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Factors That Affect Treatment Initiation Among Individuals With Serious Mental Illness and Substance Abuse Disorder

McClean, Jacob M. DO; Anspikian, Ara MD; Winters, Brittany N. MA; Tsuang, John W. MD

Addictive Disorders & Their Treatment: March 2014 - Volume 13 - Issue 1 - p 16–24
doi: 10.1097/ADT.0b013e31827914b3
Original Articles

Introduction: Studies have shown that approximately half of individuals with mental health disorders have a comorbid drug and alcohol diagnosis. Enrolling dually diagnosed patients in outpatient treatment programs has been a unique challenge for decades. Research identifying factors associated with patient treatment initiation has been limited. Clinicians have suspected that certain drugs, such as methamphetamine, may be a deterrent to treatment initiation. We wanted to identify factors that might be associated with the initiation of dually diagnosed patients in our outpatient dual diagnosis treatment program.

Materials and Methods: Data for this study were obtained by retrospective review of 165 consecutive patient charts located in the Harbor-UCLA Dual Diagnosis Treatment Program during the fall of 2011. The factors we examined were age, sex, ethnicity, marital status, education, number of dependents, living situation, employment status, number of hospitalizations, substance abuse/psychiatric treatment background, previous suicide attempts, current medication, diagnosis, specific drug use history and legal history. The dependent variable in this study was treatment initiation.

Results: On the basis of our chart review, we found 102 (62%) intake patients subsequently initiated treatment. After backward selection, 2 variables remained as independent predictors in the multivariate model: previous substance abuse treatment and history of methamphetamine use.

Discussion: We found that previous substance abuse treatment and previous methamphetamine use were 2 significant predictor variables for initiation into our treatment program. Other possible factors such as sedative/hypnotic use in last 6 months, and alcohol use may also be significant factors in treatment initiation.

*Department of Psychiatry, Harbor-UCLA Medical Center, Torrance

UCLA Semel Institute for Neuroscience and Human Behavior

Pepperdine University Graduate School of Education and Psychology, Los Angeles, CA.

The authors declare no conflict of interest.

Reprints: John W. Tsuang, MD, Department of Psychiatry, Harbor-UCLA Medical Center, Building B3,1000 west Carson Street, Torrance, CA 90509 (e-mail:

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