1. Texas COSIG Project Client and Service Characteristics Associated with Treatment Completion 4 th Annual COSIG Grantee Meeting March 2007

2. Texas COSIG Project Key Components  Substance abuse treatment counselor training on COD and the use of diagnostic and assessment instruments to improve identification of comorbidity and monitor client progress  A voucher system that provides recovery and social support services to enhance the treatment process ($1800 per client)

3. Voucher Service Categories  Child Care  Housing Support  Transportation  Food Assistance  Education Support  Employment Assistance  Clothing  Medical Care  Prescriptions  Peer Mentoring

4. COSIG Client Outcomes  Data were obtained for 424 COSIG clients who entered and were discharged from substance abuse treatment during the period of February 2005 through October 2006  76% of the sample completed treatment  Treatment completers (n=323) and non- completers (n=101) were compared on client and service characteristics

5. Client Demographics  Treatment completers were more likely to be male (51% vs. 34%) and homeless (24% vs. 14%)  The groups did not differ in race/ethnicity, education, age, marital status, employment, or past year substance- related arrests

6. MINI Diagnostic Impressions

7. Psychiatric Symptom Severity  No differences were found in client- reported symptom severity on the Brief Symptom Inventory scales  Clinicians rated non-completers as having more severe symptoms on the interpersonal sensitivity, depression, and hostility scales on the Brief Derogatis Psychiatric Rating Scale

8. Primary Substance of Abuse

9. Substance Use Patterns  Completers reported a greater primary substance use during the month prior to admission (15 vs.12 days)  A greater percentage of non-completers reported polysubstance use (56% vs. 42%)  No differences were found in total years of primary substance use or history of IV drug use

10. Substance Abuse Treatment History

11. Discharge Characteristics  Completers had higher past month abstinence rates (88% vs. 61%)  Completers had higher past month AA attendance (95% vs. 78%)  No group differences were found in length of stay in treatment (approximately 100 days)

12. Voucher Service Utilization

13. Recovery and Social Support Service Combinations

14. Conclusions  Higher treatment completion for males indicates that women with COD may need specialized interventions in substance abuse treatment  A study analyzing gender differences using a subset of these data revealed that women demonstrated higher awareness of psychiatric issues relative to substance abuse problems, suggesting that substance abuse treatment inventions may need greater focus on the interaction of the two disorders* *(Mangrum, Spence, & Steinley-Bumgarner, 2006)

15. Conclusions  Lower completion rates for clients with bipolar and posttraumatic stress disorders suggest that these syndromes may be more difficult to treat in substance abuse treatment settings  Substance abuse counselors may need training on specific interventions targeting these two disorders

16. Conclusions  The 76% completion rate for the total sample is higher than previously calculated statewide averages, suggesting that the provision of recovery and social support services may enhance treatment outcomes  A study examining clients receiving COPSD services in Texas during FY 2004 revealed a 57% completion rate*  Other analyses of general substance abuse treatment clients in Texas have indicated completion rates ranging from 51 - 54% *(Mangrum & Spence, 2005)

17. Conclusions  Peer mentoring had the strongest association with treatment completion  Social support services, particularly in the absence of peer mentoring, were associated with non-completion  Similar trends have been found in the Texas ATR voucher service data, indicating that direct recovery support services are associated with greater completion rates, whereas the provision of social support services only is more highly associated with non-completion