Social Disadvantage, Economic Hardship, and Stress As Predictors of Post-Treatment Addiction Severity: Comparison Between Court-Referred and Voluntary Substance Abuse Treatment Participants

Background and Purpose:  Factors associated with post-treatment addiction severity (AS) are important to understand since higher AS is associated with criminal behavior, psychosocial problems, illness and risky health behaviors, and increased risk of accidents.   Understanding predictors of post-treatment AS could be particularly informative for treatment providers working with criminal justice-involved clients in order to reduce risk of harm from substance use or recidivism in this population.  Demographic factors associated with social disadvantage, such as low educational attainment, low income, and racial/ethnic minority status, are often correlated with stress and substance abuse problems in general populations and therefore could potentially be related to post-treatment AS, yet few studies have examined the effects of social disadvantage and economic hardship on AS and no known studies have examined these relationships in participants referred to treatment by the criminal justice system.  Thus, this project explored predictors of post-treatment AS and compared predictors in treatment participants referred by the criminal justice system versus participants self-referred to treatment.    

Methods:  Structural equation modeling was used to examine the role of social disadvantage on economic hardship, perceived stress, and follow-up drug and alcohol AS in a secondary dataset from a statewide group of substance abuse treatment participants (N = 1123).  Comparisons of direct and indirect effects were made between the subsample referred by the criminal justice system (n =559 ) and a comparison group (n = 564).

Results:   Significant differences between the criminal justice (CJ) group and non-CJ group were present for follow-up drug AS, and the non-CJ group had higher follow-up drug AS than the CJ group (t = -2.87, p = .01).  For the criminal justice-referred participants, the overall model fit was good (CFI = .99, RMSEA = .03), and there were significant paths between unemployment and high economic hardship, higher perceived stress, and higher follow-up drug AS.  The model variables accounted for 19% (R² = .190, p ≤ .001) of the variance in both perceived stress and follow-up drug AS (R² = .194, p ≤ .001).  Additionally, indirect effects indicated mediation between social disadvantage and follow-up drug AS via perceived stress.  The model also fit the data adequately for the non-CJ group (CFI = .96, RMSEA = .04).  Group differences will be discussed in the presentation.

Conclusions and Implications:  This study is unique because it is one of few that examined predictors of follow-up AS rather than only relapse and is also the first known study to examine a social disadvantage-based model for both CJ-referred and non-CJ substance abuse treatment participants.  The findings from this study suggest that practitioners providing substance abuse treatment services to clients referred by the criminal justice system should focus on assisting clients with employment and meeting financial needs in order to reduce stress that can impact post-treatment drug use and associated criminal behavior.  Additionally, limitations of the study and implications for policy and research will be discussed.