Patients With Dual Diagnoses or Substance Use Disorders Only: 12-Step Group Participation and 1-Year Outcomes

Abstract

We compared outpatients (regional facility) with substance use and psychiatric (N == 199) or only substance use (N == 146) disorders on baseline and one-year symptoms (93%% follow-up), and treatment and 12-step group participation over the year (2005). We examined whether diagnostic status moderated associations between participation and outcomes (Addiction Severity Index) with regressions. At follow-up, dual diagnosis patients had more severe symptoms, despite comparable treatment. The groups were comparable on 12-step participation, which was associated with better outcomes. However, associations of participation with better outcomes were weaker for dual diagnosis patients. Study (VA HSR&D-funded) implications and limitations are noted and research suggested.

RÉSUMÉ

Nous avons comparé des malades externes (la facilité régionale) avec l'usage de substance et psychiatrique (N == 199) ou seulement l'usage de substance (N == 146) les désordres sur la base et un symptômes d'an (93%% suite) et le traitement et participation de groupe de 12 étapes au cours des années (2005). Nous avons examiné si le statut diagnostique a modéré des associations entre la participation et les issues (l'Indice de Sévérité de Dépendance) avec les régressions. A la suite, les malades de diagnostic doubles ont eu symptômes plus des sévéres, malgré le traitement comparable. Les groupes étaient comparables sur participation de 12 étapes, qui a été associé avec mieux les issues. Cependant, les associations de participation avec mieux les issues étaient plus faibles pour les malades de diagnostic doubles. Etudier (VA HSR&D) les implications et les limitations sont notées, et préparer suggéré.

RESUMEN

Comparamos pacientes ambulatorios (clínica regional) que parecen de trastornos co-ocurrentes, a causa del uso de sustancias y psiquiatricos, (N == 199) con los que sólo parecen de trastornos a causa del uso de sustancias (N == 146). Pacientes fueron comparados en sus datos al comienzo del estudio, síntomas que parecían al año (93%% de seguimiento), y participación en tratamiento y en el programa de 12 pasos durante el año (2005). Hemos examinado, usando regresión, si el estado diagnóstico moderaba las asociaciones entre participación y los resultados Índice de Severidad de la Adicción). En el seguimiento, los pacientes que tenían trastonos co-ocurrentes parecían de síntomas m´s severos a pesar de haber tenido un trataramiento comparable. Los grupos fueron comparables en su participación en el grupo de 12 pasos, lo cual es asociado con mejores resultados. Sin embargo, asociaciones de participación con mejores resultados fueron m´s débiles para pacientes con trastornos co-ocurrentes. Implicaciones y limitaciones del estudio (financiado por VA HSR ++ D) han sido anotadas y sugestiones para mas investigaciónes tambien.

Keywords :

• substance use disorder
• psychiatric disorder
• dual diagnosis
• treatment
• 12-step groups

THE AUTHORS

Christine Timko, PhD, is a Research Career Scientist, Health Services Research and Development Service, Department of Veterans Affairs, and Consulting Professor, Psychiatry and Behavioral Sciences, Stanford University. Within her substance abuse research at the Center for Health Care Evaluation in Menlo Park, CA, Dr. Timko's interests are the long-term course of alcohol use disorders, interventions to increase self-help participation, and the link between substance abuse and violence perpetration.

Anne Sutkowi, B.A., is a Research Health Science Specialist at the Center for Health Care Evaluation at the Department of Veteran Affairs in Menlo Park, CA. Currently, she manages a study of the extent to which intensive referral to dual-focused self-help groups increases dual diagnosis outpatients' self-help group participation and improves psychiatric and substance use outcomes. Anne will be pursuing her Master of Public Health degree, with interests in developing and evaluating addiction and eating disorder prevention programs.

Rudolf H. Moos, Ph.D., is a Senior Research Career Scientist at the Department of Veterans Affairs Health Care System and a Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University in Palo Alto, California. His main research interests focus on the quality of mental health treatment and the role of social context factors and coping skills in relation to the outcome of intervention programs for individuals with substance use and psychiatric disorders.

Notes

1 The tradition continues in the substance user treatment field of referring to mutual-help based intervention (AA,NA, etc.) as self-help; the process self-help is covered in the “natural recovery” literature. Editor's note.

2 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

3 Treatment can be briefly and usefully defined as a planned, goal directed, temporally structured change process, of necessary quality, appropriateness and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA,NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users- of whatever types and heterogeneities- which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Editor's note.