Comparing Perceptions of Effective Substance Use Treatment between Individuals with Substance Use Disorders and Those with Co-Occurring Mental Health and Substance Use Disorders

Background and Purpose: Compared with individuals who have substance use disorders (SUDs), those with co-occurring mental health and substance use disorders (CODs) often experience poorer substance use treatment outcomes. Multiple reasons are given for this including increased severity of symptoms associated with CODs, a reluctance by treatment providers to prescribe medication to treat a single disorder when it is compounded with other disorders, and a tendency to focus on the mental health disorder for treatment. One factor in this area that is often overlooked is the individual’s perception of treatment need, and consequently their perception of treatment effectiveness or helpfulness. This is important as individuals with SUDs and CODs often enter treatment more than one time, and past experiences and perceptions regarding treatment effectiveness/helpfulness can impact current and future perceptions of treatment need. The purpose of this study is to examine whether there are differences in perceptions of effective or helpful substance use treatment by individuals with SUDs compared to those with CODs.

Methods: Secondary analysis of data from the National Comorbidity Survey Replication (NCS-R) was used for this study. A binary logistic regression model was employed with the variable of whether or not the sample participants perceived effective/helpful treatment for their substance use as the dichotomous categorical dependent variable. The model examined the difference between someone with an SUD and someone with a COD perceiving effective/helpful treatment for a substance use disorder while controlling for sociodemographic factors. There were a total of 10 categorical and continuous predictor variables covering demographic and related data.

Results: The full model containing all predictors was statistically significant, χ² (13, N = 460) = 36.03, p = .001.  The model as a whole explained between 7.5% (Cox and Snell R Square) and 10% (Nagelkerke R Square) of the variance in perceptions of effectiveness/helpfulness and correctly classified 63.3% of cases. The result of interest showed that individuals with COD were 2.05 times less likely to perceive effective/helpful treatment for their SUD than those with the singular SUD. Additionally, individuals with CODs were 3.23 times less likely to perceive effective/helpful treatment if they had received treatment within the last year compare to individuals whose treatment was over one year in the past.

Conclusions and Implications: Clients with CODs present a complicated challenge to treatment providers, particularly when addressing substance use disorders. Differences in motivations for use and perceptions in need for treatment confound the treatment process and limit perceived effectiveness/helpfulness of treatment efforts. In this study the relationship between perception of effective/helpful treatment and diagnosis was examined. This study concurs with other research conducted in this field and adds an important element indicating that time since last treatment may play a role in the perceptions of its effectiveness/helpfulness. The implications of this study indicate that both treatment providers and future research in to substance use treatment effectiveness/helpfulness for individuals with CODs should consider the individual’s perception of prior treatment as well as the amount of time that has passed since that prior treatment.