Residential Treatment Research Articles

Innovations in residential treatment that promote multi-drug addiction recovery

Abstract Background As the drug addiction crisis deepens in many countries across the globe, governments are rapidly expanding publicly funded treatment facilities. At the same time, the illicit drug market has evolved with many substances now containing multiple addictive drugs that complicate recovery. The evidence base for treatment remains primarily focused on single substances. The purpose of this study was to examine the lived experience of adults who attended in-patient treatment centres for multi-drug addiction in Canada. Methods This qualitative study was conducted in 2022 with 32 adults who voluntarily attended an in-patient treatment centre for drug addiction (44% female, 23-53 years). All had been addicted to multiple substances including opioids, crack and methamphetamines. Most (70%) were homeless before treatment. In 1-hour semi-structured interviews adults described the structures and programming that helped them recover in these facilities. Many tried multiple facilities and thus had a rich history of lived experience to draw from. Narrative inquiry was used to characterize qualitative themes across interviews using a phenomenological lens. Results Seven qualitative themes emerged from the data. Residential treatment centres that were effective at helping adults recover from multi-drug addiction: (1) provided flexible stays up to 100 days; (2) felt like a home not a prison; (3) permitted opioid replacement therapies; (4) provided a variety of recovery tools (e.g., cognitive behavioural therapy, Narcotics Anonymous, cultural supports); (5) helped adults reunite with family, find a safe place to stay, and find work before discharge; (6) provided transitional housing after discharge if needed; and (7) provided free long-term recovery support and check-ins after discharge. Conclusions The findings of this study highlight 7 actions that treatment facilities can adopt and test with their own clients in an effort to better support multi-drug addiction recovery. Key messages • A stronger evidence base is needed to inform in-patient multi-drug addiction treatment. • Findings underline 7 actions treatment facilities can take to promote multi-drug addiction recovery.

Examining the associations between posttraumatic stress disorder symptom clusters across cognitive processing therapy.

Cognitive processing therapy (CPT) is a well-known trauma-focused treatment that aims to generate more adaptive posttrauma cognitions and emotions. Changes in cognitions are theorized to be the mechanism by which CPT leads to improvement in posttraumatic stress disorder (PTSD) symptoms. The present study aimed to explore associations between changes in PTSD symptom clusters during CPT. We hypothesized that early changes in negative alterations in cognitions and mood (NACM) would correlate with later changes in other symptom clusters. Data were collected from 296 veterans participating a 7-week PTSD residential treatment program at a U.S. Veterans Affairs medical center. PTSD symptoms were assessed at pretreatment (Week 1), midtreatment (Week 4), and posttreatment (Week 7). Cross-lagged path analyses demonstrated that pretreatment-to-midtreatment improvement in NACM was correlated with midtreatment-to-posttreatment improvement in avoidance, β =.52, though this association was bidirectional, suggesting pretreatment-to-midtreatment improvements in either cluster may be correlated with midtreatment-to-posttreatment improvements. Similarly, pretreatment-to-midtreatment improvement in intrusions, β =.40, and arousal, β =.49, were correlated with later improvement in avoidance, suggesting avoidance may improve after improvement in other clusters. Interestingly, pretreatment-to-midtreatment arousal improvement was significantly correlated with midtreatment-to-posttreatment NACM improvement, β =.27, though the reverse was nonsignificant, whereas a bidirectional association between arousal and intrusions emerged, β =.34, β =.53. Early changes in arousal were correlated with later changes in several other symptom clusters, whereas other clusters demonstrated bidirectional associations. These results may inform understanding of symptom improvement timing across CPT, which may aid in treatment selection and planning.

National Seclusion and Restraint Trends within Child Residential Treatment Facilities: 2010-2020 in Review.

This study aimed to estimate the percentage of child RTCs utilizing seclusion and restraint (S/R) practices and examine predictors associated with increased likelihood of S/R use between 2010 and 2020. A secondary analysis of the National Mental Health Services Survey was conducted (n-range = 580-781). Facility-level client demographics and facility characteristics were examined using multi-level logistic regression. One-way ANOVA indicated that the percentage of child RTCs using S/R significantly decreased between 2010 and 2020 [F(4, 58074) = 75.62, p <.001]. A post-hoc Bonferroni test found that the percentage of facilities reporting the use of SR in 2010 was significantly higher than in 2014, 2016, 2018, and 2020 (all p <.001). Multi-level logistic regression analysis found that facility-level client demographics (percent male, white, and involuntarily committed) did not significantly predict facility use of SR in 2010, 2014, or 2016. However, facility-level characteristics of SED program (all p <.01), use of psychotropic medication (all p <.001), and facility size as measured by number of mental health beds (all p <.01) consistently predicted usage of SR in 2010 [F(11) = 68.38, p <.001], 2014 [F(12) = 74.25, p <.001], and 2016 [F(12) = 74.48, p <.001]. Facility ownership and accepting Medicare payments did not significantly predict facility usage of SR. Use of SR within child RTCs significantly declined between 2010 and 2020. Larger facilities, facilities with an SED program, and facilities that used psychotropic medications with clients were more likely to use SR practices between 2010 and 2016. More high-quality, publicly available data for monitoring S/R use in mental health services within the United States is needed.

The effects of neighborhood perceptions on response to a technology-assisted parenting intervention for adolescent substance use: protocol of a diversity supplement to parent SMART (Substance Misuse in Adolescents in Residential Treatment)

BackgroundIt is well established that an adolescent’s neighborhood is associated with their likelihood of developing a substance use disorder. The availability of drugs, lack of access to resources, and exposure to violence are all associated with greater substance use among young people, leading to more pronounced health inequities. Technology assisted interventions (TAIs) have been touted to enhance the reach of substance use treatment and improve outcomes for high-need families living in underserved neighborhoods. A key question is whether neighborhood characteristics impact the effectiveness of TAIs, given these interventions are embedded within an adolescent’s natural environment. This National Institute on Drug Abuse-funded Diversity Supplement will examine the role of perceived neighborhood characteristics on response to Parent SMART, a TAI for parents of adolescents in residential substance use treatment (R37DA052918; PI: Becker). Aim 1 will use both adolescent and parent self-report of multiple neighborhood dimensions (e.g., physical environment, social disorder, satisfaction with community resources) to identify indicators predictive of treatment response. Aim 2 will then explore the indirect relationship between neighborhood context and response to Parent SMART, via engagement.MethodsParticipants include adolescent and parent dyads enrolled in an effectiveness trial evaluating Parent SMART, a TAI for parents of adolescents in residential substance youth treatment. Participants will complete self-report measures of neighborhood physical environment, social disorder, and satisfaction with community resources at baseline to predict parenting and youth substance outcomes at 6-, 12-, and 24-weeks post discharge.DiscussionTo date, few studies have explicitly tested how neighborhood affects response to TAIs for adolescent substance use. Assessing adolescent and parent perceptions of neighborhood characteristics holds potential to pinpoint key contextual factors that affect TAI response and to promote consideration of multi-level health equity determinants in substance use research. Understanding neighborhood influences can advance public health by helping tailor TAIs to address the unique needs of adolescents living in underserved communities.Trial registrationThis study extends the measurement and analysis plan of a pragmatic effectiveness trial. The pragmatic effectiveness trial is registered at ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385

The relationship between emotion regulation difficulties and eating disorder outcomes: a longitudinal examination in a residential eating disorder treatment facility

ABSTRACT Eating disorders (EDs) are associated with numerous comorbidities and deleterious outcomes (e.g. medical complications, high rates of death by suicide). The complexities of EDs are further compounded by treatment dropout, poor treatment outcomes, and relapse. One way to better understand these complexities is to investigate broad, transdiagnostic risk factors that contribute to the etiology and maintenance of EDs, such as emotion regulation (ER) difficulties. We longitudinally tested the relationship between ER difficulties and ED outcomes in a sample of 101 female ED patients in a southeastern U.S. residential ED treatment facility. Consistent with hypothesis, there were significant improvements in both ER difficulties and eating pathology from admission to discharge. Further, improvement in ER difficulties was associated with improvements in eating pathology. These findings further substantiate the role of ER difficulties in eating disorders and provide further evidence for the relationship between ER difficulties and eating pathology among residential eating disorder patients.

Are Suicide-Specific Interventions Required to Reduce Suicidal Ideation? An Empirical Examination in a Clinical Sample of Eating-Disorder Participants

In this research, we examined whether non-suicide-specific treatments effectively reduced suicidal ideation (SI) among a clinical sample of eating-disorder (ED) patients ( N = 3,447, of whom 50.9% presented with SI). All participants met criteria for a current ED diagnoses based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and were administered a combination of evidence-based treatments in inpatient, residential, partial hospitalization, and intensive outpatient ED treatment facilities. Mediation analyses tested whether SI at discharge decreased specifically through standardized residual change scores in ED symptoms. Both SI and ED symptoms decreased over the course of treatment without clinically meaningful differences by ED diagnosis. ED symptom improvement partially mediated the relationship between SI at admission and discharge, suggesting that treating ED symptoms with evidence-based treatments can be an effective way to reduce SI, at least partially, for many patients. These findings demonstrate the importance of facilitating evidence-based-treatment referrals for specific disorders as a component of broad-based suicide outreach and prevention strategies.

Residential treatment program outcome evaluation: one agency’s discoveries about performance measurement

ABSTRACT This paper explores the design and implementation of a comprehensive, continuous outcome evaluation for youth in therapeutic residential care (TRC) to measure program efficacy, based on The Joint Commission (TJC) accreditation guidelines. Over a 10-year implementation period, researchers analyzed changes in 281 residential care youth from baseline to reassessment after 4–6 months in treatment. The primary assessment instruments included the SASSI-A2, the FACES III, the Measure of Psychosocial Development (MPD), the Behavioral and Emotional Rating Scale (BERS), and the Youth Comprehensive Risk Assessment (YCRA). Results indicated reductions in the risk areas of self-harm, conduct disorder behaviors, and substance abuse. Significant increases occurred in psychosocial development, family engagement, and personal strengths. However, results also revealed continued low levels of youth development in trust vs mistrust, ego integrity vs despair, willingness to disclose loss of control, recognition of negative consequences of substance misuse, and response to conduct disorder treatments. Implications and recommendations for ongoing program evaluation, staff development, and institutional change are discussed.

Natural biocide-assisted ultrasonic disinfection of wastewater effluent following a response surface methodology approach

The increasing prevalence of multidrug-resistant (MDR) bacteria in wastewater poses a significant threat to public health and the environment, necessitating more effective and sustainable disinfection methods. Ozonation and chlorination frequently fall short of eliminating these bacteria and can create toxic byproducts. This study introduces a novel disinfection strategy that combines ultrasonication with tea tree oil to target MDR bacteria in residential wastewater treatment systems, aiming to provide an eco-friendly, efficient, and scalable solution. The method harnesses tea tree oil's natural biocidal properties alongside the physical effects of ultrasonication, particularly acoustic cavitation, to enhance bacterial inactivation. Temperature, biocide dosage, and ultrasonication power were the three main factors that were optimized using response surface methodology. The system achieved a 2.2–2.4 log CFU/mL reduction of total bacteria in secondary effluent within 30 min and complete disinfection of modified effluent inoculated with high-strength MDR bacteria (6-log CFU/mL) in 50 min. Optimal conditions were 698.4 Watt power, 1.234 µl/mL tea tree oil, and 20.64 °C. Nucleic acid release and respiratory chain dehydrogenase inhibition indicated bacterial cell membrane rupture. Regrowth tests showed long-term effectiveness, with no bacterial colonies after three days. Using a natural biocide, the hybrid technique reduces operational costs and time, thus having commercial and environmental benefits. The capacity to remove MDR bacteria makes it an attractive contender for large-scale wastewater treatment.

Association of Food and Housing Insecurity on Outcomes in Pregnant Patients With Substance Use Disorder.

Food insecurity (FI) may be associated with worsened neonatal abstinence syndrome severity in infants born to individuals with substance use disorder. This study evaluates FI and housing insecurity (HI) influence on maternal and neonatal outcomes. This was a cohort study of patients receiving obstetric care through a multispecialty program in Kentucky from 2015 to 2023. Inclusion criteria were: (1) program participants over age 18 consenting to observational research, (2) delivering at University of Kentucky, and (3) not withdrawing from research at any time. Initially, a subset of patients for whom FI and HI concerns were heightened were screened. In 2019, FI and HI screening became standard of care at the clinic. Housing was assessed on enrollment. A validated 2-question Hunger Vital Sign FI screen was utilized for a subset of patients. Maternal and neonatal outcomes, including adverse delivery outcomes, maternal comorbidities, and birth complications, were observed. Fisher's exact and 2 sample t tests were performed. Of 494 participants, 188 (38%) identified at risk for HI. At enrollment, 221 (45%) individuals reported owning their primary residence, 85 (17%) were in group residential treatment, 34 (6.9%) had no housing, and 134 (27%) lived at another's residence. Disposition of a child to a relative or not the patient's own care was greater with HI, 51% versus 47%. Of 155 respondents, 96 (62%) reported FI, associated with increased neonatal intensive care unit (NICU) admission, 86% versus 74%. Using the validated tool, Abuse Assessment Screen, abuse was significantly greater with FI, 76% versus 58%. Edinburgh Postpartum Depression Scales >12 indicating depression were more common with FI, 63% versus 32%, P < .05. Anxiety scores were also higher with FI, P < .05. Patients with FI were more likely to experience abuse. FI and HI were health-related needs associated with increased anxiety, depression, infant NICU admission, and loss of child custody.

Navigating Identity and Resilience: A Lesbian's Journey Through Family Substance Use

This study explores the complex journey of a young lesbian navigating her sexual identity in the challenging environment of a residential treatment center due to her mother's substance use. Through qualitative methods, this research delves into the intertwining of family dynamics, societal pressures, and minority stress in shaping self-acceptance. The study highlights the critical role of supportive relationships and affirming interventions in fostering resilience and mental well-being among LGBTQ+ individuals. This study contributes to a deeper understanding of how personal and environmental factors coalesce to impact the identity development of LGBTQ+ youth in specialized care settings.

Meaningful Associations Between Motivation for Treatment and Interpersonal Needs Within a Residential Sample of Women With Eating Disorders

ABSTRACTObjectivePerceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment.MethodsParticipants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross‐lagged panel models (AR‐CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment.ResultsMotivation was significantly negatively correlated with PB and TB at all timepoints. In AR‐CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR‐CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint.DiscussionThis study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

Predicting Mental Health Hospitalizations Among First Nations Adults in Residential Treatment

Indigenous peoples in Canada experience disproportionately higher rates of hospitalization for mental health and substance use concerns than non-Indigenous populations. Ambulatory care sensitive conditions are community-level markers of mental illness which can theoretically be managed through community-based health services, and therefore should not require urgent care services. Previous mental health related ambulatory sensitive conditions have included psychotic and mood disorders; however, limited research has explored these relationships of increased hospitalization among specific health disorders with Indigenous populations. This study analyzed predictors of prior mental health hospitalizations among a predominately First Nations population seeking residential treatment for substance use. We hypothesized that increased co-morbid mental health concerns would predict increased hospitalizations for mental health concerns, and this relationship would be moderated by higher Adverse Childhood Experience (ACE) scores. Logistic regression showed that for every increase in each reported mental health concern, the odds of prior hospitalization was 1.6 times higher among this sample, although ACEs did not moderate this relationship. Participants with depressive, anxiety-related, psychotic, and personality-related disorders reported proportionally more hospitalization. Although study results suggest ACEs are not a useful predictor of hospitalization, their presence has previously shown to exacerbate co-morbid concerns, and thus, may influence prior hospitalization history indirectly. Further research can explore relationships between exposure to childhood trauma and hospitalization, particularly in consideration of access to tertiary mental health services.

Are long-term alcohol health harms overlooked in individuals with illicit drug problems? Alcohol-related morbidity and mortality in a Danish cohort of clients in residential rehabilitation for drug use disorders

Abstract Aims This study described the burden of alcohol-related morbidity and mortality among those who had been enrolled in residential treatment for drug use disorders in Denmark and investigated whether self-reported information on alcohol use provided at treatment admission can be used to assess risk for future serious alcohol-related harms. Methods At baseline (entry in drug use disorder treatment during 2000–10), clients completed a European adaptation of the Addiction Severity Index-5. We tracked 4981 clients through 2018 using multiple national registers to identify fully (100%) alcohol-attributable hospital contacts and deaths. Results The death rate due to fully alcohol-attributable causes was 411 per 100 000 person-years, with an average of 0.18 fully alcohol-attributable hospital contacts per person-year. Using the Addiction Severity Index-5 alcohol composite score as a predictor in an adjusted competing risks regression model, a higher score was associated with a higher risk of alcohol-related death. The alcohol composite score was a significant predictor of alcohol-related hospital contacts in an adjusted recurrent events model. Conclusions A substantial proportion of people originally identified as experiencing drug use disorders have alcohol problems that need to be monitored and managed to prevent serious complications. By demonstrating the predictive power of self-reported data, our study concludes that the Addiction Severity Index-5 can be used to identify individuals with drug use disorders at risk for severe long-term alcohol-related health outcomes.

Initial evaluation of a personalized advantage index to determine which individuals may benefit from mindfulness-based cognitive therapy for suicide prevention

ObjectiveDevelop and evaluate a treatment matching algorithm to predict differential treatment response to Mindfulness-Based Cognitive Therapy for suicide prevention (MBCT-S) versus enhanced treatment-as-usual (eTAU). MethodsAnalyses used data from Veterans at high-risk for suicide assigned to either MBCT-S (n = 71) or eTAU (n = 69) in a randomized clinical trial. Potential predictors (n = 55) included available demographic, clinical, and neurocognitive variables. Random forest models were used to predict risk of suicidal event (suicidal behaviors, or ideation resulting in hospitalization or emergency department visit) within 12 months following randomization, characterize the prediction, and develop a Personalized Advantage Index (PAI). ResultsA slightly better prediction model emerged for MBCT-S (AUC = 0.70) than eTAU (AUC = 0.63). Important outcome predictors for participants in the MBCT-S arm included PTSD diagnosis, decisional efficiency on a neurocognitive task (Go/No-Go), prior-year mental health residential treatment, and non-suicidal self-injury. Significant predictors for participants in the eTAU arm included past-year acute psychiatric hospitalizations, past-year outpatient psychotherapy visits, past-year suicidal ideation severity, and attentional control (indexed by Stroop task). A moderation analysis showed that fewer suicidal events occurred among those randomized to their PAI-indicated optimal treatment. ConclusionsPAI-guided treatment assignment may enhance suicide prevention outcomes. However, prior to real-world application, additional research is required to improve model accuracy and evaluate model generalization.

A network analysis of eating disorder, PTSD, major depression, state-trait anxiety, and quality of life measures in eating disorder patients treated in residential care.

The network approach in the eating disorder (ED) field has confirmed important links between EDs and posttraumatic stress disorder (PTSD) symptoms. However, studies including comorbid symptoms are scarce, which limits our understanding of potentially important connections. We hypothesised that anxiety, depression and poor quality of life (QOL) would provide a more complete picture of central, maintaining factors. Network analysis using R was performed in 2178 adult ED patients (91% female) admitted to residential treatment. Assessments included the ED Examination Questionnaire (EDEQ), the Eating Disorders Inventory (EDI-2), the PTSD Checklist for DSM-5 (PTSD clusters (PCL-5)), the Patient Health Questionnaire (PHQ-9), the Spielberger State-Trait Anxiety Scale (STAI), and the ED QOL Scale (EDQOL), which measure symptoms of EDs, PTSD, major depression, state-trait anxiety, and QOL, respectively. EDI-2 ineffectiveness showed the highest centrality (expected influence) followed by EDI-2 interoceptive awareness, STAI state anxiety, EDEQ shape concern, EDQOL psychological subscale, and PTSD cluster D (hyperarousal) symptoms. Eating Disorder Quality of Life psychological and physical-cognitive subscales and PHQ-9 major depressive, STAI state anxiety and PCL-5 PTSD cluster E (negative alterations in mood and cognition) symptoms showed the highest bridge expected influence, suggesting their interactive role in maintaining ED-PTSD comorbidity. This is the first network analysis of the interaction between ED and PTSD symptoms to include the comorbid measures of depression, anxiety, and QOL in a large clinical sample of ED patients. Our results indicate that several symptom clusters are likely to maintain ED-PTSD comorbidity and may be important targets of integrated treatment.

Influence of Posttraumatic Stress Disorder Severity on Return to Substance Use Immediately Following Residential Substance Use Treatment

AbstractThe period immediately following residential substance use disorder (SUD) treatment is characterized by high rates of return to substance use. Posttraumatic stress disorder (PTSD) is highly prevalent among individuals in residential SUD treatment and is a primary motive for substance use among individuals with co-occurring PTSD and SUD. Addressing important gaps in the literature, the current study examined the role of PTSD severity on days of substance use during the 30 days immediately following residential SUD treatment over and above demographic, SUD, and clinical factors associated with return to substance use. Participants (N = 65, Mage = 40.6, 52% women, 79% white) completed semi-structured diagnostic interviews for PTSD and SUD and self-report measures of demographics and depression while in residential SUD treatment (approximately one week before discharge), and then a follow-up assessment (timeline follow-back for substance use) approximately one month after discharge. Greater PTSD severity was associated with more days of substance use in the 30 days immediately following residential SUD treatment over and above demographic (i.e., race/ethnicity, gender, employment, housing insecurity), SUD (i.e., alcohol, stimulant, opioid, cannabis, and sedative/hypnotic/anxiolytic use disorder severity), and clinical (i.e., depression severity) factors. Findings underscore the importance of PTSD assessment and intervention during residential SUD treatment and re-entry planning to assist in mitigating return to substance use during community reintegration.

Field urges Medicare to pay for residential treatment

Medicare's coverage for substance use disorder (SUD) care is “outdated,” and legislation is needed to fix it so that Americans aged 65 and older can be covered for residential treatment, the Legal Action Center urged in a statement last week, which included a long list of endorsing field organizations. The coverage gap is significant — residential treatment takes place in a safe and stable living environment, but it is not a hospital. Medicare also covers Americans with a disability.

Narrative Inquiry Describing Young Adult Perspectives About Leaving Residential Treatment as a Child

ABSTRACT Empirical research exploring treatment outcomes among children in residential treatment centers (RTCs) is rare. Consequentially, there is an increasing demand for more studies examining such outcomes, particularly as they pertain to an individual’s experience leaving an RTC. This transitional period is believed to be a salient component impacting mental health treatment outcomes. Yet, little is known about how this residential treatment component is experienced and whether it impacts individuals long-term. This narrative qualitative study aimed to understand the experience of young adults who transitioned out of an RTC as a child. Participants recounted their experiences before, during, and after this transition. Six participants who resided in an RTC as a child for at least six consecutive months recounted their life experiences, producing 26 hours of interview data. Data were transcribed, coded, and written in narrative and thematic form. Our analysis produced three themes: learned and used effective coping skills, developed impactful relationships, and difficult adjustment post-discharge.

A - 22 Effects of Gender on the Relationship between Coping Styles and Executive Functioning in Alcohol Use Disorders

Abstract Objective Executive functioning (EF) and coping styles are important factors likely to influence risk and resilience to relapse following Alcohol Use Disorder (AUD) treatment. This study aims to evaluate EF and coping as independent predictors of relapse and the interplay between these two constructs by treatment outcome group and gender differences. Methods 23 females and 59 males in AUD residential treatment programs completed self-report questionnaires, a neuropsychological battery, and were followed for six months to determine treatment outcome. A logistic regression analysis was performed to evaluate coping (Brief COPE Inventory) and EF (Delis-Kaplan Executive Function System, Color-Word Interference Test, CWIT; inhibition and switching conditions) variables as predictors of relapse status. Significant predictors were evaluated by group status and gender to understand the association between coping and EF using Pearson correlation within each group. Results Gender (B = 8.6, p = 0.032), two coping (self-distraction (B = 2.3, p = 0.051) and humor (B = 1.9, p = 0.051)) and two EF (CWIT inhibition (B = 0.5, p = 0.007) and CWIT switching (B = 1.9, p = 0.006)) variables resulted in 85.4% overall classification accuracy. Correlations between these coping and EF, when evaluated by treatment group and gender, revealed significant gender-specific associations only among the relapse groups: self-distraction and CWIT inhibition (r = 0.379) in females and humor and CWIT inhibition (r = 0.242) in males. Conclusion Overall, EF and coping styles have independent predictive value for determining relapse risk in individuals with AUD. Poor EF skills may inhibit an individual’s ability to engage in appropriate coping during times of emotional distress. Understanding gender differences in relation to these dynamic relationships is essential for creating supportive and effective psychosocial interventions.

Psychometric evaluation of the Dutch version of the patient-reported experience measure for addiction treatment (PREMAT-NL).

Patient-centred care has become increasingly important in health care. Patient-reported experience measures (PREM) are used to measure patient experiences in health care, but the availability of psychometrically validated PREMs is limited. The Patient Reported Experience Measure in Addiction Treatment (PREMAT) is a PREM developed with extensive service user input to assess the experiences of people in residential addiction treatment services. In this study we aimed to evaluate the psychometric properties of the Dutch translation of the PREMAT, the PREMAT-NL. Ninety-three participants completed the PREMAT-NL approximately 45 days after starting addiction treatment as part of a naturalistic prospective multi-centre study in Belgium. We examined the factorial structure using principal component analysis with Promax oblique rotation and assessed the internal consistencies of the subscales and total score using Cronbach's α. Additionally, we explored the relationship of PREMAT-NL scores with demographic and clinical variables. The PREMAT-NL had a four-factor structure, with good internal consistencies of the subscales (Cronbach's α >0.70) and excellent internal consistency of the total score (Cronbach's α = 0.94). The PREMAT-NL total score was negatively skewed, and four score categories were proposed based on z-scores. PREMAT-NL scores correlated weakly with the type of treatment centre (r = 0.21, p < 0.05) and with previously received treatment for addiction (r = -0.25, p < 0.05). Although the factor structure and thus the appropriate use of subscales need further investigation, the findings of this study support the use of the PREMAT-NL total score as a valid and reliable PREM to evaluate residential addiction treatment services.