Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, MRF 214, Los Angeles, CA, 90089, USA.
Department of Health Sciences, California State University, Dominguez Hills, 1000 East Victoria Street, Carson, CA, 90747, USA.
Subst Abuse Treat Prev Policy. 2021 Mar 2;16(1):21. doi: 10.1186/s13011-021-00357-y.
Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women's residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear.
This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women.
Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group's treatment retention outcomes.
Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient's stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001).
Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout.
ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648 .
与非强制治疗相比，法庭强制的药物使用障碍（SUD）治疗与更高的保留率和完成率有关。然而，儿童保护服务（CPS）强制的女性住院 SUD 治疗是否比刑事司法（CJ）强制和非强制治疗更能提高治疗保留率尚不清楚。
本研究比较了三种转介来源（CPS、CJ 和非强制）的住院 SUD 治疗保留天数，同时还研究了是否存在共病精神健康障碍或增加的压力、抑郁、焦虑和 PTSD 症状是否会导致保留率下降。本研究检验了以下假设：CPS 和 CJ 系统强制的女性与非强制的女性相比，住院 SUD 治疗保留率会提高。
对 245 名不同种族（西班牙裔：N=141，黑人：N=50，白人：N=50）的女性（CPS 强制：N=114，CJ 强制：N=82，非强制：N=49）进行了多变量回归分析，这些女性被强制或非强制（CJ：N=114，CPS：N=82，非强制：N=49）进入住院 SUD 治疗，以确定每个群体的治疗保留结果。
与未被强制治疗的女性相比，CPS 系统强制接受 SUD 住院治疗的女性在治疗中停留的时间明显更长（p=.046），保留率增加了 34.4%。研究结果进一步显示，患者压力评分每增加一个单位，保留率相应下降 2.3%（p=.048），而同时患有精神健康障碍的患者 SUD 治疗保留率下降 43.6%（p<.001）。
政策和临床考虑因素包括：（a）增加案件管理支持和综合服务，以满足未被强制接受住院 SUD 治疗的女性的多种服务需求；（b）在女性最容易复发和退出治疗时，采用更细致的治疗方法，早期管理精神健康障碍和压力症状。
ClinicalTrials.gov 标识符：NCT02977988（首次发布于 2016 年 11 月 30 日；最后更新于 2019 年 10 月 7 日）；美国 NIH 资助/合同：5R01DA038648。
