Gender Differences in Treatment Retention among Individuals with Co-Occurring Substance Abuse and Mental Health Disorders

Sam Choi, PhD, University of Tennessee
Samuel MacMaster, PhD, University of Tennessee
Siobhan A. Morse, MHSA, Foundations Recovery Network
Susie Adams, PhD, RN, Vanderbilt University

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Background: A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay and/or complete residential treatment. Although prior research indicates that women and men differ in substance abuse treatment, our knowledge of individuals with co-occurring substance abuse and mental health disorders as well as those attending private residential treatment is limited. Objectives: Accordingly, the purpose of this study is to examine gender differences on treatment retention for individuals with co-occurring substance abuse and mental health disorders who participate in private residential treatment. Methods: The participants were 1, 317 individuals (539 women and 778 men) with co-occurring substance abuse and mental health disorders receiving treatment at three private residential treatment centers. Bivariate analyses, life tables, and Cox regression (survival analysis) were utilized to examine gender effects on treatment retention, and identify factors that predict treatment retention for men and women. Results: This study found significant women with co-occurring disorders were more likely to stay longer in treatment when compared to men. The findings indicate different factors influence length of stay for each genders including type of substance used prior to admission; Addiction Severity Index Composite scores; and Readiness to Change/URICA scores. Age at admission was a factor for men only. Conclusions/Importance: These findings might be incorporated to develop and initiate program interventions to minimize early attrition and increase overall retention in private residential treatment for individuals with co-occurring substance use and mental health disorders.

Submitted for review January, 2014, Substance Use and Misuse
http://informahealthcare.com/loi/sum

Address correspondence to Siobhan A. Morse, Foundations Recovery Network,
Department of Research, 5409 Maryland Way, Suite 320, Brentwood, TN 37027
or email Siobhan.Morse@FRNmail.com

Integrated Recovery Management Model for Ex-Offenders with Co-occurring
Mental Health and Substance Use Disorders and High Rates of HIV Risk Behaviors

Randolph F. R. Rasch, PhD, RN, University of North Carolina Greensboro
Dawn Davidson, PhD, Foundations Recovery Network
John Seiters, BA, Foundations Recovery Network
Samuel A. MacMaster, PhD, University of Tennessee
Susie Adams, PhD, RN, Vanderbilt University
Kathleen Darby, PhD, Middle Tennessee State University
R. Lyle Cooper, PhD, University of Tennessee

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This paper provides outcomes from an evaluation of a federally funded program combining HIV prevention services with an integrated mental health and substance abuse treatment program to a population of primarily African American ex-offenders living with, or at high risk for contracting HIV in Memphis, Tennessee. During the 5-year evaluation, data were collected from 426 individuals during baseline and 6-month follow-up interviews. A subset of participants (n 5341) completed both interviews. Results suggest that the program was successful in reducing substance use and mental health symptoms but had mixed effects on HIV risk behaviors. These findings are important for refining efforts to use an integrated services approach to decrease (a) the effects of substance use and mental health disorders, (b) the disproportionate impact of criminal justice system involvement, and (c) the HIV infection rate in African American ex-offenders in treatment.

JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 24, No. 5, September/October 2013, 438-448 Copyright _ 2013 Association of Nurses in AIDS Care
http://dx.doi.org/10.1016/j.jana.2012.08.006

Address correspondence to Siobhan A. Morse, Foundations Recovery Network,
Department of Research, 5409 Maryland Way, Suite 320, Brentwood, TN 37027
or email Siobhan.Morse@FRNmail.com

Predictors of Residential Treatment Retention among Individuals with
Co-Occurring Substance Abuse and Mental Health Disorders

Sam Choi, Ph.D., University of Tennessee
Susie M. Adams, Ph.D., R.N., Vanderbilt University
Samuel A. MacMaster, Ph.D., University of Tennessee
John Seiters, B.A., Foundations Recovery Network

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A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. The purpose of this study is to identify factors during the initial phase of treatment which predict retention in private residential treatment for individuals with co-occurring substance use and mental health disorders. The participants were 1,317 individuals with co-occurring substance abuse and mental health disorders receiving treatment at three residential treatment centers located in Memphis, TN, Malibu, CA, and Palm Springs, CA. Bivariate analysis and logistic regression were utilized to identify factors that predict treatment retention at 30 days. The findings indicate a variety of factors including age, gender, types of drug, Addiction Severity Index Medical and Psychiatric scores, and readiness to change. These identified factors could be incorporated into pretreatment assessments, so that programs can initiate preventive measures to decrease attrition and improve treatment outcomes.

Journal of Psychoactive Drugs, 45 (2), 122–131, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 0279-1072 print / 2159-9777 online
DOI: 10.1080/02791072.2013.785817

Address correspondence to Siobhan A. Morse, Foundations Recovery Network,
Department of Research, 5409 Maryland Way, Suite 320, Brentwood, TN 37027
or email Siobhan.Morse@FRNmail.com

Characteristics and Outcomes of College Age Adults Enrolled in Private, Residential Treatment: Implications for Practice

Siobhan A. Morse, MHSA Foundations Recovery Network
Samuel A. MacMaster, PhD University of Tennessee-Knoxville

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Substance use among college age adults is of interest due to high levels of use and low levels of treatment access and engagement relative to other adults. Data collected from 1,972 clients in residential services were analyzed to investigate differences in use patterns, treatment outcomes and other life area problems. Participants completed an Addiction Severity Index (ASI) and the University of Rhode Island Change Assessment (URICA) at baseline, and an ASI and Treatment Services Review at 1 and 6-month post-discharge interviews. Almost a quarter (24.1%) of participants were college age (18-25 years old). They were more likely to be Caucasian, male, and less likely to complete treatment although they had a longer average length of stay. College age adults improved on all outcome measures and post-treatment service use shows significant difference between college age and older participants. Implications for practice are discussed.

Address correspondence to Siobhan A. Morse, Foundations Recovery Network,
Department of Research, 5409 Maryland Way, Suite 320, Brentwood, TN 37027
or email Siobhan.Morse@FRNmail.com

Accepted for publication in Journal of Social Work Practice in the Addictions

Characteristics and Outcomes of Young Adult Opiate Users Receiving Residential Substance Abuse Treatment

Siobhan A. Morse, MHSA Foundations Recovery Network
Samuel A. MacMaster, PhD University of Tennessee-Knoxville

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Opiate use patterns, user characteristics and treatment response among young adults are of
interest due to current high use prevalence and historical low levels of treatment engagement relative to older populations. Prior research in this population suggests that overall, young adults present at treatment with different issues. This study investigated potential differences between young adult (18-25 years of age) and older adult (26 and older) opiate users and the impact of differences relative to treatment motivation, length and outcomes. Data for this study was drawn from 760 individuals who entered voluntary, private, residential treatment. Study measures included the Addiction Severity Index (ASI), the Treatment Service Review (TSR), and University of Rhode Island Change Assessment (URICA). Interviews were conducted at program intake and six-month post-discharge. Results indicate that older adults with a history of opiate use present at treatment with higher levels of severity for alcohol, medical and psychological problems and young adults present at treatment with greater drug use and more legal issues. Significant improvement for both groups was noted at six months post treatment; there were also fewer differences between the two age groups of opiate users. Results suggest different strategies within treatment programs may provide benefit in targeting the disparate needs of younger opiate users. Overall, however, results suggest that individualized treatment within a standard, abstinence- based, residential treatment model can be effective across opiate users at different ages and with different issues, levels of severity and impairment at intake.

Address correspondence to Siobhan A. Morse, Foundations Recovery Network,
Department of Research, 5409 Maryland Way, Suite 320, Brentwood, TN 37027
or email Siobhan.Morse@FRNmail.com

Accepted for publication in Journal of Evidence-Based Social Work

Comparisons of Opiate Users and Non-Opiate Users in Private Residential Substance Use and Mental Health Treatment on Characteristics and Program Outcomes

Samuel A. MacMaster, Ph.D, University of Tennessee
Siobhan A. Morse, M.H.S.A., Foundations Recovery Network
John Seiters, B.A., Foundations Recovery Network
Cayce M. Watson, M.S.S.W., David Lipscomb University
Sam Choi, Ph.D., University of Tennessee

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As both the incidence and prevalence of opiate drug use has increased, questions regarding the specific needs and challenges of this population remain largely unanswered. These individuals are often typified as being difficult to treat and/or considered to possess more significant issues than other substance users. This study seeks to determine what, if any, meaningful differences exist between opiate and non-opiate users who enter voluntary, private, residential treatment, and the impact of any differences relative to treatment motivation, length and outcomes. Data for this study was drawn from 1,972 individuals, utilizing the Addiction Severity Index (ASI), the Treatment Service Review (TSR), the University of Rhode Island Change Assessment (URICA), and a 36-item Satisfaction measure. Interviews were conducted at program intake, and 1 and 6-month interviews post-discharge. The results suggest that there were more similarities than differences between the two groups on baseline characteristics, motivation for treatment, treatment completion, treatment engagement, levels of retention in treatment, and levels of treatment satisfaction, and post-treatment service use. The results demonstrate that although opiate users entered treatment with higher levels of impairment, they were just as successful in treatment outcomes as their non-opiate using peers; suggesting that residential, abstinence-based treatment is just as effective form of treatment for opiate users as it is for non-opiate users.

Affiliations:
1 University of Tennessee Knoxville College of Social Work (Nashville campus);
2 Foundations Recovery Network in Nashville, Tennessee;
3 David Lipscomb University in Nashville, Tennessee.

Address correspondence to Samuel A. MacMaster, College of Social Work, University of Tennessee, 193E Polk Ave. Nashville, TN 37210 (e-mail: smacmast@utk.edu).

Pending final acceptance in the Journal of Substance Use