Did You Like Your Treatment? The Influence of Treatment Satisfaction on Outcomes

Patients’ treatment satisfaction is a construct familiar to substance use disorder (SUD) programs and providers, though little is known empirically about its relationship to important outcomes, such as abstinence and psychiatric and medical functioning.

Greater understanding of these relationships could provide information to help treatment programs more effectively target this patient-centered outcome.

Kendra and colleagues used a sample of 345 Department of Veteran Affairs (VA) patients attending an outpatient SUD treatment program, grounded in evidence-based treatment approaches and emphasizing abstinence/recovery, to test whether satisfaction 6 months after treatment entry predicted critical recovery outcomes 12 months after entry (i.e., 6 months later).

Participants were 98% Male, 43% White, and 51 years old on average. They entered treatment having used a range of substances (30 days prior), including 58% with alcohol misuse, 36% cocaine misuse, 22% cannabis misuse, and 14% opioid misuse.

Patient satisfaction was conceptualized in three ways for both treatment and 12-step mutual-help groups:

as separate dimensions (it met patients’ needs, the treatment or 12-step mutual help participation agreed with their goals, it helped patients deal with their problems, and it fit their ideas about what is most helpful to people with alcohol/drug problems)
as a single-item overall satisfaction question
as a composite of these two. In addition to the study’s focus on the influence of patient satisfaction, the authors were also interested in determining how to measure satisfaction in a parsimonious, clinically useful way

In addition, 12-step participation was measured with total meetings attended and the sum of an 11-item active involvement inventory reflecting activities such as having a sponsor, engaging in service (e.g., making coffee), and reading 12-step literature.

Abstinence was measured dichotomously (yes/no) based only on the 30 days before 12-month follow-up – and medical and psychiatric functioning were measured with the LITE version of the Addiction Severity Index, 5^th edition.

The authors found that, when controlling for patients’ initial severity of substance use, overall treatment and 12-step satisfaction (and the composites) at 6 months both predicted 12-step active involvement, as well as abstinence at 12 months.

Regarding abstinence, for each added level of satisfaction (dissatisfied, mildly dissatisfied, mostly satisfied, very satisfied), the odds of being abstinent increased by factors of 1.5 or 1.88 for treatment and 12-step satisfaction, respectively.

As an example, patients who were mostly satisfied with treatment were 1.5 times more likely to be abstinent than patients who were mildly dissatisfied. Overall, 12-step satisfaction predicted less psychiatric severity, and treatment satisfaction predicted less medical severity.

IN CONTEXT

Satisfaction with treatment and 12-step mutual-help groups predicts important clinical outcomes such as abstinence and psychiatric and medical functioning.

With increased emphasis on patient-centered outcomes and care, these findings are of value to the treatment field.

The Internet is a valuable resource for the field of recovery, and it is crucial that interventions are designed to stay relevant given the shift towards an Internet-based society.

They found that a single-item measure of overall treatment satisfaction has clinical utility on par with a composite of five dimensions (including overall satisfaction). This adds to body of literature showing – somewhat counter intuitively — single item measures can be stronger predictors of outcomes than measures with several items (and dimensions) and thus valuable clinical tools (see, for example, Hoeppner’s study regarding abstinence self-efficacy).

LIMITATIONS

Despite the clinical utility of the study, it is important to consider, as with all Veterans Association (VA) studies, the sample had a greater proportion of males and was substantially older than typical treatment samples.
Also, there were several constructs not included in the authors’ models (e.g., treatment or recovery motivation) that, if included in the model and statistically controlled, may potentially increase the impact of the study.
Finally, some suggestions to increase treatment satisfaction are provided (e.g., collaborative treatment decisions), though patients’ perspectives on these issues may differ from those of clinical researchers, and patient-centered research in this regard could clarify the role of treatment satisfaction in recovery research.

NEXT STEPS

One question that lingers is why would greater treatment or 12-step satisfaction predict better outcomes? Although the researchers didn’t explicitly test such a model, it seems plausible that increased treatment and 12-step satisfaction improve abstinence rates by increasing the likelihood of further treatment engagement and 12-step mutual-help participation.

BOTTOM LINE

For individuals & families seeking recovery: The degree to which you are satisfied with treatment and 12-step mutual-help groups could make a difference in how much you benefit from your participation. If feeling dissatisfied, it may be helpful to discuss with the therapist or sponsor.
For scientists: Analyses here were appropriately set up to answer questions about relationships between treatment/12-step satisfaction and outcomes. In order to make a more compelling case for a causal link, future work could include more comprehensive statistical models to control for possible alternative explanations. Also, as the authors point out, testing how and why satisfaction is related to outcomes will provide meaningful information to patients and their clinicians about how to address satisfaction in treatment.
For policy makers: Although further research is needed, this study provides preliminary evidence that a single item measure of treatment satisfaction has good clinical utility. Given its minimal burden on patients and clinicians, policy makers may wish to require programs to assess and explore treatment and 12-step mutual-help satisfaction with patients.
For treatment professionals and treatment systems: Willingness to discuss your patients’ treatment and 12-step mutual-help organization satisfaction is valuable. This may be hard to do without arousing social desirability biases (i.e., they may want to please you and thus inflate their satisfaction), but a frank discussion while acknowledging this potential bias may help reduce it. If you do not already do so, explore with your patients what might increase their overall treatment satisfaction.

CITATIONS

Kendra, M. S., Weingardt, K. R., Cucciare, M. A., & Timko, C. (2015). Satisfaction with substance use treatment and 12-step groups predicts outcomes. Addictive behaviors, 40, 27-32.