Patients with Substance Use and Personality Disorders: A Comparison of Patient Characteristics, Treatment Process, and Outcomes in Swiss and U.S. Substance Use Disorder Programs

Abstract

Background: Cross-cultural comparisons may increase our understanding of different models of substance use treatment and help identify consistent associations between patients’ characteristics, treatment conditions, and outcomes. Objectives: The aim of the study was to compare matched samples of substance use disorder (SUD) patients with personality disorders (PD) in Swiss and the United States (U.S.) residential SUD treatment programs and examine the relationship of program characteristics to 1-year outcomes. Methods: A prospective, naturalistic design was used to compare 132 demographically matched Swiss and U.S. male patients drawn from a sample of 10 Swiss and 15 U.S. public treatment programs. Patients completed comparable inventories at admission, discharge, and 1-year follow-up. Results: Compared to Swiss SUD-PD patients, U.S. SUD-PD patients had more severe substance use and psychosocial problems at admission and follow-up. More intensive treatment and a stronger emphasis on patients’ involvement were related to better outcomes for both Swiss and U.S. SUD-PD patients. Conclusion: There may be some cross-cultural consistency in the associations between treatment characteristics and SUD-PD patients’ outcomes. Scientific Significance: Treatment evaluation findings from representative programs in one country may apply elsewhere and contribute to our overall knowledge about how to improve SUD-PD patients’ outcomes.

Keywords :

• Cross-cultural comparison
• one-year outcomes
• patient characteristics
• personality disorders
• substance use disorders
• treatment program characteristics

ACKNOWLEDGMENTS

Franz Moggi, Anna Giovanoli, and Caroline Buri, University Hospital of Psychiatry Bern, Switzerland; Franz Moggi is also with the Department of Psychology, University of Fribourg, Fribourg, Switzerland; Rudolf H. Moos and Bernice S. Moos, Center for Health Care Evaluation, Department of Veterans Affairs and Stanford University Medical Centers, Palo Alto, California, USA.

The Swiss multisite study was supported by the Swiss National Science Foundation Grant 32–58803, the University Hospital of Psychiatry Bern, and was elaborated within the MPS network Fribourg. The U.S. multisite study was supported by the Department of Veterans Affairs Mental Health Strategic Healthcare Group and Health Services Research and Development Service. Data analyses and preparation of the manuscript were supported in part by NIAAA Grant AA15685. The views expressed here are the authors’ and do not necessarily represent the views of the U.S. Department of Veterans Affairs. We express our gratitude to all the patients and staff members who participated in the study.