Residential Addiction Treatment Research Articles

High rates of homelessness among a cohort of street-involved youth

Using multivariate logistic regression, we examined the prevalence and correlates of homelessness among youth enrolled in a community-recruited prospective cohort known as the At-Risk Youth Study (ARYS), between September 2005 and October 2006. Of 478 individuals included in this analysis, 132 (27.6%) were female and 120 (25.1%) self-identified as Aboriginal. The median age was 22 (IQR: 20–24). In total, 284 (56.9%) participants reported baseline homelessness, with most living either at no fixed address, on the street, or in a hostel or shelter. Factors associated with homelessness included public injecting, frequent crack use, experienced violence, having less than a high-school education, and not having been in any addiction treatment. Homeless individuals were at-risk for various adverse health outcomes. These findings indicate the need for additional interventions, including residential addiction treatment, to address homelessness and drug use among youth.

Improving the Transition from Residential to Outpatient Addiction Treatment: Gender Differences in Response to Supportive Telephone Calls

Substance use relapse rates are often high in the first months after discharge from inpatient substance abuse treatment, and patient adherence to aftercare plans is often low. Four residential addiction treatment centers participated in a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare. A total of 282 participants (100 women, 182 men) with substance use disorders were included in this secondary analysis. The findings revealed that women were more likely than men to attend aftercare. This “gender effect” persisted after adjustment for a number of potential mediators.

Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5‐year follow‐up study

This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence. It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes. Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4-5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers. Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels. Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up. Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance. There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points. More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders. NA/AA can support and supplement residential addiction treatment as an aftercare resource. In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups.

Day hospital and residential addiction treatment: Randomized and nonrandomized managed care clients.

Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization and directed to residential treatment because of high environmental risk (n=82). American Society of Addiction Medicine criteria defined study and randomization eligibility. More than 50% of followed clients reported past-30-day abstinence at follow-ups (unadjusted rates, not significant between groups). Despite differing baseline severities, randomized, self-selecting, and directed clients displayed similar abstinence outcomes in multivariate longitudinal models. Index treatment days and 12-step attendance were associated with abstinence (p<.001). Other prognostic effects (including gender and ethnicity) were not significant predictors of differences in outcomes for clients in the treatment modalities. Although 12-step attendance continued to be important for the full 12 months, treatment beyond the index stay was not, suggesting an advantage for engaging clients in treatment initially and promoting 12-step attendance for at least a year.

An evaluation study of art therapy provision in a residential Addiction Treatment Programme (ATP)

This evaluation study explores art therapy provision in a residential addiction treatment programme. The study comprises a literature review followed by an empirical study. The literature review outlines the main theoretical writing relating to art therapy in the treatment of addictive patients. In addition literature concerning contrasting treatment perspectives for the treatment of substance abuse is considered, as is brief therapy in inpatient settings. The empirical study is divided into three parts. The first section is the initial definition of service to patients and staff, which resulted in the production of a leaflet defining service. The second section explores art therapy from a clinical perspective. In the third section consideration is given to patients’ assessment of service in response to an evaluation questionnaire introduced in order to assist quality of service. Although this study locates the art therapy provision in the particular treatment context described, I hope to clarify how art therapy might benefit patients suffering from addiction, irrespective of the treatment setting.

Inpatient Desire to Drink as a Predictor of Relapse to Alcohol Use Following Treatment

Cravings for alcohol are identified as a trigger for relapse, though laboratory studies of cravings produce mixed results in predicting relapse. The objective of this analysis is to assess the usefulness of craving as a predictor of relapse by assessing 218 adult, alcohol-dependent patients admitted to two separate residential addiction treatment programs. Days craving reported in the week prior to discharge predicted alcohol use at three-month follow-up. Admission spirituality, alcohol-refusal self-efficacy, and depression levels differentiated cravers from non-cravers. Patients who crave alcohol in residential treatment may be at higher relapse risk and identified by intake assessments of self-efficacy, depression, and spirituality.

A functional prodynorphin promoter polymorphism and opioid dependence

The prodynorphin gene (PDYN) promoter has a repeat polymorphism that is functionally important in association with substance abuse. We examined this polymorphism for association in our sample of 168 opioid-dependent patients and 122 ethnically and geographically matched controls. Patients were selected from university-affiliated residential and non-residential addiction treatment programs in the Philadelphia area. A sample of blood was drawn from consenting individuals and genomic DNA was isolated. Polymerase chain reaction amplification of the PDYN promoter was performed and various genotypes were determined on the basis of differing sizes of the polymerase chain reaction products. The genotype and allele data were analyzed by Fisher's exact test. A significant difference in genotype (P<0.0006) and allele (P<10) frequencies was found between the African American and European American populations. We did not detect any significant difference in genotype or allele frequencies between the patients and controls within the European American ethnic group. However, we detected a weak association (P=0.013) when we compared allele frequencies of patients and controls in the African American population. These data suggest that the PDYN repeat polymorphism should be studied in additional opioid-dependent populations.

A comparison of patients relapsing to addictive drug use with non-relapsing patients following residential addiction treatment in Antigua

The outcome of a 29-day residential addiction treatment programme for persons from Antigua and Barbuda with addiction to drugs or alcohol was assessed. All 100 patients entering the drug and alcohol treatment programme at Crossroads Centre Antigua between November 1998 and October 2002 were included. All patients were assessed with regards to drug or alcohol use or abstinence in November 2002 using telephone and mail follow-up as well as informal follow-up with families and other community contacts. Crossroads Centre Antigua is a 35 bed, 29-day residential treatment centre for drug and alcohol addiction serving patients from developed countries (85%) and from the Caribbean region (15%). Patients records were also reviewed to obtain age, gender, ethnicity, drug of choice, years of problematic use, completion of the 29 day programme, family member participation at Crossroads Centre Antigua (a four-day programme) and acceptance of halfway house placement. Of the 100 Antiguan patients admitted, 46 (46%) were abstinent (non-relapsers) at average 20.7+/-14.7 months after treatment. Abstinence did not have to be continuous. Forty-nine were known to be using drug or alcohol (49%) and five (5%) were lost to follow-up and considered to be using drugs (relapsers). Age (37.5 vs 41.1 years), gender (28% vs 22% female), ethnicity (87% vs 87% Afro-Caribbean), years of harmful use (12.7 vs 12.5 years) did not differ significantly between relapsers and non-relapsers. Crack cocaine use (67% vs 65%) and alcohol use (26% vs 31%) as primary addiction did not differ significantly between relapsers and non-relapsers. Relapsers were significantly less likely to complete the 29- day programme (81% vs 100%, p < 0.01), have family members participate at Crossroads (32% vs 54%, p < 0.05) or accept halfway house placement (4% vs 54%, p < 0.001). In conclusion, abstinence was achieved in 46% of those entering treatment, in 51% completing treatment, in 60% whose families participated and in 92% of those accepting halfway house placement.

The integration of tobacco dependence treatment and tobacco-free standards into residential addictions treatment in New Jersey

New Jersey was the first state to implement a licensure standard for all residential addiction treatment programs to assess and treat tobacco dependence in the context of entirely tobacco-free facilities (including grounds). A program evaluation of the first year of the policy (2001–2002) assessed the impact on programs, clients, and staff. At 1-year follow-up, all 30 residential programs surveyed provided some tobacco dependence treatment and 50% had tobacco-free grounds. Eighty-five percent of the programs accepted the state's offer to provide free NRT, reaching more than 2,326 clients. Seventy-seven percent of all clients were smokers, and 65% of the smokers reported they wanted to stop or cut down tobacco use. Forty-one percent of the smokers reported that they did not use any tobacco during their entire residential stay. There was no increase in irregular discharges, or reduction in proportion of smokers among those entering residential treatment, compared with prior years. Licensure standards regulation can be an effective mechanism for increasing the quantity and quality of tobacco dependence treatment in residential addictions programs.

Prevalence and Characteristics of Adolescent Patients with Co-Occurring ADHD and Substance Dependence

Estimates of comorbidity of SUD and ADHD in addiction treatment settings range from 30% to 50%.1,2 The Schedule II psychostimulant medications, methylphenidate and dextroamphetamine, generally considered to be safe and effective in treating ADHD in adolescent patients, 4 may be risky for an SUD population since individuals with SUD may have a higher likelihood of abusing or diverting the medications. 17 One hunderd sixty-two adolescent patients admitted to a residential addictions treatment program were administered a structured interview concerning ADHD and psychostimulant abuse as part of the clinical psychological evaluation administered by the staff psychologist. Results indicate 31% of patientshave current ADHD diagnosis and 20% reported illicit diversion of Schedule II medication. One-third of entire adolescent patient population reported prior psychostimulant abuse. Re-sults are discussed in terms of appropriate treatment for adolescents with co-occurring substance abuse or dependence and ADHD.

STUDENTJAMA. Faith-based treatment for addiction in Puerto Rico.

IN 1997 THE US DRUG ENFORCEMENT ADMINISTRATION IDENtified Puerto Rico as the Caribbean epicenter of illicit cocaine and heroin trade between Latin America and the United States and in 2001 designated it as a zone of high-intensity drug traffic. In 1998 a household-based survey of Puerto Rican adults aged 15 to 64 years found that 5.6% of the population was in need of substance abuse treatment. Furthermore, between 2000 and 2003, Puerto Rico’s drug-related homicide rate was 3 times the US average. At that time, the Puerto Rican legislature voted to define drug dependence as a spiritual and social problem, rather than simply a mental health disorder. The resolution reflected the high prevalence of faith-based programs for addiction treatment. Indeed, the Puerto Rican Mental Health and Anti-Addiction Services Administration found that as of 1998, faith-based residential addiction treatment centers comprised 75% of all state-registered drug treatment programs. This convergence of faith-based initiatives and drug treatment facilities has been due to a number of factors. As of January 2003, Puerto Rico had an unemployment rate twice the US median. Much of the illicit drug trade, such as sex work, is related to economic pressures. Concomitant with this trend over the past few decades, evangelical Protestant churches have risen to prominence in a region that historically has been dominated by Catholicism. In fact, one third of all island Puerto Ricans reportedly identify themselves as Protestant. Low-income, urban converts to evangelical Protestantism in Latin America often cite the church’s antialcohol and antidrug stance as a reason for their conversion. In an atmosphere of both active evangelism and drug trade, Puerto Rican addiction ministries have multiplied and claimed a professional niche as providers of faith-based residential addiction programs. Largely founded by ex-addicts who mirror mainland US Christian drug treatment models such as Teen Challenge, Puerto Rican addiction ministries offer peer and pastoral counseling, prayer, and bible study as methods toward recovery. In a review of ongoing drug abuse studies evaluating the interaction of social support systems with drug addiction among Hispanics, the authors reported that involvement with religious institutions had a significant impact on the drugusing behaviors of Hispanics. However, in a crosssectional survey from an Alcoholics Anonymous group in Los Angeles, several interventional models, some of which did not emphasize spirituality, were found to be equivalent in effectiveness. Despite their frequent lack of medication and clinical staff, faith-based ministries continue to thrive as a main option for drug addiction treatment, in part due to policies the Puerto Rican government has pursued in the last decade. Starting in 1994 the government began privatizing the health care system, causing most public addiction treatment programs and mental health centers to close. This compounded an existent problem of diminishing funds for drug abuse recovery in Puerto Rico, which has fewer subsidies for addiction treatment than any of the 50 US states. Residential programs that these ministries administer are actually underenrolled, while partial hospital and methadone maintenance programs are often overenrolled. This suggests that, despite continued growth in faith-based initiatives for addiction treatment, current levels still do not meet treatment demand.

Smoking status and substance abuse severity in a residential treatment sample

Treatment seeking substance abusers were classified as current smokers or non-smokers to identify differences between groups on psychiatric and substance use severity variables. The Addiction Severity Index (fifth edition; ASI) was administered to 313 substance abusers seeking treatment in a private, residential addictions treatment program. Since current smokers were younger and less educated than non-smokers, these variables were entered as covariates in all analyses. As measured by the ASI, current smokers experienced a significantly greater number of days with drug problems in the last 30 days and were seen as being in significantly more need of drug treatment and alcohol treatment by ASI interviewers. These findings indicate that smoking status may be a marker for greater substance use severity, although the fact that participants were not randomly assigned to groups precludes making causal interpretations of these data. Areas of future research are suggested including examining the potential mediating role of third variables such as personality and temperament.

The cost of residential addiction treatment in public housing

The cost of providing addiction treatment services in a variety of settings is useful information for program administrators, policy makers, and researchers. This study estimates the economic costs of providing substance abuse treatment services at Safeport, a three-phase residential treatment program focusing on addicted women living in public housing. Economic (opportunity) costs are estimated for each phase separately and for the complete program. Results indicate that the total cost of providing treatment services at Safeport in 2001 was $1,325,235. This total cost comprises $549,737 for stabilization or early abstinence (Phase I), $400,098 for relapse prevention and self-sufficiency (Phase II), and $375,400 for independent living preparation and long-term recovery (Phase III). Average daily census (number of clients/families on a typical day) was just over 11 clients/families in each phase or 34 clients/families for the entire program. The average length of stay in the three phases of the program was 12 weeks for Phase I, 20 weeks for Phase II, 18 weeks for Phase III, and 50 weeks overall. The average weekly cost per client amounted to $930 for Phase I, $677 for Phase II, $635 for Phase III, and $748 over the full program. The average cost per treatment episode amounted to $11,163 for Phase I, $13,541 for Phase II, $11,435 for Phase III, and $36,136 for the complete program. Future research should compare these cost estimates with corresponding outcome data from Safeport to perform a comprehensive economic evaluation.

A Comparison of Caribbean and Non-Caribbean Clients in a Residential Addiction Treatment Facility in Antigua, West Indies

The first 50 Caribbean clients admitted to a private, multicultural, not for profit addiction treatment center in Antigua, West Indies, were compared with the first 100 non-Caribbean clients admitted. There was no significant difference in age, 38 years (18–61 years) versus 40 years (22–63 years), or gender, 74% versus 67% male. Caribbean clients were more likely to be Black, 68% versus 2%, P <.001. Caribbean clients were less likely to have a prior psychiatric diagnosis, 18% versus 43%, P <.01, or to have been in prior treatment program, 22% versus 64%, P <.001. Caribbean and non-Caribbean clients were equally likely to be polydrug users, 48% versus 50%, and to use alcohol as a primary drug, 52% versus 51%. Caribbean clients were more likely to use cocaine, 30% versus 11%, P <.01, and marijuana, 12% versus 0%, P <.001, but less likely to use heroin, 6% versus 30%, P <.001 or pills, 0% versus 8%, P <.05. Caribbean clients were less likely to have elevated MCV, 24% versus 57%, P <.001 or serum transaminases, 23% versus 46%, P <.01. Differences between groups in this multicultural setting warrant further investigation.

Residential Drug Treatment Found to Be Good Value

Back to table of contents Previous article Next article Health Care EconomicsFull AccessResidential Drug Treatment Found to Be Good ValueKate MulliganKate MulliganSearch for more papers by this authorPublished Online:7 Feb 2003https://doi.org/10.1176/pn.38.3.0012Researchers found that the benefits of residential drug abuse treatment exceed costs by a factor of 4 to 1 in five programs in Washington state, when they used a benefit-cost analysis that considers societal costs.Michael T. French, Ph.D., Helena J. Salome, and Molly Carney, Ph.D., used recently developed methods and guidelines for using the drug abuse treatment cost analysis (DATCAP) and the addiction severity index (ASI) to estimate the economic costs and benefits in five programs in Washington state that serve patients in publicly funded programs.Their report, “Using the DATCAP and ASI to Estimate the Costs and Benefits of Residential Addiction Treatment in the State of Washington,” appears in the February issue of Social Science and Medicine.Carney is a research scientist at the Alcohol and Drug Abuse Institute at the University of Washington, and French is a professor of health care economics at the Medical University of South Carolina. Salome is a Ph.D. candidate at the University of Miami.“The average economic cost of treatment for this sample of residential clients in Washington state was $4,912. The average economic benefit was $21,329. The average net benefit of treatment was $16,418, and the benefit-cost ratio was 4.34,” they pointed out.Data from the Office of Applied Studies suggest that approximately 70 percent of the total cost of addiction treatment in the United States is funded through public budgets.According to the article, “the average cost of residential addiction treatment is about 5.69 times higher than the cost of outpatient nonmethadone services.”So, according to the researchers, the value of residential addiction treatment is being reappraised by many state agencies.Researchers estimated the economic cost by using the DATCAP, which was administered on site at each of the five residential programs. They determined treatment outcomes by analysis of client-specific baseline and follow-up data collected through the ASI.The researchers derived estimates for average weekly and total cost of addiction treatment, total benefit of treatment, net benefit of treatment, and the benefit-cost ratio.Benefit-cost analysis, they argued, is different from cost-effectiveness analysis and preferable to it when different outcomes of the treatment intervention must be included and programs with different goals or effects must be compared.Benefit-cost analysis “compares the opportunity cost of an intervention to the total benefit, while expressing both in a common monetary metric. Benefit-cost measures include a benefit-cost ratio (i.e., benefit divided by cost) or simply a net benefit estimate (i.e., cost subtracted from benefit).”Economic benefits were derived from patient self-reported information collected at the beginning of treatment and six months after discharge from the program.The researchers converted the following ASI measures into dollar-equivalent values for the benefit analysis: inpatient medical days, inpatient psychiatric days, residential addiction treatment days (follow-up only), days experiencing medical problems, income received from employment, days engaged in illegal activities, and days experiencing psychological or emotional problems.Reported number of days engaged in illegal activities was used to estimate the reduction in crime-related costs.The researchers used multivariate regression models to determine which client and/or treatment characteristics were significantly related to economic cost and benefit.Robert Rosenheck, M.D., director of the VA Northeast Program Evaluation Center and a professor of psychiatry and public health at Yale School of Medicine, told Psychiatric News, “This is a very important type of study, but one which, as the authors note, must be interpreted cautiously for two reasons. First, since there was no control group, we cannot be certain that the cost savings were the result of treatment. They may reflect the fact that improvement can come about as a result of some natural recovery process in people who have decided to get help. Second, although measuring the economic value of health gains theoretically is very important, practically such measurement is very hard to accomplish.” ▪ ISSUES NewArchived

Using the DATCAP and ASI to estimate the costs and benefits of residential addiction treatment in the State of Washington

Funding agencies and policy makers often criticize residential addiction treatment because the cost of residential services is typically higher than for outpatient services and it is unclear whether the outcomes are significantly better for most clients. To address these concerns, proponents of residential treatment require economic evidence to justify further investments in this modality over less intensive and less costly options. Recent studies have developed methods and empirical guidelines for using the drug abuse treatment cost analysis program (DATCAP) and the addiction severity index (ASI) in a comprehensive economic evaluation of addiction treatment. The present study applied these methods and guidelines to estimate the economic costs and benefits of residential addiction treatment at five programs in the State of Washington, USA that serve publicly funded clients. Program- and client-specific economic cost estimates were derived using data collected on-site with the DATCAP along with opportunity cost estimates associated with treatment attendance. Economic benefits were calculated from client self-reported information at treatment entry and at 6 months post discharge using the ASI. Outcome categories included inpatient services, employment, medical and psychiatric conditions, and criminal activity. Results indicate that average weekly economic cost of treatment services at the five programs ranged from $463 to $703. Average (per client) economic cost of treatment was $4912 (composed of $3650 in program cost and $1262 in client cost) for all subjects that completed both a baseline and follow-up questionnaire ( N=222; 82%). Average (per client) total economic benefit was $21,329, leading to estimates of $16,418 for average net benefit and 4.34 for the benefit–cost ratio. Total and net economic benefits were significantly related to gender, race, religious preference, and baseline ASI composite scores for drug use and legal status. A detailed sensitivity analysis did not alter the qualitative findings. This study provides conclusive evidence that, for this sample of programs in Washington State, the economic benefits of residential addiction treatment significantly exceeded the economic costs. Although the results are not necessarily generalizable to private-paying clients or clients from other States in the US, the methods are based on widely used data collection instruments and well-accepted economic principles. Thus, extensions of this research to other clients, States, and modalities should be feasible and straightforward.

Experiences of Addiction and Recovery: the Case for Subjective Accounts

In this paper we argue that psychology must address issues of subjective experience in accounting for addictive behaviour problems, and further, that self and identity are integral to such experiences. While the importance of self and identity issues is often recognised implicitly at the level of therapeutic practice, the extent of their involvement, and the nature of their relationship with other factors, is not yet fully understood at the level of theory and research. We offer a case for addressing this problem through the collection and analysis of subjective accounts. This is because we think that any understanding of the relationship between addiction, self and identity should be informed by participants' own accounts of their experiences of addictive behaviour problems. This argument is supported here by an account of observational data collected at a residential addictions treatment centre. The data were analysed using the IPA (Interpretative Phenomenological Analysis) approach. This represents a novel application of the IPA method to observational data, and we therefore include some reflective evaluation of its suitability for this purpose. Our interpretation of the data suggests that self and identity issues may well be crucial to our understanding of the experiences of addiction and recovery. This may have important implications for the treatment of addictive behaviour problems, not least because self and identity issues are relatively 'accessible and addressable' in a therapeutic context.

ANTISOCIAL BEHAVIORAL SYNDROMES AND RETURN TO DRUG USE FOLLOWING RESIDENTIAL RELAPSE PREVENTION/HEALTH EDUCATION TREATMENT

This study compared residential addiction treatment clients meeting full DSM-III-R criteria for antisocial personality disorder (ASPD) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS) on time to and severity of first posttreatment drug use. Antisocial syndrome and selected other mental disorders were assessed using the Diagnostic Interview Schedule, Revised for DSM-III-R, and validity of self-reported posttreatment drug behavior was measured against results of hair analysis. Among subjects followed within 180 days after treatment exit, individuals with ASPD were at modestly increased risk of a first lapse episode compared to those with AABS. However, the two groups did not differ in severity of lapse. Participants with ASPD demonstrated poorer agreement between self-reported posttreatment drug behavior and hair data. These results add to the evidence suggesting that the DSM requirement for childhood onset in ASPD may be clinically important among substance abusers in identifying a severely antisocial and chronically addicted group at elevated risk for early posttreatment recidivism. Our findings support the importance of careful classification of antisocial syndromes among substance abusers and the identification of characteristics of these syndromes that underlie clients’ risks for posttreatment return to drug use to provide optimally individualized treatment planning.

Primary Care and Addiction Treatment

A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

Antisocial behavioral syndromes among residential drug abuse treatment clients

We compared residential addictions treatment clients meeting full criteria for antisocial personality disorder (ASPD+) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS+) on demographics, antisocial symptomatology, drug history, axis I comorbidity and characteristics of index treatment episode. We examined these issues in the sample as a whole, as well as separately in male and female respondents. Among both men and women, ASPD+ initiated their antisocial behavior earlier, met more ASPD criteria and endorsed more violent symptoms, than AABS+. Male ASPD+ also met criteria for more lifetime axis I diagnoses and reported more years of drug involvement than male AABS+. Trends were observed toward poorer retention in treatment among ASPD+ than among AABS+ participants of both genders randomized to a planned duration of 180 days, but retention did not differ between ASPD+ and AABS+ randomized to a planned duration of 90 days. Our findings, which replicate and extend previously published results, carry potential implications for treatment programming and for the nosology of ASPD.