235346 Relationship of Statewide Unemployment, Dual Diagnosis and Client Reported Unemployment to Substance Abuse Treatment Outcomes in Nevada

Tuesday, November 1, 2011

Lawrence Greenfield, PhD , Work at home, Kensington, MD
George E. Bigelow, PhD , Behavioral Pharmacology Research Unit, Johns Hopkins University Medical Institution, Baltimore, MD
William C. Bailey, Supervisor-Data Team , Substance Abuse Prevention and Treatment Agency, State of Nevada, Carson City, NV
Aim: Nevada's statewide unemployment rapidly increased from 4% in 2006 to 13% in 2010, as substance abuse treatment completion with abstinence (outcomes) fell from 15.4% to 11.1% under low and high unemployment, respectively. Examined were relationships between statewide unemployment clients' unemployment and dual diagnosis (DD) in predicting outcomes. Methods: Substance abuse treatment admissions in Nevada (N=27,773 clients) were analyzed within periods of low (4%, 7/2006-12/2007, N=11,998) and high Statewide unemployment (13%, 1/2008-2/2010, N=15,775). To assess the additive contributions of unemployment and DD a four level variable was used: 1. Neither unemployed nor DD, 2. DD Only, 3. Unemployed Only 4. Both factors. With demographics, prior arrest, type of treatment and substance use frequencies controlled, Multiple Regression Analysis predicted outcomes under low and high State unemployment, respectively. Findings: The relationship between State and client unemployment was high, with 44.7% client unemployment found at admission under low State unemployment, compared to 58.8% under high. In predicting outcomes, our 4-level variable was significant (p<.01). The presence of both DD and unemployment was associated with relatively poor outcomes, as 9% and 10% completed treatment with abstinence under low and high State unemployment, respectively. In contrast, with the presence of neither factor 17.8% vs. 14.6% completed treatment with abstinence. Having either factor alone was associated with intermediate outcomes. Under high State unemployment outcomes for DD clients appeared to decline. Conclusion: Unemployment and DD have an additive relationship in predicting outcomes. DD clients may have relatively worse outcomes under high State unemployment compared to low.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning

Learning Objectives:
Assess relationship between Statewide unemployment, client unemployment, and presence of a DSM to treatment outcomes. Base on the findings, we further confimred the prediction that higher state unemployment will be associated with greater unemployment problems for unemployed clients and greater psychological problems for clients with a DSM. This may help to accout for the treatment outcomes and may have implications for expanding employment and psychological counseling to clients during times of high unemployment

Keywords: Substance Abuse Treatment, Counseling

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I hold a PhD in social psychology with 15 years of substance abuse treatment and prevention evaluation and 10 publications. Also, served pro bono as a consultant to Substance Abuse Treatment and Prevention Agency (SAPTA)in Nevada.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Nevada Substance Abuse Prevention and Treatment Agency (SAPTA) Program Evaluation Consultant, Independent Contractor (contracted research and clinical trials) and Unpaid consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.