time only plt.001
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Variability within Cocaine Client Group

• Clients who abuse cocaine and other substances
  such as heroin, amphetamines, or designer drugs
  may present more complex clinical issues than a
  client who abuses only cocaine (and alcohol)
• Investigated the outcomes of C1 clients (those
  who use cocaine only or cocaine and alcohol and
  C2 clients (those who use cocaine and other drugs)

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Comparing C1 C2 Substance Use Outcomes
Note Contrasts between C1 and C2 clients and
outcome are significant (plt.05) Also, there are
twice as many C2 clients as C1, indicating that
in general, when clients use cocaine they
probably use other drugs as well.
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Comparing C1 and C2 Clients
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Overall Findings of Substance Use Data
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Quality of Lifeand Substance Use

• Baseline
• Drug use (number years of problematic use and
  baseline number of drug-free days) correlates
  significantly with baseline quality of life
  (plt.05)
• Follow-up
• Number of drinking days and number of drinks per
  day as well as drug use (baseline and follow-up
  number of drug-free days) correlate significantly
  with quality of life at follow-up (p lt .01)

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Predicting Outcome at Follow-up

• The best predictor of quality of life at outcome
  is the quality of life at baseline
• The best predictor of substance use at follow-up
  is substance use at baseline
• Baseline number of drinking days and drinks per
  day significantly correlated with follow-up
  drinking days and drinks per day respectively
  (plt.01)
• Baseline number of drug-free days correlated
  significantly with follow-up number of drug-free
  days (plt.01)

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Abstinence Rates at 6m Follow-up by Substance Used
Significant association among outcome and
addiction type those with Alcohol or M/P
addiction more likely to do well and those with
Cocaine addiction less likely to do well. (n363)
?2 14.32, plt.01
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Aftercare Usage by Outcome
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Abstinence Rates at 6m Follow-up by EAP
involvement
Significant association between EAP referral and
outcome such that those who are referred by EAP
are more likely to do well and less likely to do
poorly compared to those who are not EAP referred
(n363) ?2 9.46, plt.01.
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Pre and Post Work Issues for All Substance Use
Clients
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Behavioural Addiction Outcomes

• Eating Disorder
• Problem Gambling
• Sexual Addiction

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Eating Disorders

• EAT-26 Questionnaire
• Measure of general eating disorder pathology
• May be repeated to measure treatment progress
• Score of 20 or greater indicates problematic
  attitudes and behaviors towards eating

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Eating Disorders
Differences are significant, plt.05
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Eating Disorder Clients Outcomes
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Problem Gambling

• CPGIs Problem Gambling Severity Index (PGSI)
• Measure of problem gambling

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Problem Gambling

• Differences are significant plt.001

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Gambling Client Outcomes
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Sex Addiction

• Compulsive Sexual Behavior Inventory (CSB)
  Control Subscale
• Measures various behaviors associated with CSB
• Low score higher compulsive sexual behaviors
• High score lower compulsive sexual behaviors
  (fewer problems controlling sexual urges)
• No cut-off score available. Coleman et al.,
  found Compulsives scored a mean of 31.7

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Sexual Addiction Clients Outcomes
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Practical Considerations and Implication for
Conducting Research in the Clinical Setting
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Practical Implications of Conducting Research in
a Clinical Setting

• Implications for the Client
• Relapsing client can reconnect with institution
  and can be referred to his/her recovery counselor
• Client can inquire about and receive information
  regarding programs offered

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Practical Implications of Conducting Research in
a Clinical Setting

• Implications for the Clinical Institution
• Results from outcome study are tailored to your
  specific institution dont have to worry about
  the generalizability of other research studies.
• Can get feedback from clients -- especially
  valuable six-months post-treatment when client
  has had time to reflect on his/her experience.

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Practical Implications of Conducting Research in
a Clinical Setting

• Implications for the Clinical Institution
• Research department is also used for internal
  evaluations (e.g. quality assurance such as
  program satisfaction and premature discharge
  data) as well as other research consultations.
• Research results impact what is emphasized in the
  program (e.g. importance of aftercare, 12-Step,
  etc.)
• Can integrate assessment tools into clinical
  program (e.g. IDTS)

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Practical Implications of Conducting Research in
a Clinical Setting

• Implications for the Community
• University students often need samples to conduct
  thesis/dissertation research. Students are a
  valuable resource and an economical way to
  conduct research projects.
• Outcome data results can be conveyed to EAP
  personnel and other referral sources.
  Institution is accountable for the effectiveness
  of the treatment program.

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