Predictors of Dually Diagnosed Patients' Psychiatric Symptom Exacerbation During Acute Substance Use Disorder Treatment

ABSTRACT

Objectives: This study identified intake risk factors that predicted dual diagnosis patients' exacerbation of psychiatric symptoms during acute substance use disorder care; and examined whether receipt of recommended services for dual diagnosis patients reduced the likelihood of exacerbation, and whether additional help post-discharge was associated with improved symptoms at a 1-year follow-up.

Methods: Dual diagnosis patients (N = 230) who received treatment in one of 14 residential substance abuse programs were evaluated at in-take, discharge (98%), and 1-year follow-up (80%).

Findings: Patients who, at intake, were anxious, untroubled by their psychiatric problems, using more than one substance, had less severe alcohol problems, lived with a problem drinker, and had no close friends were at greater risk of exacerbation of psychiatric symptoms at discharge. Patients who received, during acute treatment, recommended services (e.g., individual counseling, vocational counseling, discharge planning) were more likely to improve, even when intake risk was controlled. Additional outpatient treatment post-discharge was associated with fewer psychiatric symptoms at 1 year.

Conclusions: Substance abuse treatment staff should be vigilant about identifying and preventing dual diagnosis patients' psychiatric symptom exacerbation. Attending to changes in psychiatric symptoms and tailoring interventions to patients at greatest risk could help reduce the likelihood of in-treatment increases in psychiatric symptoms.

KEYWORDS:

• Dual diagnosis
• Psychiatric
• substance abuse
• symptom exacerbation
• treatment planning