A Comparative Evaluation of Substance Abuse Treatment: I. Treatment Orientation, Amount of Care, and 1‐Year Outcomes

TLDR

This study is part of a series examining treatment outcomes, patient characteristics, and the influence of program orientation on engagement in 12‑Step self‑help groups. The study aims to evaluate the effectiveness of inpatient treatment, outpatient care, and self‑help group participation in VA substance‑abuse programs. The evaluation involved 3,018 patients across 15 VA programs offering 12‑Step, cognitive‑behavioral, or eclectic treatment, using a naturalistic, multisite design. Patients in 12‑Step programs and those receiving more intensive outpatient care and self‑help participation were more likely to be abstinent, problem‑free, and employed at one year, supporting the effectiveness of 12‑Step treatment.

Abstract

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self‐help groups. The study was conducted among 3018 patients from 15 VA programs that emphasized 12‐Step, cognitive‐behavioral (CB), or eclectic treatment. Casemix‐adjusted 1‐year outcomes showed that patients in 12‐Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1‐year follow‐up. Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12‐Step self‐help groups, were more likely to be abstinent and free of substance use problems at the 1‐year follow‐up. These findings support the effectiveness of 12‐Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self‐help groups tend to experience better short‐term substance use outcomes. Subsequent papers in this section focus on the proximal outcomes of treatment, patients with psychiatric as well as substance use disorders, patient‐treatment matching effects, and the link between program treatment orientation and patients’ involvement in and the influence of 12‐Step self‐help groups.