Residential treatment is associated with increased odds of treatment completion compared to outpatient, but that may not be true for everyone…
Residential treatment is associated with increased odds of treatment completion compared to outpatient, but that may not be true for everyone…
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Treatment completion (versus dropout) has been associated with increased odds of abstinence, fewer relapses, higher wages, and less criminal involvement. Outpatient and residential treatment are two of the most frequently used levels of care to treat substance use disorders. There is evidence that treatment completion rates are higher for residential settings. However, this is not always true for everyone; other important factors may also affect treatment completion rates, such as demographics (i.e., age, gender, race-ethnicity) and primary substance (e.g., alcohol, methamphetamine, opioids, etc.).
At the time of this study, little was known about the way treatment settings can interact with both demographic and clinical characteristics to influence the likelihood of treatment completion in a representative U.S. dataset. Ultimately, identifying which treatment settings are best for which patients, may help increase treatment effectiveness to support remission and recovery from substance use disorder.
The purpose of this study was to investigate the relationship between residential versus outpatient treatment and treatment completion, and then to examine how this relationship might vary by demographic characteristics and primary substance.
The researchers hypothesized:
This study used retrospective secondary data analysis from the 2011 Treatment Episode Data Set (TEDS), a federal database of state administrative records on admission and discharge data on substance use disorder treatment that occur in publicly funded facilities. TEDS is considered to cover more than 67% of substance use disorder treatment admissions (public or private) in the U.S.
This analysis included data for first treatment episodes in short-term residential (30 days or fewer) combined with long term residential settings (greater than 30 days), and outpatient treatment only (ambulatory intensive outpatient and non-intensive outpatient). Medical detoxification, opioid agonist treatment (e.g., buprenorphine + naloxone, known by brand name Suboxone), and hospital-based inpatient settings were excluded.
The final sample included 318,924 cases, of which outpatient treatment accounted for 269,783 clients and residential treatment for 49,141 clients. Statistically the researchers ran four separate regression models to test for gender, age, race-ethnicity, and primary substance as a moderating variable. Their primary research question was: Do treatment completion rates for residential and outpatient treatment depend on other factors such a patient’s age, gender, race-ethnicity, or primary substance?
Outpatient treatment accounted for 84.6% of the sample, but had a lower completion rate (51.9%) as compared to residential treatment (64.5%). Clients in residential programs were more than three times as likely to complete treatment as compared to clients in outpatient treatment settings, this effect remained stable even after controlling for many client, clinical, and state level characteristics.
Follow-up analysis revealed that the positive effect of residential treatment on treatment completion was less positive for African Americans and other non-Hispanic clients in long-term treatment only. The positive relationship between treatment completion and short-term residential programs were equivalent across all racial-ethnic groups.
It is important to know which treatment setting will most likely foster treatment completion, remission, and recovery for any given individual. Residential treatment settings generally have higher treatment completion rates than outpatient settings, a finding which was replicated in this study even after controlling for the patients’ clinical or demographic background. Clinical variables included number of substances used and frequency of use; however, number of substance use disorder symptoms as an indicator for severity was not captured.
Patients who identified as White were significantly more likely to complete long-term residential treatment compared to non-White patients. Treatment program differences in factors like cultural competency and cultural communication skills may account for this discrepancy and could also be more important in a residential versus outpatient setting because of the highly structured full time living arrangements required for this level of care.
The opposite was true for patients with a marijuana use disorder – the degree of benefit offered by residential treatment on treatment completion was less compared to patients with alcohol use disorder. Intensity of cravings and lasting post-acute withdrawal symptoms may play a more substantial role for individuals with an opioid use disorder compared to a marijuana use disorder and the increased structure and clinical oversight provided by residential treatment shields patients from access to opioids while these patients go through the challenging withdrawal and post-acute withdrawal phases of recovery (patients using medications like Suboxone were excluded from this analysis). Given individuals with an opioid use disorder had the lowest completion rates in general, this finding that residential treatment makes a positive difference for treatment completion may be an important way to help this high-risk population.
More research needs to incorporate clinical characteristics such as client motivation and therapeutic alliance and the interaction with program factors to better understand who is at risk of drop-out. Research needs to further explore the findings concerning residential treatment being more beneficial for individuals with opioid use disorder compared to alcohol or other drug use disorders.
Stahler, G. J., Mennis, J., & DuCette, J. P. (2016). Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice. Addictive Behaviors, 58, 129-135.
l
Treatment completion (versus dropout) has been associated with increased odds of abstinence, fewer relapses, higher wages, and less criminal involvement. Outpatient and residential treatment are two of the most frequently used levels of care to treat substance use disorders. There is evidence that treatment completion rates are higher for residential settings. However, this is not always true for everyone; other important factors may also affect treatment completion rates, such as demographics (i.e., age, gender, race-ethnicity) and primary substance (e.g., alcohol, methamphetamine, opioids, etc.).
At the time of this study, little was known about the way treatment settings can interact with both demographic and clinical characteristics to influence the likelihood of treatment completion in a representative U.S. dataset. Ultimately, identifying which treatment settings are best for which patients, may help increase treatment effectiveness to support remission and recovery from substance use disorder.
The purpose of this study was to investigate the relationship between residential versus outpatient treatment and treatment completion, and then to examine how this relationship might vary by demographic characteristics and primary substance.
The researchers hypothesized:
This study used retrospective secondary data analysis from the 2011 Treatment Episode Data Set (TEDS), a federal database of state administrative records on admission and discharge data on substance use disorder treatment that occur in publicly funded facilities. TEDS is considered to cover more than 67% of substance use disorder treatment admissions (public or private) in the U.S.
This analysis included data for first treatment episodes in short-term residential (30 days or fewer) combined with long term residential settings (greater than 30 days), and outpatient treatment only (ambulatory intensive outpatient and non-intensive outpatient). Medical detoxification, opioid agonist treatment (e.g., buprenorphine + naloxone, known by brand name Suboxone), and hospital-based inpatient settings were excluded.
The final sample included 318,924 cases, of which outpatient treatment accounted for 269,783 clients and residential treatment for 49,141 clients. Statistically the researchers ran four separate regression models to test for gender, age, race-ethnicity, and primary substance as a moderating variable. Their primary research question was: Do treatment completion rates for residential and outpatient treatment depend on other factors such a patient’s age, gender, race-ethnicity, or primary substance?
Outpatient treatment accounted for 84.6% of the sample, but had a lower completion rate (51.9%) as compared to residential treatment (64.5%). Clients in residential programs were more than three times as likely to complete treatment as compared to clients in outpatient treatment settings, this effect remained stable even after controlling for many client, clinical, and state level characteristics.
Follow-up analysis revealed that the positive effect of residential treatment on treatment completion was less positive for African Americans and other non-Hispanic clients in long-term treatment only. The positive relationship between treatment completion and short-term residential programs were equivalent across all racial-ethnic groups.
It is important to know which treatment setting will most likely foster treatment completion, remission, and recovery for any given individual. Residential treatment settings generally have higher treatment completion rates than outpatient settings, a finding which was replicated in this study even after controlling for the patients’ clinical or demographic background. Clinical variables included number of substances used and frequency of use; however, number of substance use disorder symptoms as an indicator for severity was not captured.
Patients who identified as White were significantly more likely to complete long-term residential treatment compared to non-White patients. Treatment program differences in factors like cultural competency and cultural communication skills may account for this discrepancy and could also be more important in a residential versus outpatient setting because of the highly structured full time living arrangements required for this level of care.
The opposite was true for patients with a marijuana use disorder – the degree of benefit offered by residential treatment on treatment completion was less compared to patients with alcohol use disorder. Intensity of cravings and lasting post-acute withdrawal symptoms may play a more substantial role for individuals with an opioid use disorder compared to a marijuana use disorder and the increased structure and clinical oversight provided by residential treatment shields patients from access to opioids while these patients go through the challenging withdrawal and post-acute withdrawal phases of recovery (patients using medications like Suboxone were excluded from this analysis). Given individuals with an opioid use disorder had the lowest completion rates in general, this finding that residential treatment makes a positive difference for treatment completion may be an important way to help this high-risk population.
More research needs to incorporate clinical characteristics such as client motivation and therapeutic alliance and the interaction with program factors to better understand who is at risk of drop-out. Research needs to further explore the findings concerning residential treatment being more beneficial for individuals with opioid use disorder compared to alcohol or other drug use disorders.
Stahler, G. J., Mennis, J., & DuCette, J. P. (2016). Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice. Addictive Behaviors, 58, 129-135.
l
Treatment completion (versus dropout) has been associated with increased odds of abstinence, fewer relapses, higher wages, and less criminal involvement. Outpatient and residential treatment are two of the most frequently used levels of care to treat substance use disorders. There is evidence that treatment completion rates are higher for residential settings. However, this is not always true for everyone; other important factors may also affect treatment completion rates, such as demographics (i.e., age, gender, race-ethnicity) and primary substance (e.g., alcohol, methamphetamine, opioids, etc.).
At the time of this study, little was known about the way treatment settings can interact with both demographic and clinical characteristics to influence the likelihood of treatment completion in a representative U.S. dataset. Ultimately, identifying which treatment settings are best for which patients, may help increase treatment effectiveness to support remission and recovery from substance use disorder.
The purpose of this study was to investigate the relationship between residential versus outpatient treatment and treatment completion, and then to examine how this relationship might vary by demographic characteristics and primary substance.
The researchers hypothesized:
This study used retrospective secondary data analysis from the 2011 Treatment Episode Data Set (TEDS), a federal database of state administrative records on admission and discharge data on substance use disorder treatment that occur in publicly funded facilities. TEDS is considered to cover more than 67% of substance use disorder treatment admissions (public or private) in the U.S.
This analysis included data for first treatment episodes in short-term residential (30 days or fewer) combined with long term residential settings (greater than 30 days), and outpatient treatment only (ambulatory intensive outpatient and non-intensive outpatient). Medical detoxification, opioid agonist treatment (e.g., buprenorphine + naloxone, known by brand name Suboxone), and hospital-based inpatient settings were excluded.
The final sample included 318,924 cases, of which outpatient treatment accounted for 269,783 clients and residential treatment for 49,141 clients. Statistically the researchers ran four separate regression models to test for gender, age, race-ethnicity, and primary substance as a moderating variable. Their primary research question was: Do treatment completion rates for residential and outpatient treatment depend on other factors such a patient’s age, gender, race-ethnicity, or primary substance?
Outpatient treatment accounted for 84.6% of the sample, but had a lower completion rate (51.9%) as compared to residential treatment (64.5%). Clients in residential programs were more than three times as likely to complete treatment as compared to clients in outpatient treatment settings, this effect remained stable even after controlling for many client, clinical, and state level characteristics.
Follow-up analysis revealed that the positive effect of residential treatment on treatment completion was less positive for African Americans and other non-Hispanic clients in long-term treatment only. The positive relationship between treatment completion and short-term residential programs were equivalent across all racial-ethnic groups.
It is important to know which treatment setting will most likely foster treatment completion, remission, and recovery for any given individual. Residential treatment settings generally have higher treatment completion rates than outpatient settings, a finding which was replicated in this study even after controlling for the patients’ clinical or demographic background. Clinical variables included number of substances used and frequency of use; however, number of substance use disorder symptoms as an indicator for severity was not captured.
Patients who identified as White were significantly more likely to complete long-term residential treatment compared to non-White patients. Treatment program differences in factors like cultural competency and cultural communication skills may account for this discrepancy and could also be more important in a residential versus outpatient setting because of the highly structured full time living arrangements required for this level of care.
The opposite was true for patients with a marijuana use disorder – the degree of benefit offered by residential treatment on treatment completion was less compared to patients with alcohol use disorder. Intensity of cravings and lasting post-acute withdrawal symptoms may play a more substantial role for individuals with an opioid use disorder compared to a marijuana use disorder and the increased structure and clinical oversight provided by residential treatment shields patients from access to opioids while these patients go through the challenging withdrawal and post-acute withdrawal phases of recovery (patients using medications like Suboxone were excluded from this analysis). Given individuals with an opioid use disorder had the lowest completion rates in general, this finding that residential treatment makes a positive difference for treatment completion may be an important way to help this high-risk population.
More research needs to incorporate clinical characteristics such as client motivation and therapeutic alliance and the interaction with program factors to better understand who is at risk of drop-out. Research needs to further explore the findings concerning residential treatment being more beneficial for individuals with opioid use disorder compared to alcohol or other drug use disorders.
Stahler, G. J., Mennis, J., & DuCette, J. P. (2016). Residential and outpatient treatment completion for substance use disorders in the U.S.: Moderation analysis by demographics and drug of choice. Addictive Behaviors, 58, 129-135.
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