Impact of Abstinence Self-Efficacy and Treatment Services on Physical Health-Related Behaviors and Problems Among Dually Diagnosed Patients

Abstract

Objective: Physical health problems are pervasive among patients with co-occurring substance use and mental disorders. Yet, drug treatment programs often ignore tobacco use and its association with health. Abstinence self-efficacy has been associated with improved outcomes for co-occurring disorders, which in turn may also impact physical health. This study had the goal of assessing whether abstinence self-efficacy for drugs and alcohol and availability and use of services would influence tobacco use and other health-related outcomes among 351 individuals with co-occurring disorders in residential drug treatment. Methods: Structural models tested the impact of baseline abstinence self-efficacy and treatment service characteristics on 6-month outcomes of health problems, functional limitations, health perceptions, and cigarette and heavy alcohol use. Demographics and baseline values for outcome variables were included as covariates. Results: Correlations within time for poor health, cigarette use, and heavy alcohol use were substantial. A longer time in drug treatment was associated with less cigarette and heavy alcohol use at a 6-month follow-up. Baseline health problems were associated with more cigarette use and functional limitations at 6-months. Abstinence self-efficacy did not predict less cigarette use but predicted less heavy alcohol use and fewer functional limitations. Availability of specialized dual diagnosis groups and more on-site psychological services were not directly associated with outcomes but had an impact through indirect effects on more psychological service utilization which predicted better subjective health. Conclusions: Improving overall treatment retention and services utilization among patients with co-occurring disorders may generalize to improved health perceptions, but specific health promotion and smoking-cessation interventions are warranted to improve health outcomes.

Keywords:

• co-occurring disorders
• health
• self-efficacy
• cigarette use
• treatment outcomes

ACKNOWLEDGMENTS

Support for this research was provided by grants R01-DA011966 (Grella) and P01- DA01070-38 (Zane, Stein) from the National Institute on Drug Abuse. The production assistance of Gisele Pham is gratefully acknowledged.