Predictors Of Treatment Completion Research Articles

Predictors of Treatment Completion among Women Receiving Integrated Treatment for Comorbid Posttraumatic Stress and Substance Use Disorders

Background: Retention in treatment for individuals with comorbid posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is an area of concern in treatment outcome studies. The current study explores key variables related to retention in a group of women with comorbid PTSD and SUD enrolled in community SUD treatment randomized to eight weekly sessions of a trauma adapted mindfulness-based relapse prevention (TA-MBRP) or an integrated coping skills (ICS) group intervention. Methods: Two unadjusted and adjusted logistic discrete failure time (DFT) models were fit to examine associations between participants and the time (in weeks) to treatment completion status. Key covariates of interest, including time-varying PTSD Symptom Scale-Self Report (PSS) total score, time-varying Five Factors Mindfulness Questionnaire (FFMQ) total score, group assignment, baseline endorsements of substance use and demographics such as age, race and employment status were fit into the model. Results: In the adjusted PSS model, increased levels of PTSD symptom severity (PSS) scores at week 5 and 7 (PSS OR: 1:06: OR 1.13, respectively) were associated with higher odds of non-completion. In the FFMQ model, increased levels of FFMQ scores at week 6 (OR: 0:92) were associated with lower odds of non-completion. In both models, assignment to the ICS control group and unemployment were associated with lower odds of completion and baseline use of cocaine and sedatives were associated with higher odds of completion. Conclusion: Monitoring PTSD symptom severity and measures of mindfulness can inform providers on strategies to enhance retention early in treatment for individuals with comorbid PTSD/SUD. ClinicalTrials.gov # NCT02755103

Predictors of Treatment Completion in an Inpatient Substance Use Treatment Service in India.

Treatment completion is associated with a better outcome in substance use disorders. We examined the rates of treatment completion and its predictors in patients admitted to specialized addiction treatment settings over a 13-year period. Ours was a retrospective cohort study. We included consecutive 2850 patients admitted to the inpatient treatment between January 2007 and December 2019. We divided the patients into 2 groups: completed versus premature discontinuation of treatment. The predictor variables were based on previous research, clinical experience, and availability of the digital record. The number of patients who completed and discontinued treatments was 1873 (72.6%) and 707 (27.4%), respectively. The inpatient treatment discontinuation rate varied widely during the study period (18% in 2007 and 41% in 2012). The average rate of treatment discontinuation was 27%. The change-point analysis showed 5 statistically significant change points in the years 2008, 2010, 2012, 2014, and 2016. Patients who were prescribed medications for alcohol and opioid dependence and those who were on opioid agonist treatment had 4.7 and 6.3 higher odds of completing inpatient treatment than those who were not on medication. Patients with physical and psychiatric comorbidities had higher odds of treatment completion. Patients with a primary diagnosis of opioid dependence had lower odds of treatment completion than those with alcohol dependence. The rates of discontinuation may vary with concurrent changes in the treatment policies. Awareness of the risk factors and policy measures that may improve treatment completion must aid in informed decision making.

Comparing the effectiveness and predictors of cognitive behavioural therapy-enhanced between patients with various eating disorder diagnoses: a naturalistic study

Abstract Cognitive behaviour therapy-enhanced (CBT-E) is an effective treatment for non-underweight patients with eating disorders. Its efficacy and effectiveness is investigated mostly among transdiagnostic samples and remains unknown for binge eating disorder. The aim of the present study was to assess several treatment outcome predictors and to compare effectiveness of CBT-E among adult out-patients with bulimia nervosa (n=370), binge eating disorder (n=113), and those with a restrictive food pattern diagnosed with other specified feeding and eating disorders (n=139). Effectiveness of CBT-E was assessed in routine clinical practice in a specialised eating disorders centre. Eating disorder pathology was measured with the EDEQ pre- and post-treatment, and at 20 weeks follow-up. Linear mixed model analyses with fixed effect were performed to compare treatment outcome among the eating disorder groups. Several predictors of treatment completion and outcome were examined with a regression analysis. No predictors for drop-out were found, except the diagnosis of bulimia nervosa. Eating disorder pathology decreased among all groups with effect sizes between 1.43 and 1.70 on the EDE-Q total score. There were no differences in remission rates between the three groups at end of treatment or at follow-up. Eating disorder severity at baseline affected treatment response. The results can be generalised to other specialised treatment centres. No subgroup of patients differentially benefited from CBT-E supporting the transdiagnostic perspective for the treatment of eating disorders. Longer-term follow-up data are necessary to measure persistence of treatment benefits. Key learning aims (1) What is the effectiveness of CBT-E among patients suffering from binge eating disorder? (2) Does any subgroup of patients suffering from an eating disorder differentially benefit from CBT-E? (3) What factors predict treatment response?

Implementation of HIV non-occupational post-exposure prophylaxis for men who have sex with men in 2 cities of Southwestern China.

Non-occupational post-exposure prophylaxis (nPEP) has often relied on the joint work of emergency physicians and infectious disease specialists in busy emergency departments and human immunodeficiency virus (HIV)/sexually transmitted infections clinics abroad, where adherence education and follow-up are invariably reactive. In our pilot study, community-based organizations (CBOs) were invited to together implement the nPEP tailored to men who have sex with men (MSM) in 2 cities of Guangxi in Southwestern China, of which experiences and lessons drawn from would be provided to the promotion of nPEP in China.The study population enrolled MSM individuals prescribed nPEP from September 2017 to December 2019. One-to-one follow-ups by CBOs were applied through the treatment. Predictors of treatment completion were assessed by logistic regression.Of 271 individuals presented for nPEP, 266 MSM with documented treatment completion or non-completion, 93.6% completed the 28-day course of medication. Completion was associated with reporting side effects (aOR = .10; 95% CI: 0.02–0.38; P = .001). The follow-up rate of 91.9% was achieved based on the definition of loss to follow-up. No documented nPEP failures were found, although 1 MSM subsequently seroconverted to HIV due to ongoing high-risk behavior.CBOs’ engagement in HIV nPEP, especially the “one-to-one” follow-up supports by peer educators partly ensure adherence and retention to nPEP. Tailored interventions are needed to address the subsequent high-risk behaviors among the MSM population.

PAI-A Predictors of Treatment Response in a DBT-A-Informed Intervention for Adolescent Boys

Evidence-based assessment (EBA) involves using empirically validated psychological assessment measures to inform case conceptualization and treatment planning. EBA can improve clinical care by providing information relevant for treatment targets and expectations and can clarify how specific client characteristics may be associated with treatment outcomes. Research on EBA practices in relation to particularly challenging clinical problems (e.g., borderline personality disorder) can be especially useful for practitioners. The current study examines Personality Assessment Inventory-Adolescent (PAI-A) predictors of treatment completion, therapeutic alliance, and symptom change in a sample of 44 adolescent boys (Mage = 16.70, SD = 0.56; 75.0% White) in a residential boot camp program for at-risk youths. Participants completed Dialectical Behavior Therapy for Adolescents-informed skills training groups. PAI-A scales related to somatic complaints, depression, antisocial traits, aggression, borderline traits, problematic alcohol use, and interpersonal dominance, as well as an index measuring overall clinical severity, distinguished adolescents who completed the intervention from those who discontinued the intervention. Adolescents with more borderline personality features reported more modest improvements in emotion dysregulation. Additionally, interpersonal warmth was positively related to therapeutic alliance suggesting that client interpersonal style is an important contributor to client-rated therapeutic alliance.

Perceived social support as predictor of treatment completion in methamphetamine dependent individuals

Introduction: perceived social support (PSS) is considered an important factor to lessen the negative effects of stressful events. Likewise, the literature suggests a beneficial impact on the evolution of different diseases. However, little is known about the relationship between PSS and treatment completion in methamphetamine-dependent individuals who receive help in a forced manner. Objective: to evaluate the effect of perceived social support (PSS) on treatment completion in methamphetamine-dependent individuals. Methods: prospective study with a cohort of 67 men on whom PSS, addiction severity, anxiety, and depression were assessed. Results: analysis of variance of prospectively obtained data showed that age, years of drug use, and PSS differed between those who completed the treatment and those who did not. Logistic regression analysis showed that increases in PSS (Odds Ratio, OR = .970, Confidence Interval - CI 95 % = .943 - .999) were predictive of a decrease in the probability of completing the treatment, while age had the opposite effect (OR = 1.117, CI 95 % = .1.027 - 1.215). Discussion and conclusion: these results show that the role of social support in the treatment of chronic conditions is complex and suggest the need to study the nature and quality of the social interactions that lead to therapeutic success.

Effectiveness of methamphetamine abuse treatment: Predictors of treatment completion and comparison of two residential treatment programs

BackgroundThere is an increasing demand of evidence-based treatment options for methamphetamine users, but research in this field is limited. This study therefore evaluates the efficacy of two residential treatment programs for methamphetamine users. MethodA total of 108 patients with a history of methamphetamine abuse from two inpatient rehabilitation centers were studied for psychiatric symptoms, craving, psychosocial resources, and cognitive functioning at the start and end of therapy. Patients from one center (“amphetamine type stimulant group”) received conventional group therapy plus an additional 10 h of group therapy focusing on stimulant use. Patients from the other center (“treatment as usual”) received conventional group therapy only. Predictors of drop-out were estimated. ResultsA drop-out rate of 40.7% was observed without a significant difference between both centers. Patients remained significantly longer in treatment as usual compared to amphetamine type stimulant treatment. Irrespective of treatment program, craving and psychiatric symptoms significantly decreased while psychosocial resources, processing speed, and cognitive flexibility improved over time. Other cognitive measures yielded mixed results. History of injection drug use was a significant predictor for treatment drop-out. ConclusionsExisting treatments are effective in reducing craving and psychiatric symptoms. Additional stimulant specific groups do not appear to influence treatment completion and secondary outcome measures. Institutions should therefore offer treatment for methamphetamine users, even if they do not provide a therapy content focusing on methamphetamine. History of injection drug use should receive attention in treatment to prevent drop-out. Changes in cognitive functioning need to be further explored.

Predictors of Treatment Completion and Recidivism Among Intimate Partner Violence Offenders

ABSTRACTThis study examined the variables that predicted completion of an AMEND-Emerge-based program designed to treat men (n = 202) who had engaged in intimate partner violence and the rates of recidivism among those who completed versus those who failed to complete the program. Data were collected from an archival database that housed historical and demographic data on each participant; recidivism was determined by accessing publicly available court records, and was defined very broadly as any charges filed within a year after participating in the program. Overall recidivism for this sample was low (22.28%). Demographic factors demonstrated to correctly classify post-treatment recidivism included age, race, and relationship status. Whereas those who completed the program had lower recidivism than non-completers, the differences between those groups in age, race, and relationship status suggest that features of the program may not address the needs of younger African Americans who are not married.

Comparing predictors of treatment completion and length of stay for outpatient treatment

Comparing predictors of treatment completion and length of stay for outpatient treatment

Interplay Between Service Era, PTSD Symptom Expression, and Treatment Completion Among Veterans

The current veteran population has grown significantly as a result of 3 recent major conflicts: Vietnam, Persian Gulf War, and Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Despite a strong presence in VA PTSD specialty clinics nationwide, little is known about how these veteran cohort groups differ in PTSD symptom presentation. Additionally, it is unclear how variations in PTSD symptom presentation may in turn affect treatment adherence and completion. Understanding factors associated with treatment dropout from exposure-based therapy for PTSD is an important area of study, as individuals who drop out of treatment are likely to remain symptomatic and experience significant impairment across a number of psychosocial domains. The present study examined the relationship between service theater affiliation and pretreatment symptom expression as predictors of treatment completion in a sample of 164 veterans. Although treatment completion did not differ by service era, study data revealed statistically significant differences in initial PTSD symptom expression. Implications of the results and future directions are discussed.

Tu1780 Conservative Treatment for Fecal Incontinence: Predictors of Treatment Completion and Symptom Improvement

Tu1780 Conservative Treatment for Fecal Incontinence: Predictors of Treatment Completion and Symptom Improvement

Client predictors of treatment completion using a U.S. national sample

Client predictors of treatment completion using a U.S. national sample

Effect of criminal justice mandate on drug treatment completion in women

Background: Drug and alcohol abuse among women is a growing problem in the United States. Drug treatment is an effective way to manage the psychological, biological, financial, and social cost of drug abuse. Prior research has identified criminal justice referrals or coercion as a predictor of treatment completion among men but questions remain about the same effect in women. Objectives: This study uses the Treatment Episodes Datasets Discharge 2006–2008 (TEDS-D) to explore the association between coercion and treatment completion among women. Methods: Analysis compared primary treatment episodes of coerced women to those who entered treatment voluntarily. A logistic model of the odds of treatment success was performed controlling for race/ethnicity, age, education, employment, primary substance of abuse, number of substances reported at admission, referral source, treatment setting, and treatment duration. Results: 582 671 primary treatment episodes were analyzed comparing women with coercion referrals (n = 196 660) to those who entered treatment voluntarily (n = 390 054). Results of multivariable logistic modeling showed that coerced women had better odds of completion or transfer than women who entered voluntarily. However, this association was modified by treatment setting with better odds in ambulatory (OR = 1.49 [1.47, 1.51]) than in inpatient (OR = 1.06 [1.03, 1.10]) and worst outcomes in detoxification (OR = 0.89 [0.84, 0.96]). Conclusion: These results dispute the broad effectiveness of legal mandates across all drug treatment settings among women. They show the need for further recognition of female-specific characteristics that can affect motivation and treatment success to better inform healthcare and judicial policies on drug treatment services for women.

Predictors of Treatment Completion in a Sample of Youth Who Have Experienced Physical or Sexual Trauma

Despite significant advances in knowledge and availability of evidence-based models for child traumatic stress, many children simply do not complete treatment. There remain notable gaps in the services research literature about treatment completion among youth, particularly those who have experienced trauma and related sequelae. This study investigated the linkages among child physical and sexual trauma, posttraumatic stress disorder (PTSD) symptomatology, and treatment completion utilizing a clinical sample drawn from a large database from community treatment centers across the United States specializing in childhood trauma. Results from regression analyses indicated that neither the experience of sexual nor physical trauma directly predicted successful treatment completion. The links between sexual trauma and treatment completion, however, were mediated by PTSD avoidance symptoms. Children and youth experiencing sexual trauma reported higher levels of avoidance symptoms that were, in turn, significantly associated with a lower likelihood of completing trauma-focused mental health treatment. Practice implications are discussed and include strategies for clinicians to intervene during pivotal points of treatment to improve rates of service utilization and treatment completion.

The relationship of tobacco use with gambling problem severity and gambling treatment outcome.

This study sought to examine the impact of tobacco use on gambling treatment. Pathological gambling (PG) is a psychiatric condition associated with significant financial, emotional, and psychosocial consequences. Elevated rates of nicotine dependence have been associated with increased gambling severity and more frequent psychiatric problems. A total of 385 treatment-seeking pathological gamblers enrolled in one of 11 gambling treatment providers in Minnesota were assessed. Linear regression modeling was used to examine demographic and clinical variables at treatment entry and the relationship between those variables and the number of days gambled at a 6-month posttreatment. Logistic regression was utilized to assess predictors of treatment completion. Daily tobacco use was reported in 244 (63.4%) subjects. Tobacco users presented with significantly more severe gambling and mental health symptoms at treatment intake. Daily tobacco use, however, was not significantly associated with the number of days gambled or with treatment completion. Although tobacco users present with greater gambling problem severity, they had similar rates of treatment completion and treatment outcomes as nonusers.

Personality Disorders and Retention in a Therapeutic Community for Substance Dependence

Although therapeutic community (TC) treatment is a promising intervention for substance use disorders, a primary obstacle to successful treatment is premature attrition. Because of their prevalence within substance use treatment facilities, personality disorder (PD) diagnoses have been examined as predictors of treatment completion. Prior research on TC outcomes has focused almost exclusively on antisocial personality disorder (ASPD), and the results have been mixed. This study extends previous research by examining the impact of the 10 Axis II PDs on early (first 30 days) attrition as well as overall time to dropout in a 9-month residential TC. Survival analyses indicated that borderline was the only PD negatively related to overall program retention. In contrast, ASPD, as well as histrionic PD, were related to very early attrition, but not to overall program retention. Early assessment and identification of at-risk individuals may improve treatment retention and outcome for TC treatment.

Participant- and Study-Related Characteristics Predicting Treatment Completion and Study Retention in an Adolescent Smoking Cessation Trial

To determine which factors predict smoking cessation treatment completion and retention among adolescents. In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14-18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention. In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention. High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.

Exposure Therapy for PTSD Delivered to Veterans via Telehealth: Predictors of Treatment Completion and Outcome and Comparison to Treatment Delivered in Person

Recent research has focused on the effectiveness of evidence-based psychotherapy delivered via telehealth services. Unfortunately to date, the majority of studies employ very small samples and limited predictor and moderator variables. To address these concerns and further replicate and extend the literature on telehealth, the present study investigated the effectiveness of 12-session exposure therapy delivered either via telehealth ( n = 62) or in person ( n = 27) in veterans with posttraumatic stress disorder (PTSD). Findings demonstrated that although older veterans and Vietnam veterans were more likely to complete the telehealth treatment, telehealth findings were not influenced by patient age, sex, race, combat theater, or disability status. Exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, anxiety, depression, stress, and general impairment with large effect sizes. Interestingly, exposure therapy via telehealth was less effective than exposure therapy delivered in person; however, lack of random assignment to condition limits conclusions of differential effectiveness. Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies.

The Relationship Between the Readiness for Change and Clinical Outcomes in Response to Multidisciplinary Pain Management

The pain stages of change questionnaire (PSOCQ) has been designed to assess the willingness of chronic pain patients to engage in self-management approaches. This study sought to examine the utility of the PSOCQ as a predictor of treatment completion and the relationship with treatment outcome. A convenience sample, uncontrolled, pre- and post-intervention cohort design. Multidisciplinary pain management center. Two hundred and sixty-one participants with chronic nonmalignant pain. Eight-week program of either cognitive behavioral therapy group or a functional restoration group. Brief Pain Inventory average pain rating. The Short Form Health Survey (SF-36 version 2) mental health and physical functioning subscales as well as the PSOCQ. Results suggest that those higher on precontemplation and lower on the other scales are less likely to complete treatment. A two-way multiple analysis of variance also found that when comparing those who progress through stages with those who stagnate or regress, "progressors" show significantly more improvement in measures of mood and functionality but not pain. The treatment groups did not appear to have significantly different outcomes in terms of stage of change. These findings suggest that the PSOCQ may be useful in making treatment more efficient, both by predicting who is less likely complete treatment and by providing targeted treatments according to patients' readiness to engage in self-management.

P3a Amplitude Predicts Successful Treatment Program Completion in Substance-Dependent Individuals

This study examined P3a amplitude as a direct predictor of treatment success for substance dependence. Participants were 35 adults (27 men, 8 women) undergoing treatment for substance dependence at an urban residential treatment facility between October 2005 and July 2007. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria were used to confirm substance dependence. P3a amplitude was significantly smaller for those who dropped out of treatment. Discriminant function analysis confirmed that P3a amplitude was a robust predictor of treatment completion, more sensitive than other measures including substance abuse severity. Implications for the interpretation of P3a amplitude as an index of executive function are discussed.