News Studies

Factors that Predict Abstinence in Substance Use Disorder Treatment

Erick Guerrero
Successfully completing a substance use disorder (SUD) treatment episode, as defined by a provider, is an important milestone for clients, but most of these episodes still result in relapse. Ultimately, successful completion requires abstinence. Abstinence is defined as a determined period of nonuse of any legal or illegal drugs before discharge from treatment. Very little is known as to what client and program characteristics of a treatment episode lead to abstinence, though low-income SUD clients seem to struggle the most in this area. This is problematic for community-based SUD treatment providers because the Affordable Care Act (ACA) increased eligibility for low-income people and the ACA’s higher standards of quality assess programs based partly on this outcome. In a study published in the Journal of Behavioral Health Services & Research, Dr. Erick Guerrero and colleagues, Drs. Frimpong, Kong, and Kim investigated the factors that lead to completing a treatment episode where the discharged client is more likely to be abstinent (i.e. experience a “successful discharge”). The research team examined whether individual, program or referral factors were associated with a higher likelihood of reported abstinence:
  • Client characteristics: Older age, male, non-Hispanic White, higher education, and employed
  • Program characteristics: Methadone and residential treatment types, compared to outpatient programs
  • Sources of referral: Referral through the legal system (i.e. drug courts).
The evaluation was done by merging staff responses to a survey and information about each specific treatment episode over a specific time-period from SUD treatment providers that serve predominantly Latino and African-American residents of Los Angeles County. The 106 programs analyzed were surveyed in 2011 and information was used from 11,533 episodes they treated between July 1, 2010 and December 31, 2011. To ensure the measures from the surveys were accurate, the research team also: 1) reviewed information reported by the providers to the funding organization (LA Department of Public Health); 2) interviewed counselors and clinical supervisors in 30 of the programs; and 3) reviewed printed material available at each provider site. The study considers outcomes from individual treatment episodes, each associated to a provider. Measures from the three sets of characteristics described above are included to determine which are associated with episodes resulting in abstinence. In the statistical analysis, the research team used a method that incorporated the fact that responses from multiple individuals were being analyzed within the same organization. The research team made the following findings:
  • Individuals aged over 50, non-Hispanic Whites, and being employed at admission were related with higher odds of reporting abstinence.
  • Enrolling in recovery support services, use of medications such as methadone and Subutex, having a primary drug of choice other than heroin, and being older when first using the drug were related with higher odds of reporting abstinence.
  • Clients in residential programs (compared to outpatient) were more likely to report abstinence.
  • Being referred by Proposition 36 (compared to self-referral) was related to higher odds of abstinence.
  • Program factors such as higher percentage of public funding and having staff with graduate degrees were related with higher odds of clients reporting abstinence.
The research team notes that only 36 percent of clients entering SUD treatment reported abstinence in a successful discharge. This emphasizes the need to understand the factors that play a role in determining abstinence in publicly funded community-based programs, particularly among racially and ethnically diverse clients, individuals in need of mental health services, and individuals who inject drugs. This study highlights those important factors where providers can target in order to help individuals reach and sustain sobriety. To view the study in its entirety, please click here. Source: “Abstinence at Successful Discharge in Publicly Funded Addiction Health Services”, Journal of Behavioral Health Services & Research

About Erick Guerrero

Erick Guerrero usc

Dr. Erick Guerrero is the research director at I-Lead Institute at Red Corp

Professor Erick Guerrero has recieved awards every year since 2009 for his program on research on Latino disparities in behavioral health services and implementation of culturally responsive evidence based practices in health care settings.

Before Completing his doctorate, Dr Guerrero was a clinician for 13 years serving hundreds of families affected by child and or partner abuse

Trained as an organizational and implementation scientist, Professor Erick Guerrero has published more than 50 peer-reviewed articles in top scientific journals in his field. Dr Erick Guerrero was the first Mexican National who graduated with a Ph.D from the University of Chicago School of Social Service Administration.

Other Articles

Implementation of EBPs
Racial and Ethnic Disparities in Substance Abuse Treatment Completion
Alcohol Use among Indigenous Older Adults in Mexico