Comparing Treatment Outcomes of Opioid and Non-Opioid Users with Co-Occurring Disorders

Background and Purpose

Unfortunately, little is known about differences between opioid users and non-opioid users in residential treatment. Such information is necessary to tailor treatment to the individual. In addition, no studies have been published that compare opioid users and non-opioid users in treatment for co-occurring substance use and mental disorders. To that end, the purpose of this study was to examine differences in treatment outcome between opioid and non-opioid users enrolled in integrated residential treatment for co-occurring substance use and mental health disorders.

 Methods

This study utilized data from 1,972 adults enrolled in residential substance abuse and mental health treatment services at three private residential facilities. Treatment was delivered within an integrated model of evidence-based mental health and substance abuse services using individual and group modalities.  Baseline data was collected on recent substance use, treatment motivation, addiction severity, and mental health symptoms within 72 hours of admission. Intake data was collected by a trained masters’ level clinician. Follow-up data was collected at 30 days and 6 months post discharge via phone interviews conducted by trained research interviewers. To examine changes in substance use, addiction severity, and mental health across time and groups, repeated measures analyses of variance were utilized.  Comparisons between opioid and non-opioid users at the same points in time were measured using a series of repeated measures analyses utilizing parameter estimates table.  Comparisons of the changes from baseline to follow-up between opioid users and non-opioid users were measured based on analyses using tests of within-subjects contrasts.

 Results

At one-month, non-opioid users had higher levels of alcohol to intoxication.  At six-months, opioid users had higher levels of cannabis use. Differences were found in the rates of change on both of the alcohol use measures, all opioid categories, and sedatives at both the one-month and six-month measures.  Opioid users had higher rates of change for all three opioid categories and sedatives, as would be expected; and non-opioid users had higher rates of change for both the alcohol measures. There were no differences between the two groups on any measures of cocaine use or amphetamine use. At one-month, statistically significant differences were found between four composite scores (employment, alcohol, drug, and legal).  Opioid users had worse scores on all measures except alcohol. At six-months, differences were found between two composite scores, (alcohol and drugs), and opiate users had worse alcohol scores.  Differences were found in the rates of change for alcohol, drug and family scores at one month; and medical, alcohol, drug, and legal at six-months.  Opioid users had higher rates of change on all of the measures except alcohol composite scores, indicating greater improvement compared to non-opioid users. There were no differences between the two groups on mental health outcome measures.

 Conclusion and Implications

 We found more similarities than differences between the two groups on baseline characteristics, motivation, retention, and outcome. The results demonstrate that although opioid users entered treatment with higher levels of impairment, they were just as successful in treatment outcomes as their non-opioid using peers.