Continuation funding is requested for this project, which has been funded for the last 3 years with limited money mandated by Congress through the ANTI-DRUG ABUSE ACT OF 1986 (SECTION 1923). The project uses a patient- treatment costs relative to outcome of inpatient vs. outpatient setting for treating two distinctive patient groups of substance abuse/dependence: a) alcohol abuse/dependence only; b) alcohol with cocaine abuse/dependence.
One aim i s to address concerns about the generalizability of prior results obtained in public treatment facilities to a private treatment setting which treats patients with private insurance. Importantly, however, the focus in our investigation is to go beyond comparing the relative efficacy of the treatment setting, by examining if particular substance dependent patients benefit from a specific type of treatment setting. We are hypothesizing that psychiatrically-complicated substance dependent patients will have difficulty maintaining themselves in an outpatient treatment setting and will ultimately have a better outcome with inpatient rather than outpatient treatment. In addition, by failing outpatient treatment prior to receiving inpatient treatment, their treatment costs will be the highest of all the S groups. Ultimately, we wish to determine whether patients treated in a """"""""mismatched"""""""" setting will: a) if mismatched to outpatient treatment, have a poor outcome relative to Ss matched to inpatient treatment; or, b) if mismatched to inpatient treatment, have incurred additional costs relative Ss matched to outpatient treatment, without additional treatment benefits. To fully investigate the matching strategy which we have proposed, we continue to require the approximate number of Ss we specified in the original application. In requesting a continuation over a two-year period, 92 Ss """"""""in progress"""""""" would be completed and 80 new Ss would be added. For all eligible Ss, we will determine whether or not they are matched to treatment setting by well-defined criteria. All Ss are administered a core interview (including biological measures) biweekly during intensive treatment, monthly during aftercare, and at three follow-up times over the course of a 1-year period to assess clinical profiles and outcome, using a variety of categorical as well as dimensional outcome measures. Cost information is also collected for a cost-effectiveness analysis of treatment setting.
| Pettinati, H M; Pierce Jr, J D; Belden, P P et al. (1999) The relationship of Axis II personality disorders to other known predictors of addiction treatment outcome. Am J Addict 8:136-47 |
