Author(s): Robert Gundel*, Normand Allen III, Sarah Osborne and Sahel Shwayhat
Objective: To identify potential risk factors for subjects who leave residential treatment against staff advice (ASA).
Methods: We have completed a retrospective chart review of 4095 subjects admitted to a residential substance use disorder (SUD) treatment program to identify specific factors that may contribute to the risk of subjects leaving treatment ASA. All data including demographic information, co-occurring symptoms information obtained from standardized questionnaires, and discharge status were stored in an electronic medical record database.
Results: Of the 4095 subjects, 3448 (84%) completed the program, 340 (8.3%) left ASA, 154 (3.8%) were discharged for non-compliance with rules, and 153 (3.7%) were transferred to other facilities better suited for a subjects’ needs. The average length of stay (LOS) for subjects that left ASA was 11.5 days compared to those subjects who completed treatment had an average LOS of 29.5 days.
The highest to lowest ASA risk by substance type was cannabis, cocaine, heroin, sedatives, opioids and alcohol. Females in heroin and sedative groups had a significantly lower completion rate compared to males (74.9% vs. 81.6% and 63.4% vs. 87.0%). There were no differences in completion rates between males and females in the other substance groups.
Questionnaires for symptoms of co-occurring disorder were completed by a subset of subjects admitted to the residential facility from January to December 2016 and used to compare the average LOS and scores for anxiety, depression, craving and insomnia. Scores above threshold levels for anxiety, depression and/or insomnia were identified as risk factors for subjects in the heroin group. Risk factors for leaving treatment early in the alcohol group included scores above threshold for cravings and/or insomnia.
Conclusion: Several characteristics were identified as risk factors for leaving treatment ASA. This information is important for use in further development of evidence based treatment strategies that maximize long-term recovery.
