Predictors of outcome for patients with substance-use disorders five years after treatment dropout.

Objective: Few studies focus on the outcome of patients after they drop out of substance-use disorder (SUD) treatment, and there appear to be no prior studies of the long-term outcomes of these patients. The aim of this study is to determine how well such patients do after dropping out of treatment and to identify predictors of differential outcomes.

Method: Patients in 15 residential SUD treatment programs were assessed at treatment entry and at 5-year follow-up on their frequency and severity of substance use, expectancies and beliefs about substance use, and social resources and stressors.

End-of-treatment outcomes in cognitive-behavioral treatment and 12-step substance use treatment programs: do they differ and do they predict 1-year outcomes?

This study examined changes in treatment-related proximal outcomes from intake to follow-up, associations between continuing care and maintenance of proximal outcome gains, correlations between specific proximal outcomes and substance use outcomes, and potential mediators of treatment effects for 12-step versus cognitive-behavioral (CB) substance use disorder (SUD) treatment. The participants were 1,873 male veterans seeking SUD treatment at five CB-oriented and five 12-step-oriented VA inpatient/residential SUD programs. Patterns of change in proximal outcomes were similar across the two program types.

Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes.

Aim: This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up.

Design And Setting: The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs.

Participants: A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs.

Protective resources and long-term recovery from alcohol use disorders.

Aims: This study examined indices of personal and social resources drawn from social learning, behavioral economics, and social control theories as predictors of medium- and long-term alcohol use disorder outcomes.

Design And Measures: Individuals (N = 461) who initiated help-seeking for alcohol-related problems were surveyed at baseline and 1, 3, 8, and 16 years later. At baseline and each follow-up, participants provided information about their personal and social resources and alcohol-related and psychosocial functioning.

Course of recovery from alcoholism.

This article represents the proceedings of a symposium at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, organized and chaired by Kamilla L. Venner. This symposium integrated current empirical research on the course of recovery from alcoholism from multiple perspectives, an aim that is consistent with NIAAA's new focus on the process of recovery.

Self-efficacy, therapeutic alliance, and alcohol-use disorder treatment outcomes.

Objective: High abstinence self-efficacy reliably predicts better treatment outcomes for patients with alcohol use disorders, but little is known about aspects of treatment that may be particularly beneficial for patients who enter treatment with low self-efficacy. This study examines whether the relationship between self-efficacy and treatment outcomes is influenced by the quality of the therapeutic alliance in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three treatments for alcohol use disorders.

Method: Information on 785 patients in the outpatient sample of Project MATCH was used to test for an interaction between baseline self-efficacy and therapeutic alliance in relation to 1-year alcohol use outcomes.

Predictors of untreated remission from late-life drinking problems.

Objective: Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally", without formal treatment. We sought to describe the life history predictors of untreated remission among older adults.

Method: We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters.

Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients.

Background: Epidemiological research examining the relationship between physical activity and depression has been conducted almost exclusively with community samples. We examined associations between physical activity, exercise coping, and depression in a sample of initially depressed patients, using four waves of data spanning 10 years.

Methods: A cohort (n=424) of depressed adults completed measures of physical activity, exercise coping, depression, and other demographic and psychosocial constructs at baseline, 1-year, 4-years, and 10-years, with a 90% wave-to-wave retention rate.

Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals.

This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes.

Determinants of functioning and well-being among individuals with schizophrenia: an integrated model.

Outcomes for health conditions are typically the result of multiple factors; however, studies tend to focus on a narrow class of variables. Functioning and well-being outcomes for schizophrenia are diverse and have resisted simple explanation; however, prior research has not offered an integrated understanding of the relative contributions of enduring and episodic environmental factors, personal resources and psychiatric factors, and cognitive appraisal and coping, on functioning and well-being outcomes in schizophrenia. The present article sets out an integrated model of the determinants of functioning and well-being among individuals with schizophrenia.

Sequencing the lifetime onset of alcohol-related symptoms in older adults: is there evidence of disease progression?

Objective: The purpose of this study was to evaluate evidence of orderly symptom progression in alcohol-use disorders (disease-progression model).

Method: A sample of community-residing older problem drinkers provided information about their life history of drinking, including the age at which they had experienced alcohol-related symptoms that correspond to criteria for alcohol abuse and dependence. Symptom sets and possible sequences were formulated separately for women and men, based on the average number of years from drinking initiation to symptom onset and on symptom prevalence.

Older adults' coping with negative life events: common processes of managing health, interpersonal, and financial/work stressors.

This study examined how older adults cope with negative life events in health, interpersonal, and financial/work domains and whether common stress and coping processes hold across these three domains. On three occasions, older adults identified the most severe negative event they faced in the last year and described how they appraised and coped with that event, their ambient chronic stressors, and event and functioning outcomes. The stress and coping process was largely consistent across the three life domains.

Rates and predictors of relapse after natural and treated remission from alcohol use disorders.

Aims: This study examined the rates and predictors of 3-year remission, and subsequent 16-year relapse, among initially untreated individuals with alcohol use disorders who did not obtain help or who participated in treatment and/or Alcoholics Anonymous in the first year after recognizing their need for help.

Design And Measures: A sample of individuals (n = 461) who initiated help-seeking was surveyed at baseline and 1 year, 3 years, 8 years and 16 years later. Participants provided information on their life history of drinking, alcohol-related functioning and life context and coping.

Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care.

Objective: To evaluate Breslau's 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care.

Design: One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen.

Predictors of engagement in continuing care following residential substance use disorder treatment.

Background: Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment.

Methods: Patients (n=3032) at 15 geographically diverse SUD residential treatment programs provided data on demographics, symptom patterns, recovery resources, and perceptions of treatment environment.

The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS).

Patients often experience 'preparatory-grief' as they cope with the dying process. Some may be depressed. The Terminally Ill Grief or Depression Scale (TIGDS), comprising grief and depression sub-scales, is a new self-report measure designed to differentiate between preparatory-grief and depression in adult inpatients.

Treatment for dual diagnosis patients in the psychiatric and substance abuse systems.

The purpose of this study was to describe and compare the extent to which psychiatric and substance abuse programs treating dual diagnosis patients in the residential and outpatient modalities offered the components recommended for this client group. Surveys were completed by managers of 753 programs in the Department of Veterans Affairs that had a treatment regimen oriented to dual diagnosis patients. Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.

Paths of entry into alcoholics anonymous: consequences for participation and remission.

Background: This study compared individuals with alcohol use disorders who, in the first year after initiating help-seeking, entered Alcoholics Anonymous (AA) only, entered professional treatment and AA together, or entered professional treatment only

Methods: A sample of initially untreated individuals (N = 362) was surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. At each contact point, participants described their participation in AA and treatment and their current alcohol-related functioning. They also described their reasons for entering AA and/or treatment and the perceived benefits of these sources of help

Results: Compared with individuals who initially participated only in treatment but later entered AA, those who entered treatment and AA together participated in AA longer and more frequently and were more likely to achieve remission.

Deterioration following alcohol-use disorder treatment in project MATCH.

Objective: This study examines the prevalence and predictors of deterioration during the three months following treatment in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three different treatments for alcohol-use disorders.

Method: The outpatient and aftercare samples of Project MATCH were examined to identify the prevalence of deterioration, as reflected by a decline in percent days abstinent between the 3 months prior to baseline and the 3 months immediately following treatment. Analyses of predictors of deterioration were based on baseline sociodemographic and psychological factors, including substance-related and psychiatric symptoms and treatment-related factors, including treatment type, treatment duration and therapeutic alliance.

The influence of partner status, relationship quality and relationship stability on outcomes following intensive substance-use disorder treatment.

Objective: Addiction treatment studies examining the influence of patients' partners suggest that partner behaviors affect patients' substance-use outcomes. We examine the influence of having a partner at treatment entry as well as the influence of the general quality of support and substance-using status of the partner, on outcomes following treatment for substance-use disorder. We also examine the influence of relationship stability on treatment outcomes and examine baseline partner behaviors that may predict relationship stability.

Stress generation, avoidance coping, and depressive symptoms: a 10-year model.

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later.

Predictors of 5-year mortality following inpatient/residential group treatment for substance use disorders.

This study examined the prevalence and predictors of 5-year mortality following treatment for substance use disorders. The predictors were assessed at baseline, at discharge, and at a 1-year follow-up for 3698 male veterans, and included demographic, substance use, medical, and psychological functioning, social support, and continuing care. The annual mortality rate was 2.

Justice in health care decision-making: patients' appraisals of health care providers and health plan representatives.

This study describes the development of two versions of a Health Care Justice Inventory (HCJI). One version focuses on patients' interactions with their providers (HCJI-P) and the other focuses on patients' interactions with the representatives of their health plans (HCJI-HP). Each version of the HCJI assesses patients' appraisals of their interactions (with either their Provider or representatives of their Health Plan) along three common dimensions of procedural justice: Trust, Impartiality, and Participation.