Vandana Joshi

Drug Treatment Outcomes for Adolescents with Comorbid Mental and Substance Use Disorders

This study compared the pretreatment characteristics and posttreatment outcomes of substance-abusing adolescents with and without comorbid mental disorders in the Drug Abuse Treatment Outcome Studies for Adolescents. Subjects (N = 992) were sampled from 23 adolescent drug treatment programs across three modalities (residential, short-term inpatient, outpatient drug-free). Nearly two thirds (64%) of the sample had at least one comorbid mental disorder, most often conduct disorder. Comorbid youth were more likely to be drug or alcohol dependent and had more problems with family, school, and criminal involvement. Although comorbid youth reduced their drug use and other problem behaviors after treatment, they were more likely to use marijuana and hallucinogens, and to engage in illegal acts in the 12 months after treatment, as compared with the noncomorbid adolescents. Integrated treatment protocols need to be implemented within drug treatment programs in order to improve the outcomes of adolescents with comorbid substance use and mental disorders.

Gender Differences in Drug Treatment Careers Among Clients in the National Drug Abuse Treatment Outcome Study

Gender differences in the factors associated with having a history of drug treatment were examined among 7,652 individuals admitted into the Drug Abuse Treatment Outcome Study (DATOS), a national multisite prospective study. Bivariate relationships were examined between a history of prior drug treatment and variables measuring demographic and background characteristics, addiction career, treatment career parameters, family and social relationships, criminal justice involvement, and mental health status. Stepwise discriminant function analyses (DFAs) were conducted separately for men and women to determine both the common and unique characteristics associated with a history of prior drug treatment. More severe drug use history and criminal behavior were related to prior treatment history for both men and women. Prior drug treatment among men was associated with factors related to family opposition to drug use and support for treatment, whereas for women prior drug treatment was associated with antisocial personality disorder and self-initiation into treatment. Moreover, treatment initiation among men appears to be facilitated by social institutions, such as employment, the criminal justice system, and ones family. In contrast, treatment reentry among women was associated with referral by a social worker, suggesting that contact with family service agencies can facilitate womens treatment entry. The findings suggest that different strategies for increasing treatment utilization may be appropriate for men and women.

Program Variation in Treatment Outcomes Among Women in Residential Drug Treatment

Multilevel modeling was used to assess the program characteristics associated with treatment retention among 637 women in 16 residential drug treatment programs in the Drug Abuse Treatment Outcome Study. Women who were pregnant or had dependent children had higher rates of retention in programs in which there were higher percentages of other such women. Longer retention was associated with higher rates of posttreatment abstinence. Bivariate analyses showed that programs with higher proportions of pregnant and parenting women provided more services related to womens needs. The findings support the provision of specialized services and programs for women in order to improve outcomes of drug abuse treatment.

Patient histories, retention, and outcome models for younger and older adults in DATOS

Structural equation modeling with multiple groups was used to examine relationships among pretreatment patient characteristics, treatment retention, and treatment outcomes among younger and older adults in the Drug Abuse Treatment Outcome Studies. Separate models were tested for 551 patients treated in long-term residential (LTR) programs and 571 patients treated in outpatient drug-free (ODF) programs. There was a stronger positive relationship between treatment retention and abstinence at follow-up for younger adults in both treatment modalities. Prior treatment history had a negative effect on self-efficacy to resist drug use for older adults in LTR. Negative reference group influence was reduced for all groups following treatment, however, it was more strongly related to abstinence for younger adults in LTR and for older adults in ODF. Clinical implications of age-related differences in these relationships are discussed.

Addiction Careers and Criminal Specialization

For many drug users, the initiation of drug use and the subsequent transition to an addiction career is accompanied by criminal activities. However, the use of general crime and drug use categories often obscures important features of their relationship. In the present study, data from the national Drug Abuse Treatment Outcome Studies sample of 7,189 clients in substance abuse treatment were analyzed to explore the relationships between several addiction career variables and the likelihood of lifetime participation in predatory, victimless, and nonspecialized criminal behaviors. The order of initiation of addiction and criminal careers was significantly related to participation in certain types of crimes, with those beginning criminal careers after beginning their addiction careers being more likely to engage exclusively in victimless than in predatory crimes. Likewise, dependence on cocaine, heroin, or both, relative to alcohol, was associated with greater criminal diversity but a reduced likelihood of participating specifically in predatory crimes.

Gender differences in drug treatment outcomes among participants in the Chicago Target Cities Study

Gender differences in the characteristics of individuals entering drug treatment and their post-treatment substance use were examined among 904 individuals, the majority of whom were female (63%) and predominantly African American (93%), who were admitted into the Chicago Target Cities Project. Bivariate relationships were examined in background characteristics, addiction and treatment career parameters, family and social relationships, psychosocial functioning, and treatment/social interventions received. Path analysis was used to determine the predictors of drug/alcohol use at 6- and 24-months following intake at a central referral agency, by developing separate path models for males and females. Drug/alcohol use was significantly reduced for men and women at 6- and 24-months, dropping by about 50% for both. Women had more episodes of subsequent treatment and men had higher rates of incarceration during the follow-up periods. The path analyses showed that at 6-months following intake, living with someone with a drug/alcohol problem was related to higher rates of drug/alcohol use for women, but not for men. For both men and women, psychological distress was related to higher levels of substance use at the 6-month follow-up, whereas having an improved living situation and participating in 12-step groups were related to lower levels of use at both follow-up points. The findings suggest that, although there are some similarities in the factors related to recovery for both men and women, women are more vulnerable to relapse because of having substance-using partners.

Effects of program and patient characteristics on retention of drug treatment patients

Abstract Objective: To examine effects of program and patient characteristics on patient retention in residential drug treatment programs, outpatient drug-free programs (ODF), and methadone maintenance (MM) programs. Data sources/study setting: Patient data were based on admission and discharge records for individuals entering treatment programs in Los Angeles County during 1992 and 1993. Program data were collected from program directors via a mail survey. The study sample included 26,047 patients in 87 programs. The dependent variable was patient completion of a critical threshold of treatment (360 days for MM and 180 days for the other two modalities). We applied logistic regression hierarchical linear modeling analysis for each modality. Principal findings: Threshold retention rates were generally low in all three modalities (18.1% for residential programs, 22.9% for ODF, and 13.6% for MM). An articulated programmatic focus and low caseload increased patient retention in residential programs. A lower level of group therapy focus increased patient retention in ODF programs. A low programmatic focus and a low percentage of recovering staff were associated with high retention rates among MM patients. For ODF programs, none of the slopes showed random effects, while for residential and MM programs, some program factors contributed to the explanation of the random effects in several slopes (e.g., drug use severity). Conclusion: Program practice and service provision played important roles in determining patient retention in treatment. Service providers and planners should consider these key factors to improve retention of patients, which is likely to increase overall treatment effectiveness and efficiency.

Treatment Processes and Outcomes Among Adolescents With a History of Abuse Who Are in Drug Treatment

This study reports on the effects of having a history of physical and/or sexual abuse on treatment processes and posttreatment abstinence among adolescents (N=803) in a multisite study of drug treatment outcomes. A history of physical and/or sexual abuse was reported by 59% of the girls and 39% of the boys and was related to being White and having higher levels of comorbidity, exposure to other traumatic events, dependence on alcohol and marijuana, problem recognition, and negative peer or family influence. Abused adolescents had more service needs at treatment admission and there was some variation in treatment processes related to gender and abuse status. Youths with a history of physical abuse had a lower likelihood of posttreatment abstinence, except among those who had better rapport with their counselors. Attention to treatment processes and engagement strategies is crucial for treating youths in drug treatment who have a history of abuse.

Effects of Comorbidity on Treatment Processes and Outcomes Among Adolescents in Drug Treatment Programs

ABSTRACT This study examined the relationship between treatment processes and posttreatment abstinence using data from the Drug Abuse Treatment Outcomes Studies for Adolescents (N = 810), with a focus on differences between adolescents with and without a comorbid mental disorder. The majority of the sample (62%) was diagnosed with at least one co-occurring mental disorder, most often conduct disorder. Overall, comorbid youth had more service needs and received more services compared with non-comorbid youth, and there were significant differences in service delivery by type of treatment modality. Posttreatment abstinence among the comorbid youth was positively associated with rapport with counselors and participation in 12-step groups while in treatment.

Followup of cocaine-dependent men and women with antisocial personality disorder

Long-term outcomes following drug treatment were examined for cocaine-dependent men (N = 453) and women (N = 254) with and without antisocial personality disorder (ASP). In-depth assessments were conducted at treatment intake in 1991-93 and at 1 and 5 years following treatment discharge. Overall, 47.2% of the males and 34.3% of females were diagnosed with ASP using DSM-III-R criteria derived from the Diagnostic Interview Schedule. All groups reduced their cocaine, marijuana, and alcohol use; reduced their levels of psychological distress; and improved in functioning (e.g., employment, arrests, residential status). At Year 5 ASP was associated with an increased likelihood of heavy alcohol use and additional substance abuse treatment among men, whereas women with ASP were more likely to report psychological problems and to receive mental health treatment and other services than either women without ASP or men with ASP. The findings suggest the need to address the specific treatment needs of male and female cocaine abusers with ASP.