Gender Differences in Treatment Retention Among Individuals with Co-Occurring Substance Abuse and Mental Health Disorders

Abstract

Background: A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. Although prior research indicates that women and men differ in their substance abuse treatment experiences, our knowledge of individuals with co-occurring substance abuse and mental health disorders as well as those attending private residential treatment is limited. Objectives: The purpose of this study is to examine gender differences on treatment retention for individuals with co-occurring substance abuse and mental health disorders who participate in private residential treatment. Methods: The participants were 1,317 individuals (539 women and 778 men) with co-occurring substance abuse and mental health disorders receiving treatment at three private residential treatment centers. Bivariate analyses, life tables, and Cox regression (survival analyses) were utilized to examine gender effects on treatment retention, and identify factors that predict treatment retention for men and women. Results: This study found that women with co-occurring disorders were more likely to stay longer in treatment when compared to men. The findings indicate the factors influencing length of stay differ for each gender, and include: type of substance used prior to admission; Addiction Severity Index Composite scores; and Readiness to Change/URICA scores. Age at admission was a factor for men only. Conclusions/Importance: These findings can be incorporated to develop and initiate program interventions to minimize early attrition and increase overall retention in private residential treatment for individuals with co-occurring substance use and mental health disorders.

Keywords :

• gender differences
• co-occurring disorders
• dual diagnosis
• substance abuse and mental health disorder
• retention
• predictors
• residential treatment

THE AUTHORS

Siobhan A. Morse, MHSA, CRC, CAI, MAC is the Director of Research and Fidelity at Foundations Recovery Network. Her current research interests focus on providing high-quality care and outcomes research in private residential dual diagnosis treatment.

Samuel MacMaster, Ph.D. is an Associate Professor at the University of Tennessee within the College of Social Work. Dr. MacMaster's research interests center on the intersection of substance use and HIV/AIDS; and have focused specifically on the development of culturally appropriate interventions to overcome barriers to service access for underserved and incarcerated populations.

Sam Choi, Ph.D is a director at Tennessee Korean American Social Service Center and research fellow at Children and Family Research Center. Dr. Choi's research revolves around two main areas: the relations of service delivery to child welfare and treatment outcomes for parents with co-occurring problems and the relations of service delivery to treatment outcomes for individuals with co-occurring substance abuse and mental health problems.

Susan M. Adams, PhD, RN, is Faculty Scholar for Community Engaged Behavioral Health at Vanderbilt University School of Nursing in Nashville, TN. Dr. Adams’ current research concerns are efficacy of trauma-informed interventions and sustained recovery for women with co-occurring substance use and mental health disorders in community based programs.

GLOSSARY

• Co-occurring Disorders [COD] (previously called Dual Diagnosis): refers to individuals who have one or more disorders relating to the use of alcohol and/or other substances of abuse as well as one or more mental health disorders. The diagnosis of co-occurring disorders is used when at least one disorder of each type occurs independent of the other and is not a cluster of symptoms resulting from one disorder alone. COD replaces the term Dual Diagnosis which can be confusing since it has been used to identify other co-morbid disorders such as a primary medical disorder and a mental health disorder.

• Cox regression (or proportional hazards regression): is a method for investigating the effect of several variables upon the time a specified event takes to happen (such as in treatment). The method does not assume a specific “survival model,” although it is not truly nonparametric because it does make the assumptions that the effects of the predictor variables on survival are constant over time and that they are additive in one scale.

• Life table: is a statistical calculation of survival analysis that deals with “time to an event” such as death, relapse, time in treatment, or other health events. It can answer the question of the chance of survival after diagnosis or entry to treatment. It can address the variable of entry and withdrawal from treatment. The life table generates a survival curve.

• Predictors, sometimes called independent variables, are factors or variables that can be used to “predict” or forecast the value of another variable, called the dependent or outcome variable, based on observations and measurements. Within the addictions field, predictor variables can include characteristics of an individual or population (such as age, gender, education, severity of disorder, involvement in criminal justice system, readiness to change, motivation for treatment, etc.), characteristics of the treatment environment, theoretical approach to treatment, models of service delivery, characteristics of the therapist/counselor and therapeutic alliance.

• Private residential treatment: is a 24 hour/7 days a week treatment program for co-occurring substance abuse and mental health disorders provided in a residential setting for extended time periods (up to 6–12 months) beyond an acute detoxification or psychiatric inpatient hospitalization stay. Residential treatment may be publicly funded (Medicaid/Medicare, state/federal block grants, or nonprofit agencies without fees) or privately funded (private insurance or direct out-of-pocket payment).

• Treatment retention: refers to the quantity or amount of time in treatment. Most commonly treatment retentions refer to the length of stay in treatment measured by days, months, or specific time period. Historically, longer treatment retention is a consistent predictor of better post-treatment outcomes.

Notice of Correction:

The order of authors and their corresponding affiliations has changed since the article's original online publication date of January 14, 2015.