The Imperative for Integrated Treatment for CODs and Trauma Exposure: The Role of Psychiatric Disorders and Trauma Exposure on Residential SUD Treatment Outcomes, Aftercare Participation, and AOD Counselor Prognoses for Patients’ Abstention

Over 20 million American adults met the diagnostic criteria for a substance use last year, and 40% of those also have a co-occurring psychiatric condition. With the ever-rising death toll associated with alcohol and drugs, enhancing SUD treatment completion rates and promoting ongoing participation in posttreatment aftercare services to promote long term abstinence is imperative. This study attempts to identify predictive factors of residential SUD treatment completion, type of residential SUD treatment outcomes, posttreatment aftercare service participation, and AOD Counselors’ positive prognoses for patient abstention from drugs and/or alcohol through binary, multivariate, and ordinal logistic regression, respectively, for 200 adults who enrolled in an abstinence-based residential SUD treatment program between August 2017 and March 2018 in Hawthorne, California. Ratings for readiness for change, presence of mental health symptoms and treatment, number of lifetime inpatient psychiatric episodes, and past 30 day use of primary substance used at time of admission significantly influenced treatment noncompletion. Past 30 days of use of primary substance used, number of lifetime acute inpatient psychiatric episodes, and presence of mental health treatment and symptoms significantly predicted participants abandoning residential SUD treatment and receiving administrative discharges from residential SUD treatment. Longer residential treatment episodes and being homeless predicted enrollment in posttreatment outpatient SUD treatment and the Recovery Bridge Housing (RBH) program. Gender, past 30 days of use of primary substance used, type of pretreatment polysubstance use, number of acute inpatient psychiatric hospitalization episodes, and readiness for change significantly predicted AOD Counselors’ ratings of patients’ prognoses for abstention. These results highlight the importance of assessment for and stabilization of psychiatric symptoms as well as withdrawal symptoms from high levels of pretreatment methamphetamine use in order to enhance treatment completion rates. Furthermore, the results demonstrate the importance of assessing pretreatment readiness for change and motivation in order to successfully engage patients and use targeted interventions to enhance readiness to change, thereby improving treatment retention and completion rates. Finally, this study illustrates the value of long term residential SUD treatment episodes, as they enhance retention and likelihood of participation in posttreatment aftercare services, which serves to maintain initial treatment gains and promotes long term abstinence from drugs and alcohol