Category: Comorbidity - Substance Use and Other
The lack of a structured, supportive, alcohol and drug-free living environment can be a serious detriment to sustained abstinence. This challenge is particularly heightened for individuals with substance use challenges in rural areas, where cultural differences, poverty, geographic isolation, limited availability of providers, and other barriers further prevent sustained treatment utilization and sobriety. One potential hypothesis is that supplementing intensive substance use treatment with a structured living environment might improve treatment success. This study examines clients enrolled in intensive outpatient (IOP) substance use treatment and aims to determine the degree to which added participation in a therapeutic living program (TLP) might predict treatment completion. A secondary goal of the study will be to determine the degree to which client demographic (e.g., age, gender, substance of choice, employment status, level of education), programmatic (e.g., number of days between initial referral and intake appointment, level of care), or systematic (e.g., court-mandated) variables predict treatment completion from IOP for clients either enrolled or not enrolled in TLP.
Sample. Participants (approximately N=3000) in the current study consist of all adults enrolled in (a) IOP or (b) IOP+TLP in a rural, state-contracted substance abuse treatment organization between August 2008 and October 2016. The sample was ethnically diverse (approximately 40% Hawaiian or Part-Hawaiian), 70% male, and approximately 45% of the population was between the age of 18 and 30 years. Primary diagnoses varied across clients, such that approximately 30% of clients had an amphetamine dependence diagnosis, 24% alcohol dependence, 16% cannabis dependence, 11% alcohol abuse, 5% cannabis abuse, and 5% for the remaining categories of opioid dependence, sedative dependence, cocaine dependence, poly-substance dependence, sedative abuse, cocaine abuse, opioid abuse, and amphetamines abuse. Approximately 11% of the 3000 clients in IOP were also enrolled in TLP. 53% of clients in IOP only successfully completed treatment with some or no substance use or were transferred to another program, compared to 68% of clients in IOP+TLP.
One logistic regression will be utilized to predict categorical outcomes (i.e, “completed treatment with no or some substance use” versus “program decision to discharge client for noncompliance with program rules”) based on enrollment status in TLP and the aforementioned demographic, programmatic, and systematic variables. Two additional logistic regressions (one with the IOP sample and another with the IOP+TLP sample) will be utilized to predict the same categorical outcomes based on the aforementioned demographic, programmatic, and systematic variables. All results will be discussed cohesively for examining the added benefits of TLP and identifying interventions aimed at increasing successful discharge for substance abuse problems in rural settings.
Trina Orimoto– Clinical Affiliate, University of Hawaiʻi at Mānoa, Honolulu, Hawaii
Brad Nakamura– Associate Professor, University of Hawaii at Manoa, Honolulu, Hawaii
Gary Schwiter– Information Technology Systems Administrator, Big Island Substance Abuse Council
Hannah Preston-Pita– Chief Executive Officer, Big Island Substance Abuse Council
Information Technology Systems Administrator
Big Island Substance Abuse Council