Comparison of substance abuse treatment outcomes for inpatients and outpatients in the adolescent treatment population

The purpose of this research is to determine whether inpatient treatment is associated with higher post treatment relapse rates than outpatient treatment for adolescents treated for psychoactive substance use disorder (PSUD). This is important since abstinence is the most important treatment outcome. Subjects are 502 adolescents discharged from ASAM-defined levels III.3 & III.5 (inpatient N=278) and levels I, II.1 & II.5 (outpatient N=224) from 2001-2006. Data was collected as part of the treatment program's annual outcomes evaluation. The sampling frame was all who successfully completed treatment. Response rate was 63%. Analysis of characteristics of nonrespondents shows no significant differences compared to respondents. The survey is based on a 234-item questionnaire. Treatment records of each adolescent completing the questionnaire were obtained so that treatment outcomes from the questionnaire could be matched to treatment and sociodemographic variables contained in treatment records. A comprehensive data set was created from these two sources. Data are analyzed using three Cox proportional hazard regression models. The first includes all 502 subjects using psychosocial, treatment and environmental characteristics reported to be associated with abstinence as covariates. Treatment settings (inpatient versus outpatient) are compared by means of a stratification variable. The second and third models are built independently of the first model and of each other and include setting-specific variables reported in the literature to be associated with abstinence. Model two is of inpatients and model three is of outpatients. Model one indicates a slightly better cumulative survival function for outpatients. In model two (inpatients), race (whites 64.5% less likely to relapse than other races; blacks are 6.7 times more likely), diagnosis of alcohol abuse/dependence (alcohol diagnoses 64.3% more likely), and supportive friendships (one SD improvement on peer support scale corresponds to a 10.1% reduction in relapse risk) are associated with abstinence. In model three (outpatients) the races, those diagnosed with alcohol abuse/dependence, and score on peer support scale were at parity, but family support (those with supportive families 47.8% less likely to relapse). Outpatient care is associated with slightly better treatment outcomes. Several treatment-setting-specific risk factors for relapse are identified that can be used to improve treatment, such as race-sensitive skill building techniques for inpatients or family interventions for outpatients.