Psychological Distress and Return to Substance Use Two Years Following Treatment

Abstract

This study examined client background characteristics, substance use severity, and psychological distress in relation to return to alcohol and drug use among men and women 2 years following substance user treatment. Participants (n = 180) completed a baseline interview within their first month of substance user treatment (conducted in 1995/1996) and follow-up interview 2 years following the baseline interview (conducted in 1997/1998). Structural equation modeling analyses were used to examine the relationship among client background characteristics and problem severity indicators, measured during treatment, in relation to alcohol and illicit drug use 2 years posttreatment. Psychological distress directly predicted alcohol and illicit drug use during follow-up and appeared to mediate the relationship between client background characteristics (such as gender, race, and marital status) and substance use consequences on posttreatment substance use. Income directly predicted alcohol use and age directly predicted illicit drug use, regardless of problem severity (including psychological distress and substance use consequences). Results support long-term clinical monitoring of psychological distress as a marker for return to drug or alcohol use.

• Psychological distress
• Substance use consequences
• Relapse
• Relapse markers
• Treatmentoutcome
• Income
• Age

Resumen

Este estudio examinó características del fondo del cliente, severidad del uso de la sustancia, y señal de socorro psicologica en lo referente a vuelta al uso del alcohol y de la droga entre hombres y mujeres dos años que seguían tratamiento del abuso de la sustancia. Los participantes (n = 180) terminaron una entrevista de la línea de fondo dentro de su primer mes del tratamiento del abuso de la sustancia (conducido en 1995/1996) y entrevista de la carta recordativa dos años que seguían la entrevista de la línea de fondo (conducida en 1997/1998). La ecuación estructural que modelaba análisis fue utilizada para examinar la relación entre los indicadores de la severidad de las características y del problema del fondo del cliente, medidos durante el tratamiento, en lo referente al alcohol y al uso ilícito de la droga dos años que seguian tratameinto. La señal de socorro psicologica predijo directamente el alcohol y el uso ilícito de la droga durante carta recordativa y aparecía mediar la relación entre las características del fondo del cliente (tales como género, raza, y estado civil) y las consecuencias del uso de la sustancia en el uso post-treatment de la sustancia. La renta predijo directamente uso del alcohol y la edad predijo directamente uso ilícito de la droga, sin importar severidad del problema (las consecuencias psicologicas incluyendo del uso de señal de socorro y de la sustancia). Los resultados apoyan la supervisión clínica a largo plazo de la señal de socorro psicologica como marcador para la vuelta al uso de la droga o del alcohol.

Résumé

Parmi cette étude a examiné des caractéristiques de fond de client, la sévérité d’utilisation de substance, et la détresse psychologique par rapport au retour à l’utilisation d’alcool et de drogue les hommes et des femmes deux ans traitement d’abus suivant substance. Les participants (n = 180) ont accompli une entrevue de ligne de base dans leur premier mois du traitement d’abus de substance (conduit dans 1995/1996) et entrevue de suivi deux ans suivant l’entrevue de ligne de base (conduite dans 1997/1998). L’équation structurale modelant des analyses ont été employées pour examiner le rapport parmi des indicateurs de sévérité de caractéristiques et de problème de fond de client, mesurés pendant le traitement, par rapport à l’alcool et l’utilisation illicite de drogue deux ans d’après traitement. La détresse psychologique a directement prévu l’alcool et l’utilisation illicite de drogue entre pendant le suivi et a semblé de négocier le rapport les caractéristiques de fond de client (telles que le genre, la course, et l’état civil) et les conséquences d’utilisation de substance sur l’utilisation après traitement de substance. Le revenu a directement prévu l’utilisation d’alcool et l’âge a directement prévu l’utilisation illicite de drogue, indépendamment de la sévérité de problème (des conséquences psychologiques y compris d’utilisation de détresse et de substance). Les résultats soutiennent la surveillance clinique à long terme de la détresse psychologique comme marqueur pour le retour à l'utilisation de drogue ou d’alcool.

Additional information

Notes on contributors

Heather A. Flynn

Heather Flynn, Ph.D., is an Assistant Professor at the University of Michigan, Department of Psychiatry. Trained as a clinical psychologist, her primary research interests include co-morbidity of depression and alcohol use, particularly in women, as well as prevention and brief intervention with mental health and substance use issues in primary care settings. Dr. Flynn has conducted research and published in the area of depression including vulnerability factors for depression, time series methodology, and the recurrent nature of depression. She has also collaborated on studies involving large scale screening for depression and alcohol problems in primary care and brief interventions with older adult high-risk drinkers. Currently, Dr. Flynn is conducting a project aimed at identification of and intervention with alcohol use and depression in pregnancy.

Maureen A. Walton

Maureen Walton, M.P.H., is an Assistant Research Scientist in the Substance Abuse Division, Depart-ment of Psychiatry, at the University of Michigan. Her research interests include the spectrum of treatments for alcohol and drug use related problems, from brief interventions in community settings to more traditional substance user treatment and relapse prevention. She is currently a co-investigator on two Emergency Department based projects: “Tailored Alcohol Messages in the Emergency Department” (funded by NIAAA) and “Cocaine and Chest Pain in the ED: Services and Outcomes” (funded by NIDA). Dr. Walton's publications focus on treatment outcome, particularly among traditionally understudied populations including women, African-Americans, and older adults; the relationship between violence and substance use; and on tracking issues in longitudinal research. Dr. Walton has a Ph.D. in Ecological and Community Psychology from Michigan State University and a M.P.H. in health promotion from San Diego State University.

Geoffrey M. Curran

Geoffrey Curran, Ph.D., Centers for Mental Healthcare Research, Faculty Rank: Assistant Professor; Joined Faculty: 1997; Ph.D. Degree: Sociology, Rutgers University, 1996; Fellowships: HSR&D Field Program for Mental Health, VA Medical Center, Little Rock, AR; Substance Abuse Research, University of Michigan; Special Interest: Medical Sociology, Drug and Alcohol Studies (funded research); Cultural/Social Construction of Reality.

Frederic C. Blow

Frederic Blow, Ph.D., is the Director of the Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) for Health Services Research and Development in the Department of Veterans Affairs Medical Center, Ann Arbor as well as Professor at the University of Michigan in the Department of Psychiatry. He has a longstanding research focus on brief interventions for a variety of mental health and substance abuse issues including alcohol use problems among older adults and women, seriously mentally ill adults, and adult depression in the community and medical settings.

Steven Knutzen

Steven R. Knutzen, M.S., graduated from the University of Michigan in 2001 with a Master of Science degree in Biostatistics. He has collaborated on several projects at the University of Michigan Addiction Research Center where he was employed for 15 months before returning home to the Pacific Northwest. He currently works as an analyst in education.