SANTA BARBARA, CALIF. – Psychiatric symptoms are common among people with substance abuse disorders, but in most patients those symptoms improve over the course of residential substance abuse disorder treatment.
A recent Veterans Affairs study sheds light on patients whose psychiatric symptoms actually worsen during substance abuse treatment, with the aim of providing insight into which patients are at risk.
Mark Ilgen, Ph.D., and Rudolf Moos, Ph.D., prospectively studied 3,322 men with psychiatric symptoms who underwent treatment for substance use disorders at one of 15 residential programs in the VA health care system. (Women were not included in the study because of the small number treated within the VA system.)
Results were presented in a poster at the annual meeting of the Research Society on Alcoholism.
Symptoms improved during treatment in 85% of patients, as measured by the Brief Symptom Inventory, a self-reported 5-point scale of severity on each of 22 psychiatric symptoms. Symptoms were unchanged in 2% of patients, and symptoms worsened in 13%, reported Dr. Ilgen and Dr. Moos, both of whom are affiliated with the VA Palo Alto Health Care System and Stanford (Calif.) University.
When they closely compared the patients with worsening symptoms to a matched sample of patients whose conditions did not deteriorate, they could find no differences in baseline psychiatric symptom scores, demographic characteristics, or severity of substance use.
However, those who worsened were more likely to have been treated under court order and to have a diagnosis of psychosis. They were also more likely to use substances during treatment, to express dissatisfaction with the treatment experience, and to drop out early, the investigators said.
A year later, those patients were more likely to be using alcohol and/or drugs than were their counterparts whose psychiatric symptoms improved during treatment.
“Finally, they continued to report elevated psychiatric symptoms relative to nondeteriorated patients despite roughly equivalent scores on the same measure between groups at baseline,” Dr. Ilgen and Dr. Moos noted.
The type or length of substance abuse treatment did not appear to influence the worsening of psychiatric symptoms.
“Given the importance of psychiatric symptoms in influencing the response to substance use disorder treatment hellip; it is important to identify those for whom treatment has been associated with an increase in psychiatric symptoms,” they wrote. “Monitoring patients for psychiatric deterioration in treatment may be a way to identify patients at risk for treatment dropout and for poor prognosis following treatment,” they concluded.
