Determinants of Reduced Substance Use and Treatment Completion Among Adults with Comorbid Substance Misuse and Psychotic Disorders

Background: Alcohol and illicit substance use behaviors are more prevalent among persons with psychotic disorders than the general population. The harmful effects of substance misuse disproportionately impact persons with psychotic disorders. Previous studies have found that those with psychotic disorders experience increased difficulty in changing their substance use, and substance use interventions have demonstrated modest effectiveness in reducing substance use for persons with psychotic disorders. Importantly, little is known about determinants that influence substance use and behavior change among this population. To address these gaps, this study explored sociodemographic and treatment-related factors of reduced substance use and treatment completion among persons with psychotic disorders who received treatment.

Methods: Study data were obtained from the 2015–2019 Treatment Episode Dataset-Discharges (TEDS-D). TEDS-D contains data on adolescent and adult discharges from U.S. state-certified substance use treatment centers. All analyses were conducted using a subsample of 2526 adults with a psychotic disorder who received treatment services from an outpatient substance use treatment center for at least one month in duration. χ2 tests of independence and multivariable logistic regression analyses were used to examine associations of sociodemographic and treatment-related characteristics with 1) reduced substance use during treatment and 2) treatment completion (α < 0.05 analyses). Results from multivariable logistic regression models are presented as adjusted odds ratios (AORs) with 95 % confidence intervals (CI).

Results: Women, persons aged 50 or older, persons with criminal legal system involvement, and persons who attended substance use self-help groups had higher odds of reduced substance use at treatment discharge relative to treatment admission. Educational attainment, employment status, living situation, type of substance use, and treatment history were not significantly associated with reduced substance use. In terms of treatment completion, only self-help group attendance and housing status were associated with higher odds of completing treatment.

Conclusions and Implications: Interventions and treatment services should consider focusing on cultural and socioeconomic factors that can affect more positive substance use behavior change and treatment completion among those with psychotic disorders and comorbid substance misuse. Further research is needed to identify factors that may promote positive substance use behavior change and treatment completion for specific subgroups among persons with psychotic disorders and substance misuse. Study results suggest that self-help group attendance may be a critical factor of positive treatment outcomes for persons with psychotic disorders.