Top

International Journal of Mental Health and Addiction

Published in:

01-10-2021 | Substance Abuse | Original Article

Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness

Authors: Andreia P. de Moura, Hélder Fernando Pedrosa e Sousa, Maria Alzira Pimenta Dinis, Lígia L. Ferros, Inês Jongenelen, Jorge Negreiros

Published in: International Journal of Mental Health and Addiction | Issue 5/2021

Abstract

Although there is extensive literature on the processes and outcomes of drug and alcohol dependence treatments, little is known about specific predictors of treatment effectiveness. The present study aims to identify the predictors of abstinence in outpatient drug and alcohol dependence treatments, as well as the predictors of treatment effectiveness, according to a biopsychosocial approach. The study followed a cross-sectional research design. Participants (n = 290) were recruited from an outpatient treatment of the Intervention Division in Addictive Behaviors and Dependencies (DICAD), in the northern region of Portugal. A convenience sample was used. Data was collected using questionnaires administered at the facilities of the DICAD, in a private, quiet room. Results indicate that predictors of abstinence were involvement in treatment, psychopathology symptoms, and treatment program (i.e., outpatient drug vs alcohol dependence treatments). The full model of logistic regression analysis was significantly reliable (χ²(3) = 33.93, p < 0.001), with 72.5% successfully predicted for the non-substance abuse group and a 53.1% accurate prediction rate for the substance abuse group. The predictors of treatment effectiveness, according to a biopsychosocial approach, were social support and the treatment program. The full model was significantly reliable (χ²(2) = 68.28, p < 0.001), with 33.0% successfully predicted for the treatment effectiveness group and a 91.1% accurate prediction rate for the non-treatment effectiveness group. Results suggest that interventions need to focus not only on reducing substance abuse, but also on decreasing psychopathology and promoting therapeutic involvement, acting as predictors of abstinence. Furthermore, interventions must focus on promoting social support and the treatment program, acting as predictors of treatment effectiveness, according to a biopsychosocial approach.

Adamson, S. J., Sellman, J. D., & Frampton, C. (2009). Patient predictors of alcohol treatment outcome: a systematic review. Journal of Substance Abuse Treatment, 36(1), 75–86.PubMed

Ahmadi, J., Kampman, K. M., Oslin, D. M., Pettinati, H. M., Dackis, C., & Sparkman, T. (2009). Predictors of treatment outcome in outpatient cocaine and alcohol dependence treatment. The American Journal on Addictions, 18(1), 81–86.PubMedPubMedCentral

Almeida, D., Vieira, C., Almeida, M. C., Rijo, D. M., & Felisberto, A. J. (2005). Toxicodependência e comorbilidade psiquiátrica – Sintomatologia do eixo I e perturbações da personalidade [Addiction and psychiatric comorbidity - Axis I symptomatology and personality disorders]. Psiquiatria Clínica, 26(1), 55–70.

Amato, L., Minozzi, S., Davoli, M., Vecchi, S., Ferri, M. M., & Mayet, S. (2008). Psychosocial and pharmacological treatments versus pharmacological treatment for opioid detoxification. Cochrane Database of Systematic Reviews, 3. https://doi.org/10.1002/14651858.

APA (2010a). Ethical Principles of Psychologists and code of conduct. American Psychological Association. Retrieved from: https://www.apa.org/ethics/code/principles.pdf. Accessed 7 Oct 2019.

Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychological Review, 111(1), 33.PubMed

Ball, S. A., Carroll, K. M., Canning-Ball, M., & Rounsaville, B. J. (2006). Reasons for dropout from drug abuse treatment: symptoms, personality, and motivation. Addictive Behaviors, 31(2), 320–330.PubMed

Beutler, L. E., & Harwood, T. M. (2000). Prescriptive psychotherapy: a practical guide to systematic treatment selection. Oxford: University Press.

Beutler, L. E., Consoli, A. J., & Lane, G. (2005). Systematic treatment selection and prescriptive psychotherapy: an integrative eclectic approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (2nd ed.). New York: Oxford University Press.

Brook, D. W., Brook, J. S., Zhang, C., Cohen, P., & Whiteman, M. (2002). Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Archives of General Psychiatry, 59(11), 1039–1044.PubMed

Brorson, H. H., Arnevik, E. A., Rand-Hendriksen, K., & Duckert, F. (2013). Drop-out from addiction treatment: a systematic review of risk factors. Clinical Psychology Review, 33(8), 1010–1024. https://doi.org/10.1016/j.cpr.2013.07.007.CrossRefPubMed

Burns, L., & Teesson, M. (2002). Alcohol use disorders comorbid with anxiety, depression and drug use disorders: findings from the Australian National Survey of mental health and well being. Drug and Alcohol Dependence, 68(3), 299–307.PubMed

Canavarro, M. C. (1999). Inventário de sintomas psicopatológicos – BSI [Psychopatological symptoms inventory – BSI]. In M. R. Simões, M. Gonçalves, & L. S. Almeida (Eds.), Testes e Provas Psicológicas em Portugal [psychological tests and proofs in Portugal] (pp. 87–109). Braga: SHO/APPORT.

Carroll, K. M., Power, M. E. D., Bryant, K., & Rounsaville, B. J. (1993). One-year follow-up status of treatment-seeking cocaine abusers: psychopathology and dependence severity as predictors of outcome. The Journal of Nervous and Mental Disease, 181(2), 71–79.PubMed

Davidson, L., & White, W. (2007). The concept of recovery as an organizing principle for integrating mental health and addiction services. The Journal of Behavioral Health Services & Research, 34(2), 109–120.

Derogatis, L. R. (1977). SCL-90-R: administration, scoring and procedures manual. Baltimore: Clinical Psychometric Research.

DiMatteo, M. R., Giordani, P. J., Lepper, H. S., & Croghan, T. W. (2002). Patient adherence and medical treatment outcomes: a meta-analysis. Medical Care, 40(9), 794–811.PubMed

DiMatteo, M. R., Haskard, K. B., & Williams, S. L. (2007). Health beliefs, disease severity, and patient adherence: a meta-analysis. Medical Care, 45(6), 521–528.PubMed

Dobkin, P. L., Civita, M. D., Paraherakis, A., & Gill, K. (2002). The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers. Addiction, 97(3), 347–356.PubMed

Fox, H. C., Talih, M., Malison, R., Anderson, G. M., Kreek, M. J., & Sinha, R. (2005). Frequency of recent cocaine and alcohol use affects drug craving and associated responses to stress and drug-related cues. Psychoneuroendocrinology, 30(9), 880–891.PubMed

Godinho, R. (2007). Estudo comparativo entre uma população toxicodependente sem abrigo e uma população toxicodependente domiciliada [comparative study between a homeless individuals with substance use disorders population and a domiciled individuals with substance use disorders population]. Toxicodependências, 13(3), 3–14.

Greener, J. M., Joe, G. W., Simpson, D. D., Rowan-Szal, G. A., & Lehman, W. E. (2007). Influence of organizational functioning on client engagement in treatment. Journal of Substance Abuse Treatment, 33(2), 139–147.PubMedPubMedCentral

Henriques, A. B., & Paixão, R. (2009). Padrões de consumo de álcool em programas de substituição de opiáceos [Alcohol Patterns in Opioid Replacement Programs]. Toxicodependências, 15(3), 39–49.

Hervás, E., Gradolí, V., Gallús, E., Gurrea, R., & Bou, N. (2002). Características Clínicas en três grupos de dependientes a Drogas [Clinical features into three groups of Drug dependents]. Health and Addictions/Salud y Drogas, 2(2), 27–39. https://doi.org/10.21134/haaj.v2i2.158.

Horvath, T., Misra, K., Epner, A., & Cooper, G. (2019). Social learning theory of addiction and recovery implications. In Gracepoint Retrieved from: https://www.gracepointwellness.org/1408-addictions/article/48347-social-learning-theory-of-addiction-and-recovery-implications.

Hosmer, D. W., & Lemeshow, S. (1999). Applied survival analysis. New York: Wiley.

Hser, Y. I., Evans, E., Huang, D., & Anglin, D. M. (2004). Relationship between drug treatment services, retention, and outcomes. Psychiatric Services, 55(7), 767–774.PubMed

Joe, G. W., Simpson, D. D., & Broome, K. M. (1999). Retention and patient engagement models for different treatment modalities in DATOS. Drug and Alcohol Dependence, 57(2), 113–125.PubMed

Joe, G. W., Broome, K. M., Rowan-Szal, G. A., & Simpson, D. D. (2002). Measuring patient attributes and engagement in treatment. Journal of Substance Abuse Treatment, 22(4), 183–196.PubMed

Kirsten, P., Smith, K. P., & Christakis, N. A. (2008). Social networks and health. Annual Review of Sociology, 34, 405–429.

Laudet, A. B. (2007). What does recovery mean to you? Lessons from the recovery experience for research and practice. Journal of Substance Abuse Treatment, 33(3), 243–256.PubMedPubMedCentral

Lehman, W. E., Greener, J. M., & Simpson, D. D. (2002). Assessing organizational readiness for change. Journal of Substance Abuse Treatment, 22(4), 197–209.PubMed

Lepore, S. J. (1992). Social conflict, social support, and psychological distress: evidence of cross-domain buffering effects. Journal of Personality and Social Psychology, 63(5), 857–867.PubMed

Machado, P., Klein, J., & Farate, C. (2005). Monitorização dos resultados terapêuticos no contexto de tratamento das toxicodependências [Monitoring of therapeutic results in the drug treatment context]. Psicologia: Teoria, Investigação e Prática, 1, 19–29.

Majer, J. M., Jason, L. A., Ferrari, J. R., Venable, L. B., & Olson, B. D. (2002). Social support and self-efficacy for abstinence: is peer identification an issue? Journal of Substance Abuse Treatment, 23(3), 209–215.PubMed

McKay, J. R., & Weiss, R. V. (2001). A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow-ups preliminary results and methodological issues. Evaluation Review, 25(2), 113–161.PubMed

McLellan, A. T., McKay, J. R., Forman, R., Cacciola, J., & Kemp, J. (2005). Reconsidering the evaluation of addiction treatment: from retrospective follow-up to concurrent recovery monitoring. Addiction, 100(4), 447–458.PubMed

Moggi, F., Brodbeck, J., Költzsch, K., Hirsbrunner, H. P., & Bachmann, K. M. (2002). One-year follow-up of dual diagnosis patients attending a 4-month integrated inpatient treatment. European Addiction Research, 8(1), 30–37.PubMed

Morrens, M., Dewilde, B., Sabbe, B., Dom, G., De-Cuyper, R., & Moggi, F. (2011). Treatment outcomes of an integrated residential programme for patients with schizophrenia and substance use disorder. European Addiction Research, 17(3), 154–163.PubMed

Moura, A. (2015). Evaluation and monitoring of effectiveness of treatments for psychoactive substance. (Dissertação de Doutoramento). Faculdade de Psicologia e Ciências de Educação da Universidade do Porto, Portugal.

Moura, A., Ferros, L., & Negreiros, J. (2013). Evaluation and monitoring instrument: client evaluation of self and treatment. Revista de Psiquiatria Clínica, 40(4), 165–166.

Moura, A., Ferros, L., & Negreiros, J. (2015). The effectiveness of substance abuse treatment: development of a brief questionnaire. Archives of Clinical Psychiatry, 42(4), 83–89. https://doi.org/10.1590/0101-60830000000055.CrossRef

Moura, A., Pinto, R., Ferros, L., Jongenelen, I., & Negreiros, J. (2017). Efficacy indicators of four methods in outpatient addiction treatment. Archives of Clinical Psychiatry, 44(5), 117–121. https://doi.org/10.1590/0101-60830000000134.CrossRef

Nagelkerke, N. J. D. (1991). A note on the general definition of the coefficient of determination. Biometrika, 78(3), 691–692.

Norcross, J. C. (2002). Psychotherapy relationships that work: therapist contributions and responsiveness to patients. Oxford: University Press.

Novak, A., Burgess, E. S., Clark, M., Zvolensky, M. J., & Brown, R. A. (2003). Anxiety sensitivity, self-reported motives for alcohol and nicotine use, and level of consumption. Journal of Anxiety Disorders, 17(2), 165–180.PubMed

Public Health England. (2013). Medications in recovery: best practice in reviewing treatment. Supplementary Advice from the Recovery Orientated Drug Treatment Expert Group Medications in Recovery: Best Practice in Reviewing Treatment.

Rahioui, H., & Reynaud, M. (2008). Terapias cognitivo-comportamentais e adicções [cognitive behavioral therapies and addictions]. In 1°edição. Lisboa: Climepsi.

Ribeiro, M. S., Ribeiro, L. C., Garcia, M. A., Souza, G. F., Sousa, K. D. C., & Nogueira, R. B. (2009). Características demográficas e sociais associadas à adesão a um programa de tratamento de alcoolistas [demographic and social characteristics associated with adherence to an alcohol treatment program]. Cam Inic Cient, 1(9), 10–24.

Ross, J., Teesson, M., Darke, S., Lynskey, M., Ali, R., Ritter, A., & Cooke, R. (2005). The characteristics of heroin users entering treatment: findings from the Australian treatment outcome study (ATOS). Drug and Alcohol Review, 24(5), 411–418.PubMed

Rutter, M. (2005). Environmentally mediated risks for psychopathology: research strategies and findings. Journal of the American Academy of Child & Adolescent Psychiatry, 44(1), 3–18.

Schütz, C., Linden, I. A., Torchalla, I., Li, K., Al-Desouki, M., & Krausz, M. (2013). The Burnaby treatment center for mental health and addiction, a novel integrated treatment program for patients with addiction and concurrent disorders: results from a program evaluation. BMC Health Services Research, 13(1), 288.PubMedPubMedCentral

Simpson, D. D. (2004). A conceptual framework for drug treatment process and outcomes. Journal of Substance Abuse Treatment, 27(2), 99–121.PubMed

Simpson, D. D., & Joe, G. W. (2004). A longitudinal evaluation of treatment engagement and recovery stages. Journal of Substance Abuse Treatment, 27(2), 89–97.PubMed

Simpson, S. H., Eurich, D. T., Majumdar, S. R., Padwal, R. S., Tsuyuki, R. T., Varney, J., & Johnson, J. A. (2006). A meta-analysis of the association between adherence to drug therapy and mortality. BMJ, 333(7557), 15.PubMedPubMedCentral

Sons Cox, D. R., & Snell, E. J. (1989). The analysis of binary data (2nd ed.). London: Chapman.

Terra, M. B., Tannhauser Barros, H. M., Stein, A. T., Figueira, I., Palermo, L. H., Athayde, L. D., … da Silveira, D. X. (2008). Do alcoholics anonymous groups really work? Factors of adherence in a Brazilian sample of hospitalized alcohol dependents. American Journal on Addictions, 17, 1, 48–53. https://doi.org/10.1080/10550490701756393.

Torres, N. M. (2003). A química da dependência e as dependências-tóxicas. Para um modelo bio-psico-social [The chemistry of addiction and toxic dependencies. Towards a bio-psycho-social model]. Revista Toxicodependências, 9(1), 29–45.

Wang, Z. X., Zhang, J. X., Wu, Q. L., Liu, N., Hu, X. P., Chan, R. C., & Xiao, Z. W. (2010). Alterations in the processing of non-drug-related affective stimuli in abstinent heroin addicts. Neuroimage, 49(1), 971–976.PubMed

White, W. L. (2007). Addiction recovery: its definition and conceptual boundaries. Journal of Substance Abuse Treatment, 33(3), 229–241.PubMed

WHO (2004). Neurociências: consumo e dependência de substâncias psicoativas [Neuroscience: psychoactive substance use and addiction]. Geneva: World Health Organization.

WMA (2000). Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. In WMA General Assembly (52 ed.), Edinburgh, Scotland: World Medical Association. Retrieved from: https://www.wma.net/wp-content/uploads/2016/11/DoH-Oct2000.pdf. Accessed 7 Oct 2019.

Zolnierek, K. B., & DiMatteo, M. R. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medical Care, 47(8), 826–834.PubMed

Zvolensky, M. J., & Leen-Feldner, E. W. (2005). Anxiety and stress vulnerability and substance problems: Theory, empirical evidence, and directions for future research. Clinical Psychology Review, 25(6), 707–712.PubMed

Title: Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness
Authors: Andreia P. de Moura
Hélder Fernando Pedrosa e Sousa
Maria Alzira Pimenta Dinis
Lígia L. Ferros
Inês Jongenelen
Jorge Negreiros
Publication date: 01-10-2021
Publisher: Springer US
Keywords: Substance Abuse
Substance Abuse
Published in: International Journal of Mental Health and Addiction / Issue 5/2021
Print ISSN: 1557-1874
Electronic ISSN: 1557-1882
DOI: https://doi.org/10.1007/s11469-020-00235-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outpatient Drug and Alcohol Treatment Programs: Predictors of Treatment Effectiveness

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2021

Outcomes of a Residential and Community-Based Co-occurring Disorders Treatment Program

Distorted Cognitions, Substance Use and Suicide Ideation Among Gamblers: A Moderated Mediation Approach

A Scoping Review of the Use of Cannabis and Its Extracts as Potential Harm Reduction Strategies: Insights from Preclinical and Clinical Research

Nonmedical Benzodiazepine Use in Adolescents: Indirect Effects of Internalizing and Externalizing Symptoms

Psychopathological Consequences Related to Problematic Instagram Use Among Adolescents: The Mediating Role of Body Image Dissatisfaction and Moderating Role of Gender

Psychometric Properties of a Brief Metamemory and Metaconcentration Scale in Substance Use Problem