Impact of co-occurring disorders and domestic violence victimization on substance abuse treatment outcomes among women seeking publicly funded substance abuse treatment services in Washington State

Aims: To compare baseline client characteristics at index admission by self-reported co-occurring mental health and substance abuse disorder (COD) status and to examine predictors of treatment completion and treatment reentry in the year following discharge among female substance abuse (SA) treatment clients.

Methods: A retrospective study using data from publicly funded SA treatment services in Washington State from 2004-2008 and State death certificate records. Bivariate comparisons were made using Chi-square tests; logistic regression was conducted to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for each outcome.

Results: Over one-half (53%) of women presented with COD and 5% of women reported current ‘domestic violence' (DV) victimization. Women with COD were less likely to have personal resources (e.g. personal residence and employment) and more likely to report current DV, more severe SA, polysubstance use, and greater SA treatment need than those without COD. In multivariate analyses, COD and DV were negatively associated with treatment completion (AOR 0.72, CI 0.67-0.77 and AOR 0.77, CI 0.66- 0.90, respectively). COD was positively associated with treatment reentry (AOR 1.13, CI 1.05-1.21). Other significant predictors, including demographic, SA and treatment (e.g. length of stay, treatment modality) factors were similar across outcomes.

Conclusions: The findings of this study suggest that women with COD are at greater risk of severe SA and DV, and that those with COD and DV have poorer treatment outcomes. COD and DV are critical issues that need to be addressed in SA and DV prevention, intervention, and treatment programs.