Impact of co-occurring disorders and domestic violence perpetration on substance abuse treatment outcomes among men 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 male 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 patrol arrest and 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: Approximately 30% of men presented with COD and 12% of men were arrested (by self-report or arrest record) for ‘domestic violence' (DV) related crimes in the previous year. Men with COD were less likely to have personal resources, more likely to report severe SA and treatment need, and more likely to have been arrested for DV or other violent crimes than non-COD clients. In multivariate analyses, COD was negatively associated with treatment completion (AOR 0.71, CI 0.67-0.75). COD and DV were positively associated with treatment reentry (AOR 1.10, CI 1.04-1.16 and AOR 1.16, CI 1.07-1.25, respectively). Other significant SA and treatment predictors were similar across outcomes.

Conclusions: The findings of this study suggest that men with COD are at greater risk of severe SA and DV perpetration, and 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.