Texas COSIG ProjectTexas COSIG Project

Client and Service Client and Service Characteristics Associated Characteristics Associated with Treatment Completionwith Treatment Completion

44thth Annual COSIG Grantee Meeting Annual COSIG Grantee MeetingMarch 2007March 2007

Texas COSIG Project Texas COSIG Project Key ComponentsKey Components

Substance abuse treatment counselor Substance abuse treatment counselor training on COD and the use of diagnostic training on COD and the use of diagnostic and assessment instruments to improve and assessment instruments to improve identification of comorbidity and monitor identification of comorbidity and monitor client progressclient progress

A voucher system that provides recovery A voucher system that provides recovery and social support services to enhance the and social support services to enhance the treatment process ($1800 per client)treatment process ($1800 per client)

Voucher Service CategoriesVoucher Service Categories

Child CareChild Care

Housing SupportHousing Support

TransportationTransportation

Food AssistanceFood Assistance

Education SupportEducation Support

Employment AssistanceEmployment Assistance

ClothingClothing

Medical CareMedical Care

PrescriptionsPrescriptions

Peer MentoringPeer Mentoring

COSIG Client OutcomesCOSIG Client Outcomes

Data were obtained for 424 COSIG clients who Data were obtained for 424 COSIG clients who entered and were discharged from substance entered and were discharged from substance abuse treatment during the period of February abuse treatment during the period of February 2005 through October 20062005 through October 2006

76% of the sample completed treatment76% of the sample completed treatment

Treatment completers (n=323) and non-Treatment completers (n=323) and non-completers (n=101) were compared on client completers (n=101) were compared on client and service characteristicsand service characteristics

Client DemographicsClient Demographics

Treatment completers were more likely to Treatment completers were more likely to be male (51% vs. 34%) and homeless be male (51% vs. 34%) and homeless (24% vs. 14%)(24% vs. 14%)

The groups did not differ in race/ethnicity, The groups did not differ in race/ethnicity, education, age, marital status, education, age, marital status, employment, or past year substance-employment, or past year substance-related arrestsrelated arrests

MINI Diagnostic ImpressionsMINI Diagnostic Impressions

0%

10%

20%

30%

40%

50%

60%

BIPOLAR DEPRESSION HYPOMANIC DYSTHYMIA PANIC OCD PSYCHOTIC GENANXIETY

PTSD

COMPLETER NON-COMPLETER

*

**

*

Psychiatric Symptom SeverityPsychiatric Symptom Severity

No differences were found in client-No differences were found in client-reported symptom severity on the Brief reported symptom severity on the Brief Symptom Inventory scalesSymptom Inventory scales

Clinicians rated non-completers as having Clinicians rated non-completers as having more severe symptoms on the more severe symptoms on the interpersonal sensitivity, depression, and interpersonal sensitivity, depression, and hostility scales on the Brief Derogatis hostility scales on the Brief Derogatis Psychiatric Rating ScalePsychiatric Rating Scale

Primary Substance of AbusePrimary Substance of Abuse

0%

5%

10%

15%

20%

25%

30%

35%

40%

ALCOHOL COCAINE CRACK OPIATES MARIJUANA OTHER

COMPLETER NON-COMPLETER

Substance Use PatternsSubstance Use Patterns

Completers reported a greater primary Completers reported a greater primary substance use during the month prior to substance use during the month prior to admission (15 vs.12 days)admission (15 vs.12 days)

A greater percentage of non-completers A greater percentage of non-completers reported polysubstance use (56% vs. 42%)reported polysubstance use (56% vs. 42%)

No differences were found in total years of No differences were found in total years of primary substance use or history of IV drug useprimary substance use or history of IV drug use

Substance Abuse Treatment HistorySubstance Abuse Treatment History

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

PRIOR DETOX PRIOR NON-DETOX AA PAST 30 DAYS

COMPLETERS NON-COMPLETERS

*

*

*

Discharge CharacteristicsDischarge Characteristics

Completers had higher past month Completers had higher past month abstinence rates (88% vs. 61%)abstinence rates (88% vs. 61%)

Completers had higher past month AA Completers had higher past month AA attendance (95% vs. 78%)attendance (95% vs. 78%)

No group differences were found in length No group differences were found in length of stay in treatment (approximately 100 of stay in treatment (approximately 100 days)days)

Voucher Service UtilizationVoucher Service Utilization

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

CHILDCARE

VOCATIONAL

PRESCRIPTIONS

MEDICAL

CLOTHING

EDUCATION

PEER MENTORING

FOOD

TRANSPORTATION

HOUSING

COMPLETER NON-COMPLETER

**

*

*

*

Recovery and Social Support Recovery and Social Support Service CombinationsService Combinations

0%

10%

20%

30%

40%

50%

60%

70%

PEER MENTORING AND SOCIAL SUPPORT SOCIAL SUPPORT ONLY

COMPLETER NON-COMPLETER

*

*

ConclusionsConclusions

Higher treatment completion for males indicates Higher treatment completion for males indicates that women with COD may need specialized that women with COD may need specialized interventions in substance abuse treatmentinterventions in substance abuse treatment

A study analyzing gender differences using a A study analyzing gender differences using a subset of these data revealed that women subset of these data revealed that women demonstrated higher awareness of psychiatric demonstrated higher awareness of psychiatric issues relative to substance abuse problems, issues relative to substance abuse problems, suggesting that substance abuse treatment suggesting that substance abuse treatment inventions may need greater focus on the inventions may need greater focus on the interaction of the two disorders* interaction of the two disorders*

*(Mangrum, Spence, & Steinley-Bumgarner, 2006)*(Mangrum, Spence, & Steinley-Bumgarner, 2006)

ConclusionsConclusions

Lower completion rates for clients with Lower completion rates for clients with bipolar and posttraumatic stress disorders bipolar and posttraumatic stress disorders suggest that these syndromes may be suggest that these syndromes may be more difficult to treat in substance abuse more difficult to treat in substance abuse treatment settings treatment settings

Substance abuse counselors may need Substance abuse counselors may need training on specific interventions targeting training on specific interventions targeting these two disordersthese two disorders

ConclusionsConclusions

The 76% completion rate for the total sample is higher The 76% completion rate for the total sample is higher than previously calculated statewide averages, than previously calculated statewide averages, suggesting that the provision of recovery and social suggesting that the provision of recovery and social support services may enhance treatment outcomessupport services may enhance treatment outcomes

A study examining clients receiving COPSD services in A study examining clients receiving COPSD services in Texas during FY 2004 revealed a 57% completion rate* Texas during FY 2004 revealed a 57% completion rate*

Other analyses of general substance abuse treatment Other analyses of general substance abuse treatment clients in Texas have indicated completion rates ranging clients in Texas have indicated completion rates ranging from 51 - 54% from 51 - 54%

*(Mangrum & Spence, 2005)*(Mangrum & Spence, 2005)

ConclusionsConclusions

Peer mentoring had the strongest association Peer mentoring had the strongest association with treatment completionwith treatment completion

Social support services, particularly in the Social support services, particularly in the absence of peer mentoring, were associated absence of peer mentoring, were associated with non-completionwith non-completion

Similar trends have been found in the Texas Similar trends have been found in the Texas ATR voucher service data, indicating that direct ATR voucher service data, indicating that direct recovery support services are associated with recovery support services are associated with greater completion rates, whereas the provision greater completion rates, whereas the provision of social support services only is more highly of social support services only is more highly associated with non-completionassociated with non-completion