Remission from alcohol and other drug problem use in public and private treatment samples over seven years

Abstract

Background The treatment of alcohol and other drugs is now more commonly framed in terms of a chronic condition which requires ongoing monitoring. A model which includes continuing access to health care may optimize outcomes. Most studies of chronic care models have not included health care and have only examined short term effects. Methods The sample (n = 783) included consecutive admissions in ten public and private alcohol and other drug (AOD) treatment programs followed over seven years. The outcome was remission which was defined as alcohol and drug abstinence or non-problem use. Results In the private sample, receiving health care services predicted remission across the seven years; however this did not occur in the public sample. More patients in the public treatment sample received AOD treatment readmissions each year, while more of those in the private sector received psychiatric and general health visits. Except for drug problem severity, there were no other clinical differences between the samples. There were no differences in the proportions of patients in the two sectors who received the full spectrum of chronic care services. In the final models, 12-step participation was markedly significant for both samples. Conclusions Models of chronic care for substance use need to consider differences between private and public treatment and should take into account that individuals may not always have access, or avail themselves of services that may optimize long-term outcomes.

Situational factors affecting abstinence from drugs: Panel data analysis of patients with drug use disorders in residential drug use treatment

“…However, it is unclear whether the results of these studies indicate the characteristics of the nonrelapsed patient population associated with abstinence status or whether these show the individual‐level situation changes associated with or a mixture of the two. Owing to the complex patterns of stability and changes in drug use in each patient, studies should be designed to predict changes in abstinence status at the intra‐individual level, while controlling for inter‐individual differences to assess the impacts of the patient's situation 10,11 . A panel survey in which the same question or test is repeated several times for the same person is an effective method to assess the degree of changes in situation X (e.g., employment, unemployment, admission, discharge, living at home, living in an institution) that occurs at the intra‐individual level to predict the dependent variable Y (e.g., continued abstinence or not) that occurs at the intra‐individual level while controlling for inter‐individual differences (e.g., sex, age, and medical history).…”

“…Owing to the complex patterns of stability and changes in drug use in each patient, studies should be designed to predict changes in abstinence status at the intra‐individual level, while controlling for inter‐individual differences to assess the impacts of the patient's situation. 10 , 11 A panel survey in which the same question or test is repeated several times for the same person is an effective method to assess the degree of changes in situation X (e.g., employment, unemployment, admission, discharge, living at home, living in an institution) that occurs at the intra‐individual level to predict the dependent variable Y (e.g., continued abstinence or not) that occurs at the intra‐individual level while controlling for inter‐individual differences (e.g., sex, age, and medical history). In particular, a panel data analysis avoids the missing variable bias because the effects of the unknown personal factors on the independent variables can be controlled for.…”