Young adults with co-occurring disorders: substance use disorder treatment response and outcomes

Abstract

Compared to other life stages, young adulthood (ages 18-24) is characterized by qualitative differences including the highest rates of co-occurring substance use and psychiatric disorders (COD). Little is known, however, regarding young adults' response to substance use disorder (SUD) treatment, especially those with COD. Greater knowledge in this area could inform and enhance the effectiveness and efficiency of SUD care for this patient population. The current study investigated differences between 141 COD and 159 SUD-only young adults attending psychiatrically-integrated residential SUD treatment on intake characteristics, during-treatment changes on clinical targets (e.g., coping skills; abstinence self-efficacy), and outcomes during the year post-discharge. Contrary to expectations, despite more severe clinical profiles at intake, COD patients showed similar during-treatment improvements on clinical target variables, and comparable post-treatment abstinence rates and psychiatric symptoms. Clinicians referring young adults with COD to specialized care may wish to consider residential SUD treatment programs that integrate evidence-based psychiatric services.

Keywords: Addiction; Co-occurring disorders; Dual diagnosis; Emerging adults; Substance use disorder treatment; Young adults.

Figure 1

Mean percent days abstinent (PDA) over time as a function of diagnostic group: co-occurring disorders (COD) vs. substance use disorder-only (SUD-only). COD and SUD-only patients have similar PDA at baseline (25.56% vs. 22.56%). Over time, COD patients had similar PDA when controlling for baseline (i.e., 0-month) PDA and other covariates (p = .604). Descriptively, at 3-month follow-up, the groups’ PDA are somewhat comparable (93.7% vs. 92.3%), while COD patients begin to report fewer PDA at 6-month (85.7% vs. 88.6%) and 12-month follow-ups (78.3% vs. 85.5%). COD SUD-Only

Figure 2

Mean psychiatric symptoms, measured by the Global Symptom Inventory (GSI), at baseline and each follow-up assessment, as a function of diagnostic group: co-occurring disorders (COD) vs. substance use disorder-only (SUD-only). Symptoms are represented quantitatively with T-scores, where the mean is 50 and standard deviation is 10 in the normative sample. COD patients endorsed significantly more psychiatric symptoms at baseline (T = 67.5 vs. T = 59.5). On average, however, over time COD and SUD-only patients endorsed similar levels of psychiatric symptoms controlling for baseline psychiatric symptoms and other covariates (p = 864). Descriptively, the baseline disadvantage for COD patients attenuates dramatically by 3-month follow-up (T = 53.3 vs. T = 50.4), a difference that remains relatively stable at 6-month (T = 52.75 vs. T = 49.0) and 12-month follow-ups (T = 52.2 vs. T = 49.7). COD SUD-Only