Psychological Symptoms and Outcomes in Adults Receiving Community-based Treatment for Substance Use Disorders

Abstract

Background

Mental health issues in individuals with substance use disorders are common and can affect treatment outcomes.

Objectives

Secondary analysis of a multi-center trial of an internet-delivered psychosocial SUD treatment intervention (Therapeutic Education System; TES) to: 1) describe psychological symptoms over time, 2) explore whether treatment assignment was associated with psychological symptoms 3) explore whether psychological symptoms at baseline moderated the effect of TES on abstinence or retention at the end of treatment.

Methods

Psychological symptoms were measured using the Global Severity Index (GSI) from the Brief Symptom Inventory (BSI-18), PHQ-9, and MINI SPIN (social anxiety). Zero-inflated-negative-binomial models given high numbers of “0” GSI scores and multivariate logistic regression models were run to estimate the effect of the interaction between treatment and baseline psychological symptoms.

Results

The mean age was 35, 37.9% were female, 56.0% were white. Fifty-four percent had a negative urine drug or breath alcohol screen at baseline. Mean GSI score at baseline was 13.5 (SD = 12.6). GSI scores significantly improved (p<.0001) over time. Treatment was not significantly associated with GSI scores (aIRR = 0.97, 95%CI = 0.85–1.11). Those with social anxiety at baseline had a higher likelihood of achieving abstinence when receiving TES compared to TAU (b = 1.2071, SE = 0.6109, p = 0.0482).

Conclusions

Psychological symptoms may improve over time in individuals seeking treatment for SUD, and for those with social anxiety, technology-based treatments may result in a better response. Examining the effect of SUD treatment on broader psychological outcomes in addition to abstinence may help clinicians provide more individualized care for those with co-occurring conditions.

Keywords:

• Community reinforcement approach
• contingency management
• substance use disorders
• psychological symptoms
• technology-assisted interventions

Acknowledgements

Dr. Nunes has received medication for research studies from Alkermes/Cephalon, Duramed Pharmaceuticals, and Reckitt-Benckiser. The other authors report no financial relationships with commercial interest.

Additional information

Funding

This work was supported by grants from the National Drug Abuse Treatment Clinical Trials Network (CTN), NIDA: U10 DA013035 (Edward V. Nunes and John Rotrosen), T32DA07209 (Natalie Gukasyan), U10 DA015831 (Kathleen M. Carroll and Roger D. Weiss), U10 DA013034 (Maxine L. Stitzer and Robert P. Schwartz), U10 DA013720 (José Szapocznik and Lisa R. Metsch), U10 DA013732 (Theresa Winhusen), U10 DA020024 (Madhukar H. Trivedi), U10 DA013714 (Dennis M. Donovan and John Roll), U10 DA015815 (James L. Sorensen and Dennis McCarty), U10 DA013045 (Walter Ling), and K24 DA022412 (Edward V. Nunes)