Psychiatric Comorbidities and Outpatient Substance Abuse Treatment Retention

描述（由申请人提供）：流行病学研究表明，共病疾病是普遍存在的，而不是例外。药物滥用治疗项目通常报告说，50%至75%的客户患有共病精神障碍。共病疾病的治疗可能是有效的;然而，这些好处往往无法实现，因为人们通常无法持续足够长的治疗时间来实现任何临床益处。由于方法上的局限性，以往研究精神共病和药物滥用治疗保留之间的关系的结果是不确定的，并没有被复制。本研究的目的是：1）探讨精神共病与物质滥用治疗中的保留之间的关系; 2）探讨服务需求与（医疗、心理健康、家庭、职业、儿童保育、财务、社会关系和住房）和有和无精神病合并症的人继续接受药物滥用治疗;以及3）测试服务需求匹配对有和没有精神病合并症的人在物质滥用治疗中保持的贡献。这项研究使用的数据从全国治疗改善评价研究（NTIES），1992年至1997年-一个前瞻性研究的影响，毒品和酒精治疗的弱势群体。主要的分析策略包括生存分析和稳健估计方法。拟议的研究将有助于确定与药物滥用治疗保留相关的因素，包括精神病合并症，服务需求和服务匹配的作用。这对于制定干预措施和政策，增加完成足够治疗的客户数量非常重要。通过更好地了解综合服务包在药物滥用治疗中的有效性，这项研究将有助于指导有限治疗资金的使用。总之，这项研究有助于对药物滥用治疗过程的一般知识，解决了广泛的认识，需要更多地关注过程，而不是结果的问题。这项研究还将使新的研究人员具备实质性，方法和分析技能，以从事研究工作，重点是为患有合并症的人提供护理和服务的质量。

DESCRIPTION (provided by applicant): Epidemiological research shows wide agreement that comorbid disorders are the rule, rather than the exception. Substance abuse treatment programs typically report that 50 to 75 percent of their clients have comorbid psychiatric disorders. Treatment for comorbid disorders can be effective; however, the benefits are often not realized because persons typically fail to stay in treatment long enough to achieve any clinical benefits. The results of prior studies examining the relationship between psychiatric comorbidities and substance abuse treatment retention are inconclusive, due to methodological limitations, and have not been replicated. The aims of this study are: 1) to examine the relationship between psychiatric comorbidities and retention in substance abuse treatment; 2) to examine the relationship between service needs (medical, mental health, family, vocational, childcare, financial, social relations, and housing) and retention in substance abuse treatment among persons with and without psychiatric comorbidities; and 3) to test the contribution of service-need matching on retention in substance abuse treatment for persons with and without psychiatric comorbidities. This study uses data from the National Treatment Improvement Evaluation Study (NTIES), 1992-1997 - a prospective study of the impact of drug and alcohol treatment on vulnerable populations. The primary analytic strategy involves survival analysis with robust estimation methods. The proposed research will help identify factors that are associated with substance abuse treatment retention, including the role of psychiatric comorbidities, service needs, and service matching. This is important for developing interventions and policies that will increase the number of clients who complete an adequate amount of treatment. By building a greater understanding of the effectiveness of comprehensive service packages in substance abuse treatment, this research will help guide the use of limited treatment dollars. Taken together, this research contributes to the general knowledge about substance abuse treatment process, addressing the wide recognition that greater attention needs to be paid to questions of process rather than outcomes. This research will also equip a new investigator with the substantive, methodological and analytic skills to pursue a career in research focusing on quality of care and services for persons with comorbidities.