Psychiatric Comorbidities and Outpatient Substance Abuse Treatment Retention

描述（由申请人提供）：流行病学研究表明，普遍同意共病是规则，而不是例外。药物滥用治疗项目通常报告说，他们的客户中有50%到75%患有共病性精神疾病。对合并症的治疗是有效的；然而，这些益处往往无法实现，因为患者通常无法在治疗中停留足够长的时间以获得任何临床益处。由于方法上的限制，先前关于精神疾病合并症和药物滥用治疗保留之间关系的研究结果是不确定的，也没有被复制。本研究的目的是：1)探讨精神疾病合并症与药物滥用治疗中滞留的关系；2)检查服务需求（医疗、心理健康、家庭、职业、儿童保育、经济、社会关系和住房）与有或无精神合并症的人继续接受药物滥用治疗之间的关系；3)检验服务需求匹配对有和无精神疾病患者药物滥用治疗留用的贡献。本研究使用1992-1997年国家治疗改善评估研究（NTIES）的数据，这是一项关于药物和酒精治疗对弱势群体影响的前瞻性研究。主要的分析策略包括使用稳健估计方法进行生存分析。拟议的研究将有助于确定与药物滥用治疗保留有关的因素，包括精神合并症的作用，服务需求和服务匹配。这对于制定干预措施和政策非常重要，这些干预措施和政策将增加完成适当治疗的客户人数。通过对药物滥用治疗中综合服务包的有效性建立更深入的了解，这项研究将有助于指导有限治疗资金的使用。总的来说，这项研究有助于对药物滥用治疗过程的一般认识，解决了广泛认识到需要更多地关注过程问题而不是结果的问题。这项研究还将使一名新的研究人员具备实质性、方法学和分析技能，以便从事关注合并症患者护理和服务质量的研究。

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.