Patient predictors of substance abuse treatment outcome

Some clients with substance abuse are more likely to benefit from treatment than others and the same treatment may work differently for different individuals. The social services assign a variety of treatments for substance abuse to their clients and therefore, they asked SBU for research on personal and demographic factors that can be predictive of treatment outcome.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

Which personal and demographic factors are important to consider in the choice of treatment for substance abuse?

Table with identified studies

Table 1 Systematic reviews.
Included studies Population Outcome
Brorson et al. (2013) [1]
122 studies   The primary purpose of this systematic review is to conduct a comprehensive and clinically oriented evaluation of the available research regarding predictors of drop-out from addiction treatment.
Authors' conclusion:
  • The most consistent risk factors across the different study designs, samples, and measurement methods were cognitive deficits, low treatment alliance, personality disorder, and younger age.
  • With the exception of younger age, none of the demographic factors emerged as consistent risk factors. Further research on the relationship between simple demographic factors and drop-out risk is of limited value.
  • Little is known about the potential risk factors related to treatment programs and to the treatment processes. Based on the review, clinical recommendations include assessing cognitive functioning and personality disorders at baseline and continuous monitoring of treatment alliance.
Newton-Howes (2017) [6]
22 studies on that report on the relationship between personality disorders and alcohol outcome treatment. 4861 participants with personality disorder: ASPD* (range 15%-41%), BPD** (range 11%-27%) Any personality disorder (34%-71%). To determine the size and direction of the association between personality disorder and outcome of treatment for AUD***.
Personality disorders were associated with more alcohol-related impairment at baseline and less retention in treatment. However, during follow-up people with a personality disorder showed a similar amount of improvement in alcohol outcomes to that of people without such disorder. Synthesis was hampered by variable outcome and a low quality of evidence overall.

References

  1. Brorson HH, Ajo Arnevik E, Rand-Hendriksen K, Duckert F. Drop-out from addiction treatment: a systematic review of risk factors. Clinical Psychology Review. 2013;33(8):1010-24.
  2. Newton-Howes GM, Foulds JA, Guy NH, Boden JM, Mulder RT. Personality disorder and alcohol treatment outcome: systematic review and meta-analysis. Br J Psychiatry. 2017;211(1):22-30.

 

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Published: Report no: ut201913 Registration no: SBU 2018/716
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Literature search

Literature search.pdf

Project group

Alexandra Snellman, Maja Kärrman Fredriksson, Sara Fundell and Miriam Entesarian Matsson at SBU.

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