依存症研究と治療ジャーナル

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The Imperative for Expanding the Asam Continuum of Care: Exploring Predictive Factors of Long-Term Residential Substance Use Disorder Treatment Outcomes

Ashleigh Herrera

Introduction: Despite the rise in opioid and amphetamine morbidity and mortality, only about 1% of persons with substance use disorders (SUDs) pursue specialty treatment. Furthermore, the SUD treatment dropout and attrition rates remain high with less than 42% of clients completing treatment across settings. However, limited research has focused on predictive factors of treatment completion for long-term residential (LTR) SUD treatment, especially among clients with co-occurring psychiatric conditions (CODs).

Methods: A de-identified dataset was obtained from an abstinence-based LTR SUD treatment facility in an urban county. The dataset included a sample of 200 clients admitted between August 1, 2017, and March 1, 2018. The dataset included information provided by the clients during their ASAM Multidimensional Assessment and treatment disposition from their Discharge/Transfer Form. The sole dependent variable of interest in this study was the clients’ treatment disposition.

Results: Significant predictor variables of LTR SUD treatment noncompletion at p < .05 were past 30 days of use of primary substance used reported at intake (OR = 1.069, p < .001), mental health treatment and symptoms (p < .01), number of inpatient psychiatric episodes (OR = 1.375, p < .019), and readiness for change (p < .03). There were no significant predictors for participants who completed residential SUD treatment and transferred to a lower level of SUD care. However, past 30 days of use of primary substance used reported at intake, number of inpatient psychiatric episodes, and mental health treatment and symptoms predicted treatment outcomes for participants who left treatment and those who received an administrative discharge compared to those participants who completed residential SUD treatment and did not pursue aftercare services.

Conclusions: Clients reporting high levels of pretreatment substance use, including MA, at time of assessment should be referred to withdrawal management to decrease the likelihood of treatment noncompletion. Continuity of care for clients discharging from inpatient psychiatric hospitalization episodes is critical to improve their likelihood of completing LTR SUD treatment. Additional states need to expand their ASAM Continuum of Care and apply for 1115 Section Waivers to enhance the quality of care and treatment outcomes for clients with CODs.