White patients were less likely to complete residential substance abuse treatment in a program in which the majority of both therapists and patients were black. Younger black veterans and those with back pain were also less likely to complete treatment.

A cohort of 207 veterans admitted to a residential substance use treatment program was followed for 5 years following discharge to determine factors associated with reduced relapse or mortality following discharge. Subsequent utilization of medical and psychiatric hospitalization and emergency room utilization was also examined. Retrospective chart review was conducted using demographic, diagnostic, and prior treatment as independent variables. Dependent variables included aftercare compliance and subsequent morbidity as measured by relapse, emergency room visits, subsequent hospitalizations, and mortality. Cox proportional hazards models were used to examine factors associated with relapse and mortality. Aftercare attendance was higher in those who completed treatment (p < 0.01). Factors associated with higher risk of relapse included comorbid disorders, failure to complete the index residential substance use treatment program, and psychiatric rehospitalization. Factors associated with higher mortality included failure to complete residential substance use treatment, longer medical rehospitalization, and nicotine dependence. Longer psychiatric rehospitalization was associated with a lower risk of mortality. Comorbid psychiatric conditions and failure to complete residential substance use treatment were associated with higher relapse. Limitations include that this population has severe substance use disorder, that subjective report of symptom severity was not assessed and that attendance at Alcoholics Anonymous aftercare was not surveyed.

BackgroundA person-centered substance use treatment component, the Natural Recovery Program, was developed. The Natural Recovery Program is comprised of small group therapy combined with pursuit of hobbies.MethodsThis was a pilot study of the program and was not randomized. A retrospective record review of 643 veterans in an inpatient mental health recovery and rehabilitation program was analyzed to determine if participants of Natural Recovery had a different rate of treatment completion than those who elected to participate in the core program alone. Univariate and multivariate analyses were conducted on: participation in the Natural Recovery Program; co-morbid psychiatric disorders; and legal, medical, and psychiatric issues.ResultsParticipation in Natural Recovery was significantly associated with successful treatment completion when analyzed by univariate analysis (p = 0.01). Other significant variables associated with successful completion included: no co-morbid psychiatric diagnosis, fewer prior suicide attempts, and no homelessness prior to admission. Binary logistic regression demonstrated that participation in Natural Recovery was associated with improved treatment completion, even when other variables were considered (p = 0.01). Treatment retention was longer for patients who participated in Natural Recovery, even if they did not complete treatment.ConclusionsThe Natural Recovery Program was associated with improved outcomes, as measured by treatment retention in the first 60 days and by treatment completion. Participants of Natural Recovery with co-morbid psychiatric disorders completed treatment at a higher rate than those with co-morbid psychiatric disorders who participated in the core program. Patients reported high satisfaction with the program. This program may be a valuable adjunct to residential treatment.

: This study suggests the benefit of relatively brief, specific educational efforts to increase motivation to quit smoking in this high-use population.