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

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.